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How low can you go? Missouri ranks falls to 39th in health rankings

This article first appeared in the St. Louis Beacon, Dec. 27, 2010 - At a time of much talk about health disparities and programs to improve public health, Missouri stands out for what it isn't doing. The state dropped another notch in health rankings this year while some other states improved their showings, according to a report by United Health Foundation, the American Public Health Association and Partnership for Prevention.

The study says Missouri now ranks 39th, down from 38th last year, on a number of state-by-state health-related issues. These include health behaviors, public and health policies, and community and environmental conditions.

"The point we take from the survey is that many of these health conditions are preventable through our own lifestyle choices" says Steve Walli, chief executive officer for UnitedHealthcare-Missouri and Central Southern Illinois.

"A lot of things contributes to why we are not the healthiest state. We have high rates of smoking, and obesity has increased in five years from 24.9 percent to 30.5 percent of the population. We also have relatively low rates of public-health funding."

In the survey, Vermont topped the list of healthiest states, followed by Massachusetts, New Hampshire, Connecticut and Hawaii. Several states improved by at least five ranks. Georgia improved the most, to 36th from 43rd; Idaho rose to 9th from 14th, while Nebraska jumped to 11th from 16th. Mississippi remained at the very bottom, followed by Louisiana, Arkansas, Nevada and Oklahoma.

A Wakeup Call

Missouri's level of public-health funding was cited earlier this year in a Trust for America's Health report. It said the state spent only $9.26 a person on public health, compared to a national average of $28.92. The funding ranges from a low of $3.55 a person in Nevada, followed by Missouri's $9.26 rate, to a high of $169.92 a person in Hawaii. An example of what the low spending can mean: Missouri's low child immunization rate of only 56 percent, compared to a national rate of nearly 71 percent. Four years ago, the rate was nearly 81 percent.

"This should be a wakeup call," Jeff Levi, executive director for Trust for America's Health, said of Missouri's ranking. "Things aren't going to get better in these fiscal times of even more budget cuts. But we absolutely need to make investments in public health even in difficult times. You shouldn't cut back on health."

The Missouri Public Health Association sent that same message to Gov. Jay Nixon last month, appealing to him to find ways to invest more in public health. The letter from the association's president, Patrick Morgester, stressed that "no single administration, legislative body or state health department director is to blame since the decline has been ongoing over 10-15 years."

The group also made the frequently mentioned suggestion that Missouri raise its tobacco tax and make sure the millions of dollars from the tobacco settlement lawsuit be used for programs to stop smoking.

Overall, Missouri is spending 16.3 percent less for public health this year than in 2000, the association says. It adds that "until such time as a public-health system is allowed to grow and prosper in this state, Missourians are doomed to reap the miserable outcomes and unnecessary human and economic costs that they face."

In a response to the group's letter, Nixon's office said the governor was "working toward making state government more efficient and ensuring the highest possible quality of life for all Missourians."

Invest In Prevention

Bernard Malone, an association board member, says, "The problem is that Missouri does not invest in prevention, which is the major focus of public health. The state's priorities are unbalanced. It would rather pay for medical care than for preventive services."

In its comprehensive report, developed by research coordinator Maggie Callon, Vision for Children at Risk calls attention to Missouri's relatively low investment in promoting children's well-being.

Vision also notes that one of the only bright spots in human development programs in Missouri is coming, not from the state, but from local jurisdictions through the creation of Community Children's Services Funds.

In 2004, St. Louis set up its fund, as did St. Charles, Jefferson and Lincoln counties. In 2008, St. Louis County set up one through a 1/4-cent tax measure. These are turning out to be a lifeline. Vision notes that the funds have generated about $60 million a year to meet the needs of children and their families.

Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.