Georgia finishes near the bottom of state-by-state rankings of overall health. Some counties perform worse than developing countries
By James Hataway
Public Health News Bureau
How healthy is Georgia?
According to recent reports Georgia finishes near the bottom of state-by-state rankings of overall health.
Georgia ranked 43rd in 2009 for overall health performance, dropping from 41st in 2008, according to “America’s Health Rankings,” a joint effort of United Health Foundation, the American Public Health Association and Partnership for Prevention.
The rankings are based on health determinants and health outcomes.
Determinants refer to behaviors, community and environmental factors, public and health policies, and clinical care factors that influence future health outcomes of the population in a state. Georgia ranked 47th in determinants.
Outcomes traditionally have been measured using mortality measures like premature death, infant mortality, cancer and cardiovascular mortality. America’s Health Rankings includes measures of the quality of life — poor mental health days and poor physical health days. Georgia ranked 41st in health outcomes.
Another report – Aiming Higher: Results from a State Scorecard on Health System Performance, 2009 by The Commonwealth Fund, a private foundation designed to promote better functioning health care systems, ranked Georgia 38th based on 38 indicators of health system performance. That was an improvement: Georgia ranked 44th in the 2007 version of the report.
Among the states, Georgia gets these poor health rankings according to the “2008 Health Rankings: Georgia and Georgia’s Children”:
- 31st for the percentage of adults who do smoke.
- 37th for the percentage of adults who do not exercise regularly.
- 38th for the percentage of overweight high school students.
- 39th for the percentage of adults who are obese.
- 41st for the percentage of adults with diabetes.
- 40th for infant mortality.
- 41st for teen birth rate.
- 43rd for pre-term births.
- 45th for low birthweight babies.
- 47th for the prevalence of infectious diseases like tuberculosis, hepatitis and AIDS.
Equally disturbing is the finding that Georgia has the second highest rate of obese 10-to-17-year olds in the nation – Mississippi has the highest – according to the 2010 “F as in Fat” report released this summer.
‘No better than developing countries’
Nor does Georgia even compare well with other parts of the world.
Georgia ranks about 40th in the United States in life expectancy, according to Phillip Williams, Dean of Public Health at the University of Georgia.
Georgia’s median life expectancy is about 73.9, according to the most recent Community Health Status Indicators (CHSI) report. That’s well below the U.S. median of 76.5.
According to The World Factbook, a reference resource produced by the Central Intelligence Agency, Georgia’s life expectancy is lower than countries like Cuba, Costa Rica, Libya, Mexico, Sri Lanka, the West Bank, Morocco and Croatia.
“Nothing against Morocco and Croatia, but they’re not highly developed countries that we want to emulate,” Williams said.
But if one looks at county rankings, there are portions of Georgia that perform much worse, Williams said.
“There are large areas where we perform no better than developing countries – and worse than a lot of them, and that’s really discouraging to me,” he said.
Thirty Georgia counties have a life expectancy less than 73 years according to the most recent Community Health Status Indicators (CHSI) report. That’s lower than the Dominican Republic, the Gaza Strip, Thailand and El Salvador.
Education, poverty and health
The numbers suggest that Georgia is performing well below the national average for behaviors that lead to disease or injury. But Georgia also performs poorly in terms of disease prevention and treatment.
Many believe that the problems are tied particularly to low education and income rates.
“The low graduation rate perpetuates the poverty,” said Dave Palmer, Public Information Officer for the Division of Public Health in Gainesville. “If you don’t have a high-school diploma and you don’t have enough money, you won’t have enough for health insurance, and that will bring down the health status of the entire state.”
But education is not limited to the classroom. Georgia’s public health system needs to do a better job educating people about risky behaviors and proper disease management, according to Jan Cooke, President of Southern Health Association, a regional organization advocating for public health development.
“Look what we’ve done with H1N1,” Cooke said. “How many kids now cough in their sleeve instead of coughing in the air? How many are now washing their hands?”
The response to the H1N1 flu outbreak serves as an example that with the proper level of investment and attention, state initiatives can change bad health behaviors.
