America’s Health Rankings 2015 Annual Report, affiliated with United Health Foundation, has listed Missouri as one of the most unhealthy states, coming in 36th in the nation with Hawaii listed as the healthiest state.
“The 2015 America’s Health Rankings Annual Report shows improvements in preventable hospitalizations, decreases in cigarette smoking, and increases in immunizations among children — all marking progress in some of our public health challenges,” the report stated. “However, these gains are set against a backdrop where different and complex health challenges are compromising our nation’s health. The rates of drug deaths, diabetes, obesity, and children living in poverty are currently on the rise.”
Missouri has one of the highest rates in the country for smoking, but the report did state smoking in the state is decreasing. In the past two years, smoking has decreased 14 percent for adults.
Pettis County Health Center Administrator JoAnn Martin, MSN, RN, CPNP, said cigarette use is one factor that contributes to Missouri’s lower health rating.
“I’m not 100 percent sure what this particular organization uses as the data scores, for how they do their rankings,” she said. “But, there are several issues that Missouri has been dealing with that often impact those types of ratings.
“Missouri struggles with things such as we have the lowest cigarette tax in the United States,” she added. “Often, that will appear in some of the rankings. Research has indicated that when cigarette taxes are higher, it does reduce the number of young people who begin to smoke. That’s one of the things that we really work on trying to prevent … again, we know very few people actually begin to smoke after they’re 21.”
She emphasized that most people who smoke begin at an early age.
“Another area that Missouri has struggled with is that we have obesity rates that are higher than the national average,” she noted. “Again, that frequently appears in rankings.”
Stephanie Hanning, Bothwell Regional Health Center community outreach coordinator and a licensed dietitian, said that “from a nutrition perspective” states dealing with issues such as obesity usually find it arises from busy lifestyles.
” … A lot of people grab convenience food,” she noted.
Convenience foods and a lack of physical activity are large contributors to weight problems.
“You couple both of those things together, and it’s a recipe for weight gain,” Hanning noted. “A perfect storm for weight gain and poor health, long-term, if that continues.”
She also said when one goes out to eat, restaurants serve huge portion sizes.
“That plays into over consumption and weight gain,” she added. “Another thing is soda consumption (and) sweetened beverage consumption. Those things are definitely a problem. I call them empty calories, because they aren’t providing any nutrition. At all.”
Martin stressed that Missouri’s low health ranking may have to do with Medicaid concerns as well.
“Another area that is a concern, is that our state has not expanded Medicaid,” Martin added. “Because of that, we have a portion of our population of people who are employed, but they do not make more then 100 percent of the federal poverty level. Because of this fact … they are not eligible for any assistance under the Affordable Care Act. So, they are caught in that dilemma, they can’t afford to purchase insurance on the open market and they are not eligible for assistance.”
She also noted that many of these people may work for employers who don’t offer health insurance or they work multiple part-time jobs where they have no access to insurance.
According to the report, one of Missouri’s strengths is listed as a low percentage of children in poverty — children living in poverty has gone down in the state in the past five years, with a decrease of 40 percent. Missouri’s strengths also include a low prevalence of excessive drinking and a high rate of high school graduation.
Its challenges are low per capita public health funding, low immunization coverage among adolescents and limited availability of dentists. Missouri is ranked, in the report, in the bottom five for state public health funding.
“Missouri also spends the least per capita for public health services,” Martin noted. “We were 51st, we’ve moved up to 50 now. Those are a lot of the things that may not be as obvious, but certainly do impact the public’s health in a variety of areas.
“Those are some of the things that they take into account, when they are looking at their state’s rank,” she said. “Other issues they sometimes look at are low birth weight babies. We have in Missouri several areas that really struggle with this. Particularly down in the boot heel, in southwest Missouri, and also in our urban areas.
“Fortunately in Pettis County we are doing fairly well in that area,” she added. “We are within the state averages, generally. But, there are parts of the state that really struggle with low birth weight babies.”
According to the report, in the past 20 years, the low birth weight in Missouri has increased to 10 percent of live births. Low birth weight babies in Missouri can be due to a combination of factors.
“Certainly not having access to medical care can contribute to that,” Martin said. “However, Missouri does have a Medicaid program for uninsured women that does cover the cost of pregnancy related expenses. So, that is a benefit. But if you don’t have a provider that you can get to, because you don’t have any transportation, that becomes another problem to getting maternity care.
“Smoking is also a problem that contributes to low birth weight babies,” she added. “Missouri does tend to have a higher smoking rate nationwide.”
Diabetes in the state is also on the rise in the past year, with a 16 percent increase for adults.
Hanning, who is also the co-chair for the Healthy Living Action Group and Healthy-U, said not eating healthy can often contribute to an increase in diabetes.
“Certainly it can,” she noted. “Because as people’s weights increase the risk for developing diabetes increases. That’s one thing that you see a lot.”
Martin said other issues that impact Missouri’s health is access to fresh fruits and vegetables.
“In the county health ranking, which is a national survey they do, they look at things like access to fresh fruits and vegetables,” she said. “(They look ) at a lot of socioeconomic factors. We know those factors do have an impact on people’s health.
“They look at teen pregnancy rates, they look at access to physicians,” Martin added. “In parts of our state there are counties where they may have one or no physicians in the entire county. So there are a variety of factors that go into how we rank. Every ranking tends to look at things just a little bit different.”
Faith Bemiss can be reached at 530-0289 or @flbemiss.