RI Ranked 19th Healthiest State in Nation, Last in New England
Friday, December 20, 2013
The health of Rhode Islanders has slipped again compared to the rest of the nation.
Rhode Island placed 19th in this year's state-by-state health rankings by the United Health Foundation, down three places from last year and the lowest in New England.
“For us this is a call for action,” said Michael Fine, director of the Rhode Island Department of Health, who said indicators in the survey were continuously monitored by the state.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLAST“It tells us about things that we knew about, and have been working on already,” he said, including issues around drug abuse, binge drinking, and sexually transmitted diseases.
But Rhode Island's ranking change can be partly attributable to a low sample size and changes in methodology.
“It's a little hard to tell,” said Patricia Nolan, executive director of the Rhode Island Public Health Institute and a former state health director, when asked about the state's latest showing. “The actual place you rank is hard to interpret.”
“One of the things with Rhode Island on some of these indices, is it doesn't take any big changes here to change our overall place on the report,” she said, illustrating the point with infant mortality rates amidst a low overall number of births each year in the Ocean State.
Survey informs state officials
The longest running annual state-by-state health assessment, the United Health Foundation's analysis has informed Rhode Island health officials, who previously identified three “winnable battles”: preventable hospitalizations, binge drinking, and sedentary lifestyle.
Fine said the latest survey was still being analyzed, but those three areas would likely remain at the forefront, in addition to substance abuse more broadly.
Looking at individual measures included in the survey, “one of the things they're particularly good for is to signal when the change is not where you want it to be,” in the opposite direction, Nolan said.
This past summer, Fine proposed a Rhode Island Primary Care Trust that would work toward a robust statewide system of “neighborhood health stations.”
“We have issues around preventable hospitalizations,” Fine acknowledged this week. He said there were opportunities for collaboration on primary care, and reducing disparities in health outcomes based on educational attainment.
As recently as 2010, Rhode Island held the 10th ranked spot, for three consecutive years. But the state has slipped three spots each year since then.
Positives, and opportunities
Strengths in the state included a relatively low obesity rate, high immunization coverage among children, and a readily available number of primary care physicians.
The state began an initiative to add more residents to insurance rolls in 2008 through the Healthy Rhode Island Reform Act.
“Immunizations, access to health insurance — there's a lot that's gone very well,” Nolan said.
Smoking prevalence declined faster than the national average, dropping 15 percent year-over-year, from 20 percent to 17.4 percent of adults. But approximately 150,000 Rhode Islanders still smoke, and many states saw more dramatic declines.
“For smoking we do reasonably well,” Fine said, tallying successful “smoke-free” measures in beaches, parks, and state buildings. “Could it be better? Should it be better? Absolutely.”
Nolan said the state's previous investments in smoking cessation and education programs had resulted in earlier benefits. “That investment has been dropped,” she said, which is “one reason our previous decline in smoking has plateaued.”
Efforts to reduce tobacco use continue, however, including a citywide ordinance in Providence banning non-cigarette flavored tobacco products this year.
In the past year, residents throughout the state became more active, with fewer than one in four adults who reported no physical activity or exercise in the previous 30 days.
To continue to improve, Fine said the state would be getting on board with the national Let's Move initiative.
Healthy living begins early
Successes touted by the Rhode Island Healthy Schools Coalition include a “PE law” that went into effect last year and requires standards-based physical education curriculum in schools.
Better nutrition in schools has also been enshrined at the state and federal level, including a beverage and snack law that outlines what can be sold in vending machines, cafeterias, and school stores.
But over the past decade, the number of children living in poverty has increased sharply, from 11 percent to 20.4 percent today.
In the survey, 57.7 percent of adults age 25 years or older with at least a high school degree reported their health as “very good or excellent,” compared to only 26.2 percent with less than a high school education — a gap of 31.5 percent.
Nolan said that evidenced a very significant shift across the population in health outcomes.
In a comprehensive community health needs assessment reported this year, led by the Hospital Association of Rhode Island, commonly identified health issues in the state included access to health care, mental health services, obesity, and substance/alcohol abuse.
“We really need to find more inventive ways for people to maintain a healthy weight, a healthy lifestyle, and eat healthy foods,” Nolan said.
“Public health is a huge collaboration,” according to Fine. “It's a huge collaboration, and (the health department's) job is to be the cheerleader.”
Hawaii took the top spot in the annual survey for the second year in a row, while Mississippi came in at 50th, where it has sat for more than half of the time surveyed by the United Health Foundation.
Related Slideshow: New England’s Healthiest States 2013
The United Health Foundation recently released its 2013 annual reoprt: America's Health Rankings, which provides a comparative state by state analysis of several health measures to provide a comprehensive perspective of our nation's health issues. See how the New England states rank in the slides below.
Definitions
All Outcomes Rank: Outcomes represent what has already occurred, either through death, disease or missed days due to illness. In America's Health Rankings, outcomes include prevalence of diabetes, number of poor mental or physical health days in last 30 days, health disparity, infant mortality rate, cardiovascular death rate, cancer death rate and premature death. Outcomes account for 25% of the final ranking.
Determinants Rank: Determinants represent those actions that can affect the future health of the population. For clarity, determinants are divided into four groups: Behaviors, Community and Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of the population in a state, and improving these inputs will improve outcomes over time. Most measures are actually a combination of activities in all four groups.
Diabetes Rank: Based on percent of adults who responded yes to the question "Have you ever been told by a doctor that you have diabetes?" Does not include pre-diabetes or diabetes during pregnancy.
Smoking Rank: Based on percentage of adults who are current smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).
Obesity Rank: Based on percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher.
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