Monday, June 18, 2007

Guest Post: Health Care Panel Report

Guest post by Mrs. sco

Last week, The Boston Foundation held a panel to discuss the release of its health care report, The Boston Paradox: Lots of Health Care, Not Enough Health. TBF President Paul Grogan began by sounding a warning bell: he forecast a long-term decline in health due to skyrocketing costs, an aging workforce, and a rise in chronic illness.

Wendy Everett, President of New England Healthcare Institute, presented the report. She started out by describing Boston as a healthcare paradise – lots of jobs in the industry, lots of doctors and world-class institutions, average life expectancy of just under eighty years. But she pointed to signs of trouble in paradise, including increases in healthcare costs outpacing income, a decrease in fitness, and an obesity rate of over 20%. (The obesity statistics were the most alarming part of her presentation – go look at the CDC's PowerPoint presentation, which shows the fattening of America from 1985 to 2005. There is currently no state in the Union where less than 15% of the population is obese. 46 states have an obesity rate of 20% or more.)

The rest of the discussion was devoted to ideas for improving the bleak outlook. All of the panelists emphasized public health. Public health spending has dropped by 12.5% over the past six years, while healthcare spending has risen by 25%. Meanwhile, within healthcare spending, we spend 88% of our budget on access to care when only 10% of our health is influenced by access to care. We spend 7% of our budget on behavior and environment, which accounts for 50% of our level of health.

The common theme was that public health isn't just about improving access; it's about improving environment and behavior. And not just in ways that you might think, encouraging people to get preventative medical care and to be physically active.

In fact, Dr. Judy Ann Bigby, the Secretary of Health and Human Services for the Commonwealth, discussed gun violence, the lack of grocery stores in low-income communities, and the impact of race on health outcomes. (Dr. Bigby's alarming statistic: a college-educated black woman with regular prenatal care is likely to have a worse outcome than a high-school educated white woman with minimal prenatal care.) Judith Kurland, Mayor Menino’s Chief on Staff, picked up on some of these points. She talked about programs like urban gardens, bringing farmer's markets to low-income neighborhoods, encouraging use of food stamps – which wouldn't cost Massachusetts a dime because it's federally funded – and making school lunches palatable for kids. She also discussed Mayor Menino's initiative to plant 100,000 trees (actually, she corrected herself and said he would "cause them to be planted") in Boston. That appears to be an environmental issue, but dig just a tiny bit deeper and it's a public health issue too – the rate of asthma has risen dramatically in the past decade or two. Similarly, Dr. Barry Zuckerman, Chief of Pediatrics at Boston Medical Center, talked about a medical-legal partnership that, among other things, helped people resolve disputes with their landlords. Again, it doesn't seem to be related, but if you're living in a dangerous environment because your landlord won't fix the broken window or the rusty water pipes, your health will suffer.

The takeaway message for me was: racial and socioeconomic disparities, environmental problems, issues with public housing, education, and even bureaucracy are obstacles to health. Containing costs is important, but investing now to address all the interrelated issues may pay off more in the future.