Every March, the Robert Wood Johnson Foundation publishes their “County Health Rankings.” Every parish in Louisiana is ranked according to their “Health Outcomes” and “Health Factors.” “Health Outcomes” include measures of morbidity and mortality such as premature death, low birth weight, and poor self-reported physical and mental health days. “Health Factors” (sometimes called “Health Determinants”) include a wide variety of indicators including “Health Behaviors” (such as smoking, obesity, inactivity, drinking, STDs and teen birth) and “Clinical Care” (including uninsured rates, availability of providers, preventable hospital stays and screening tests for diabetes and breast cancer). Health Factors also include “Social and Economic Factors,” notably high school graduation rates, poverty, violent crime rates, injury deaths and single-parent households. Lastly, health factors include elements of the “Physical Environment,” such as air pollution, drinking water violations, housing problems and long commutes. Each of these factors is weighted differently, with the highest being for Social and Economic Factors (40%).
Factors demonstrate a close cause and effect relationship to outcomes, with poorer factors (determinants) generally resulting in worse outcomes. How do parishes in Central Louisiana stack up against others in the state? Results show that there are three separate groups with respect to health outcomes: those with the best outcomes (Vernon 10/64, Grant 11/64 and LaSalle 18/64), a middle group (Rapides 36/64, Natchitoches 41/64, Avoyelles 41/64 and Winn 44/64), and a lower tier (Concordia 58/64 and Catahoula 62/64). These groupings have held true for nine years, with the unhealthiest parishes being along the Mississippi River, a distinction they share with counties on the other side of the river.
Since health factors and health outcomes are so closely related, you would expect a similar grouping for health factors. For the most part, that does hold true. Rapides (14/64), Vernon (18/64), LaSalle (20/64) and Grant (25/64) have the best health factors, while Natchitoches (39/64) and Winn (48/64) fall in the middle. Once again, the Mississippi parishes of Catahoula (53/64), Avoyelles (55/64) and Concordia (58/64) have the worst health factors, correlating with their equally poor outcomes.
What is sadly obvious from looking at these statistics is their stability over time, with only a few positive trends. Grant has improved its health factors, as have LaSalle and Vernon. Otherwise, both factors and outcomes appear to be rather static.
While there is merit in looking at individual parishes (or counties) within individual states, it is important to put these statistics in the context of Louisiana results when compared with other states. In the latest America’s Health Rankings (2017), Louisiana ranked 49/50 overall, with 43/50 in outcomes and 49/50 in health determinants (factors). While we have a host of poor results (40/50 or worse for cancer, cardiovascular deaths, diabetes, infant mortality and premature deaths among others), we have very good rankings for adolescent vaccinations (8/50 or better) for meningococcus and Tdap (tetanus, diphtheria and pertussis.) Vaccinations have always been a Louisiana bright spot, mostly related to LINKS (Louisiana Immunization Network for Kids) and our strict “no shots, no school” policies. Favorable statistics for one aspect of health prove that improvements can be made with the proper programs, policies and adequate investments. Louisiana is not doomed to be last.
Another bright spot for Central Louisiana is its very low infant mortality rates. CENLA’s 2014-2016 average remained the state’s lowest (6.3/1,000 live births) among the nine public health regions. Our CENLA health units provide among the highest coverage of contraceptive needs among all state parishes (over 23% satisfaction of contraceptive needs and higher than Title X goal of 20 %.) We also have the busiest health unit (Rapides Parish) in the state in
absolute numbers and our per capita regional visits for reproductive health, (over 4,000/100.000) are the highest of any OPH Region. Our Fetal-Infant Mortality and Child Death Reviews continue to monitory infant and child deaths and seek opportunities for prevention.
Our state and parish statistics often hide tragic disparities in outcomes between groups based on income, education and race. Health providers, policy makers and civic leaders in all locations should target these disparities, as persistent as they have been historically, for elimination. We need to build on our strengths and continue to improve health factors and their resulting health outcomes. Partnerships and persistence will help us raise our regional and state rankings so Louisiana will no longer be located at the bottom of the health statistical barrel.
LOUISIANA PUBLIC HEALTH ASSOCIATION