Tom Sgouros: Health Rankings a Good Sign for RI. Maybe.

Monday, December 19, 2011

Tom Sgouros, GoLocalProv MINDSETTER™

 

Some good news for a change, sort of. It seems that a new survey deems Rhode Island the tenth healthiest state in the country. "American Health Rankings" a project of the United Health Foundation, has rated all the states on several dozen health indicators, and distilled them into a ranking.

It's interesting to browse through the various indicators. You learn that Rhode Island has a lot of binge drinking, is middling in the number of children living in poverty, and does pretty darn well on childhood immunizations. The graphics are cool, too, with images of the states sliding back and forth to show who's ahead. It's easy information to browse.

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But the whole project has an unsettling feel. After all, what exactly is the point of all this information and the sexy graphics? As a guide to public policy, it's pretty much useless. For example, I see that all the New England states rank in the top ten. Vermont is ranked number one and New Hampshire at number two. Those two states have dramatically different approaches to public health issues, so what are they doing as neighbors on this list?

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New Hampshire has fewer children living in poverty and a better record of childhood immunization, while Vermont has a better record on treating infectious diseases, the number of primary care physicians, and preventable hospitalizations. That is, indicators that go with wealth seem to be better in New Hampshire, with the seventh highest per-capita income in the country. Indicators that go with activist health policy are mostly better in Vermont, where the median income is 15% lower, only barely above the national median.

Ranking obsession

So where's Rhode Island? We do ok on some rankings and less so on others. We're richer than Vermont by a little, though poorer than New Hampshire. We have better public health provisions than New Hampshire, but lag substantially behind Vermont on that scale. But really, what's the point of this exercise? There are rankings that tell you something about the state of public policy in some state, and there are ones that do not. This one does not, even if there are clues lurking in its data. Overall it's little more informative about public policy than a ranking of hippest colleges or good places to retire.

Maybe it's meant to be a guide about where to live? Even there, the survey fails. After all, there are huge disparities in health outcomes in America due to wealth. Wealthy people get better care, live longer, have less stress, and are simply healthier than poor ones. If I learn that New Hampshire is a healthier state than Rhode Island from this survey, I haven't learned that it will improve my health to move there. I've learned that it will improve my health to be richer.

If you want to learn about that, though, you won't get it from this survey, except reading between the lines of the fancy graphics. A better place to look is to some interesting work on relating health outcomes to income disparities done by Gallup. They polled 265,314 adults last year (you can do that if you're Gallup), and documented some alarming disparities, both of access and outcomes. For example, you learn from them that fewer than half of people whose incomes are below $24,000 have seen a dentist in the past year, and only two-thirds of them have a doctor, both far less than high-income respondents to the survey. You can also find more information at the Center for Disease Control, whose fact sheet on the subject has the section every report like this should have: "What Can Be Done." The CDC has added disparity research to the variables they track regularly, so more and better information will be available. 

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Is information what we need?

The sad truth, however, is that there is already plenty of information out there about the effects of poverty on people's health. What we need now isn't more information -- especially half-digested information like in the America's Health Ranking report -- did I mention its cool graphics? What we need is the will to act and the means with which to do so.

And when it comes to talking about means, one can't help notice that the AHR report is a product of the United Health Foundation. United Health is, of course, one of the two dominant health insurance companies in the Rhode Island market. They are also run by famously well-paid executives, and their current CEO, Stephen Hemsley, received nearly $102 million last year. This would be approximately 1% of all the revenue received by that company. Perhaps this is why it's so hard to draw any conclusions from the data presented by the UH Foundation.

After all, any conclusions you might draw might lead you to wonder why a corporation that clearly has the means to reshape health policy in America seems uninterested in doing so. In fact, they spend millions of dollars each year on lobbying to prevent health care from being reshaped to make the system more equitable. Where did the "public option" go? It went down due in part to pressure from companies like United Health. Anyone with enough cash to put out useless but expensive reports like this has enough cash to make serious trouble for a member of Congress seeking reelection.

Which brings us to another ranking, where Forbes recently named United Health CEO Hemsley the highest-paid CEO in America in 2010, ahead of his nearest competition by $36 million.

Tom Sgouros is the editor of the Rhode Island Policy Reporter, at whatcheer.net and the author of "Ten Things You Don't Know About Rhode Island." Contact him at [email protected].
 

 

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