“Policy really does matter,” said Cindy Zeldin, Executive Director for Georgians for a Healthy Future. “If you put the right policy in place with the right incentives, it does have an impact.”
No single solution
But the magnitude of Georgia’s health problems requires numerous initiatives to overcome its many deficiencies.
“Most of these problems are not of a singular cause, and they cannot be solved by a single application,” said Russ Toal, Clinical Associate Professor at Georgia Southern University and Director for the Center for Rural Health and Research.
The determinants that lead these diseases are often interrelated, and to change the state’s health outcomes, Georgia must address problems early. Doing so will not only save lives and reduce the burdens placed on health care providers, but it will save money by reducing the number of people seeking treatment for advanced or chronic disease.
“If we are interested in saving lives and saving money, we need to be thinking earlier in the life course,” said Michael Eriksen, Director of the Institute of Public Health at Georgia State University. “What are the things that need to be done in order to prevent these things later on?”
Avoiding tobacco, eating healthily and getting regular physical activity are all behaviors that contribute immensely to the prevention of chronic disease like cancer, heart disease, stroke and diabetes, Eriksen said.
“There is a systems approach needed,” Eriksen said. “What things can government do, what can media do, what can the private sector do to alleviate some of these issues?”
Tackling Georgia’s health problems is a difficult venture, especially considering that a number these negative determinants have been commonplace in the region for many years.
Habits that are not good for us
“I was born and raised in the South, so I’m not saying negative things about this region of the country, but we have some habits in this area that are not good for us,” Williams said. “I’m not sure how we got to where we are, but the data supports that there are problems in this area.”
Looking at a color-coded map, the Southeast and much of the Southwest is a mass of deep blue, indicating that these areas are the nation’s poorest health performers. In terms of overall health performance, South Carolina ranks 33rd; Tennessee 39th; Alabama 40th; North Carolina 41st; Florida 44th and Mississippi 50th, according to The Commonwealth Fund’s 2009 State Scorecard.
States with the best performance are located primarily in New England and parts of the Midwest. Vermont is number one, followed by Hawaii, Iowa, Minnesota, Maine and New Hampshire.
But to understand the unique problems facing our state, one must also consider Georgia’s increasingly diverse population. An estimated 780,000 people of Hispanic descent live in Georgia, and 49 percent of that population does not have health insurance, according to the Pew Hispanic Center. Also, over the last 10 years, the number of Georgia Hispanics who are overweight has increased more than 95 percent, according to a ten-year study published in 2009 by America’s Health Rankings.
“We are a more diverse state than we were 30 years ago,” Palmer said. “We have people who do not speak English well or at all, and we have to be sensitive to other people and their culture when we try to educate them about the proper way to eat and get exercise.”
Investing in public health
Experts say that solving Georgia’s health problems and improving the state’s rankings is not going to be easy, but Georgia must be willing to invest more in its public health system.
Budget woes and the ongoing economic downturn have placed significant strain on the resources available for public health, but there is no way to make Georgia healthier without it.
“You can’t create a health solution without public health,” Toal said. “It takes investments – you can’t attack a public health problem without the resources to do so.”
In order to implement good public health policy, Georgia needs leadership that values public health and recognizes its importance, according to Eriksen.
“I think it’s important to look at this in a non-partisan way,” he said. “Somehow we need to transcend the partisan politics and look at the outcomes that we’re concerned about, but right now ideology trumps outcomes.”
The importance of proper funding is central to the development of strong, effective public health performance. The legislature and the private sector must be willing to commit to a long-term reinvestment in public health.
“You can’t make progress in anything without committing resources to it,” Williams said. “Right now the resources are probably not available, but even if they were available I’m not sure we have the commitment to give them, and that needs to greatly improve.”
About the Public Health News Bureau: Staffed by graduate students from the health and medical journalism concentration in the University of Georgia’s Grady College of Journalism, the Public Health News Bureau project is funded by the Healthcare Georgia Foundation and provides information about the state’s public health system that is distributed to Georgia’s news media and the public via the Partner Up! For Public Health advocacy campaign. For more information, contact Tom Wall, 770 522-8855 or firstname.lastname@example.org.