Author Archives: Pragati Jain

A Financial Case for Public Health

Pay now or pay later. States face this choice every day, particularly with how and when they invest in clinical preventive health services leading to prevention and reduced economic burden in terms of length of hospital stay and general health care costs.

The rewards of paying now are better known than ever before. Research has demonstrated that supporting healthy early childhood development–from before through age 5–generates substantial educational, social and financial benefits for individuals, families and communities.

A major study, The High Costs of Failing to Invest in Young Children produced by Partnership for America’s Economic Successhighlighted that the price society pays when a single person experiences child abuse, drops out of high school, or abuses alcohol can range up to tens to thousand dollars over that person’s lifetime. The study’s purpose was to help policy makers and the public fully evaluate the consequences of their present funding decisions.

The latest RWJ/University of Wisconsin County Health Ranking (CHR) revealed that morbidity numbers are rather low in Lehigh County (37 out of 67 counties) and Northampton County (a shocking 60 out of 67). Morbidity is a term that refers how healthy people feel in the community while alive and it captures the Birth Outcomes along with Health-related quality of life (HRQoL) within the community. Birth Outcomes are measured using low birth weight (LBW) that represents child’s current and future morbidity. Low birth weight is reported to be higher in both Lehigh Valley (8.3%) and Northampton County (8.7%) as compared to the State average of 8.2% and way higher than the national average of 6.0%, according to CHR report.

It was mentioned in the blog on County Health Ranking Across Pennsylvania that the public health spending in Pennsylvania is extremely low as compared to other states in U.S. In this context of scarce resources, the advantage of economic analysis is that helps substantiate present action in terms of investing in prevention and public health. Such an analysis helps providers in managing an individual’s health and administrators in appropriately focusing resources, and — moreover — illustrates the return on investment (ROI) for public health initiatives. According to a study in Western New York, a positive ROI was demonstrated for a prenatal program developed at the Managed Care Organization using a model of economic analysis.

In general clinical preventive services are cost-effective; some are cost-saving. Some clinical preventive services prevent disease or injury (e.g. cervical cancer screening); some preventive services catch disease in early stages when treatment is most effective and least expensive (e.g. STI screening). Because clinical preventive services can prevent or reduce the need for treatment, they provide a cost-offset. Lehigh County has the highest number of sexually transmitted infection rates as compared to state or national average, according to CHR report. Key studies have been done that support the cost-offset value of prevention.

Below are the examples of cost-offset of clinical preventive services recommended in the Plan Benefit Model conducted as part of study that provides rationale to our current work on establishing a regional health department for Lehigh Valley. Of particular note is the cost offset by screening for Chlamydia and Sexually Transmitted Diseases (STDs). Screening for gonorrhea and Chlamydia allows for early recognition of diseases that could prevent the costly implications of late stage complication such as Pelvic Inflammatory Disease (PID). The average life-time cost of PID and its major complications for women have been estimated to be in the range of 1,060-6,840 US dollars. Check out the image below for details on how investment in prevention saves financial resources over the long term.

County Health Rankings Across Pennsylvania

When the annual County Health Rankings were released late last month, the Morning Call, Express Times and Patch reported on the very high morbidity numbers in Northampton County and Lehigh County. Meanwhile, these county rankings received coverage that looked at how other parts of the state were faring as well. Union County was ranked the highest [Check out WNEP news for more info] and Philadelphia was ranked the least in regards to health outcomes and health factors [Here’s the link]. Closer to home, both Montgomery and Bucks Counties ranked in the top 10 of Pennsylvania counties in terms of overall health [Here’s the link here for phillyburbs.com article].

Generally, the rankings showed that counties located in south and central Pennsylvania performed better than did counties in the northeast and northwest. Also, more of the urban counties are ranked in top half than the rural counties — this using the definitions of “urban” and “rural” developed by the Center for Rural Pennsylvania (The Center defines rural vs. urban Pennsylvania based on population density).

Amid these overall regional trends, in some cases the rankings show significant differences even among neighboring counties. Consider the area to the north of Harrisburg, where Union and Snyder Counties both are amongst the top five counties statewide in overall health, while adjacent Northumberland County is ranked in lower one-third. The factors that contribute to such great disparities among neighboring counties would lend itself to further analysis that could shed light on the local conditions that contribute to – or stand in the way of – good health. (As a side note: For an interesting resource on county-level conditions across economics, demographics, and other areas, check out Patchwork Nation – an interactive data site.)

While considering how Pennsylvania counties fare among themselves, it is important to look at where Pennsylvania stands nationally on support for public health. Public health infrastructure in Pennsylvania clearly lags that in others. For its population size, Pennsylvania has the lowest number of public health professionals. Also, according to a study released last month, public health spending in Pennsylvania is very low itself. Here’s the link.

Ultimately, failing to adequate support public health is a short-sighted policy and an unwise investment of public dollars. As noted in the local coverage of the county health rankings [Patch article], we either invest upfront in public health and prevention or we spend far more on what it takes to address illness and injury after they occur.

What is impressive and valuable about the County Health Rankings is not only the numbers themselves, but the huge potential to use these data to improve the health of our communities. Look here to see how people can take action. Patrick Remington, who is the University of Wisconsin Professor and has lead the County Health Rankings report, remarks that the County Health Rankings report is a teaser to catch interest. The point is get people to take some action towards the health of their community.

The current work on establishing a regional health department for the Lehigh Valley represents an important step toward building a strong system of prevention and health promotion for our region. For more information on this effort, visit RenewLV’s Regional Health Initiative page.

County Health Ranking And What It Means For Us

A new report released by County Health Ranking (CHR) reveals that morbidity numbers are shockingly low in Lehigh County (37 out of 67) and Northampton County (60 out of 67).

Morbidity is a term that refers how healthy people feel in the community while alive. Morbidity numbers capture the Health-related quality of life (HRQoL) and Birth Outcomes within the community. The measures used to assess the HRQoL of the population were self-reported health and number of physically and mentally unhealthy days per month. Birth Outcome was measured using low birth weight (LBW) that represents child’s current and future morbidity.

Lehigh County of Pennsylvania has slipped in overall county health rankings from a ranking of 19 in 2010 to 27 rank in 2011. In regards to morbidity numbers, age-adjusted numbers of poor physically unhealthy days reported in past 30 days have gone up as compared to 2010 numbers and 2 points higher than the average state numbers (3.7 in 2011; 3.5 in 2010; PA rates of 3.5 in 2011). There were no changes in the reported low-birth weight percentages as compared to last year percentages (8.3%); however state percentages were still better at 8.2%. Northampton county, too, has slipped from last year overall ranking of 26 to current ranking of 27 primarily due to increase in morbidity rates. Even though there were no changes in age-adjusted numbers of adults reporting poor health and low-birth weight percent this year from last year numbers (Poor or fair health at 16% in 2010 and 2011; Low birth weight at 8.7% in 2010 and 2011), average number of physically unhealthy days and mentally unhealthy days reported have increased (poor physical health days 3.7 in 2011 and 3.6 in 2010, and poor mental health days 3.8 in 2011 and 3.6 in 2010). Poor mental health days were comparable to state last year; however, this year the numbers are more than the state average.

The above rankings, based on model of population health, clearly depict the need of public health prevention efforts in order to make the community a healthier place to live, work, and play. Apart from morbidity numbers, the report ranks mortality and health factors including healthy behaviors, clinical care, socio-economic factors, & physical environment. Crossroads will be reporting more on CHR in the coming weeks as it has implications on improvement of public health infrastructure in Lehigh and Northampton County.