The high costs of poor health are sown in childhood

WAKEUP CALL: A report co-sponsored by Rhode Island Kids Count shows that good health begins early in life. Above from left, pediatrician Karla Fuentes and Kids Count Director Elizabeth Burke Bryant. / PBN PHOTO/RUPERT WHITELEY
WAKEUP CALL: A report co-sponsored by Rhode Island Kids Count shows that good health begins early in life. Above from left, pediatrician Karla Fuentes and Kids Count Director Elizabeth Burke Bryant. / PBN PHOTO/RUPERT WHITELEY

Obesity, heart disease, stroke, diabetes, alcoholism, smoking and drug use, depression, adolescent pregnancy and high blood pressure: these are the modern plagues that will “determine the trajectory of our future health care costs in Rhode Island,” said Catherine Walsh, the deputy director of Rhode Island Kids Count.
Walsh detailed the findings of the report she wrote, “Disparities in Children’s Health,” to a gathering of more than 50 of Rhode Island’s top children’s health experts, advocates and providers in Rhode Island on Feb. 29 at the Providence Marriott.
These adverse adult-health outcomes, Walsh continued, are shaped in large part by what happens in maternal, infant and children’s health, the evidence-based research showed. And, in Rhode Island, the disparities by race, by ethnicity, by geography and by family income are still persistent and very damaging, despite the best attempts at intervention.
The report, co-sponsored by Blue Cross & Blue Shield of Rhode Island, was introduced by Peter Andruszkiewicz, president and CEO of Blue Cross. He praised the significant leadership role that Elizabeth Burke Bryant, the director of Rhode Island Kids Count, has played in bringing evidence-based research to the discussion of children’s health across a broad spectrum of issues.
The differences found were stark. “I do this research all the time, but I am still startled by the huge disparities,” Walsh said, pointing to a slide entitled “Disparities in Educational Attainment.” In Rhode Island for the class of 2011, the high school dropout rate for blacks was 17 percent, for Hispanics, 20 percent, for low-income students, 19 percent, and for Asians, 14 percent. By comparison, the drop out rate for whites was 9 percent, and for higher-income students, 5 percent. By comparison, only one in 20 high-income, high school students dropped out in 2011.
Another compelling finding was the high incidence of obesity, with 50 percent of Hispanic seventh-graders in Rhode Island being overweight or obese in the 2010-2011 school year, putting them at an increased risk for Type 2 diabetes, asthma, sleep apnea, high blood pressure and other chronic health problems. The figures of the number of children hospitalized in Rhode Island with asthma, by race/ethnicity between 2006-2010 showed that black children under 18 were five times as likely as white students to be hospitalized.
“These numbers are remarkable. These disparities are preventable, they are not natural, and we have the power to change them,” said Carrie Bridges, the team leader in Health Disparities and Access to Care Team at the R.I. Department of Health, addressing the gathering.
What happens in early childhood, Bridges continued, has long-term consequences for public health. “Health is not just health care,” she said, saying research has shown that health outcomes are 10 percent access to health care, 20 percent genetics and 70 percent physical and social factors. “Inequality and social deficits are bad for our health, and bad for the health of our offspring.”
The report was startling and sobering to the audience, too. “This is a crisis, and it’s a crisis that’s going to get worse,” said Patricia Martinez, the executive director for Family and Student Support for Central Falls High School. Martinez praised the report and its recommendations, but asked: “What are the action steps? We don’t want to be sitting in the same place 10 years from now.”
The role of the business community in addressing and improving the public health crisis will be crucial, according to Beau Stubblefield-Tave of Cultural Imperatives. “Healthy students are healthy learners,” he said. “We’re talking about the future employees and customers. We need to get [the business community] to the table.”
After the briefing, Andruszkiewicz told Providence Business News that he saw the call for the business community’s engagement as something more than a request to pick up the tab. “Many times, when people say, ‘Why doesn’t the business community get involved,’ that’s code for ‘Why don’t they pay for some program,’ ” Andruszkiewicz said. . Bridges, in her talk, challenged the health professionals at the issue briefing to recognize the importance of their own decision-making. “We run this system; we create the policies. We need to address the social and economic determinants of health.”
The reality of that challenge was made transparent the day before, during a hearing on Feb. 28 before the House Finance Committee, during which Secretary Steven M. Costantino of the R.I. Executive Office of Health and Human Services defended his budget proposal to eliminate dental coverage for some 93,000 adults on Medicaid, in hopes of saving about $5.6 million in the fiscal 2013 budget.
“Teeth cannot be separated from the body,” Jill Beckwith, senior policy analyst with Rhode Island Kids Count, told PBN after the issue briefing, saying the proposed budget cut would affect pregnant women and parents with RIte Care coverage. “There is a causal link between dental plaque and decay, and pre-term birth,” she said, connecting the proposed policy of budget cuts with the findings of the issue briefing and the significant disparities in maternal and infant health incomes – minority women are more likely than white women to receive delayed prenatal care, have a baby born with low birth weight or delivered too early in a pre-term birth, and have an infant who dies in the first year of life.
On the day of the hearing, a new report was issued by Pew Center on the States, “A Costly Destination: Hospital Care Means States Pay Dearly,” which found that more Americans were seeking care in an emergency room for routine dental problems, a choice that often costs 10 times more than preventive care.
In Rhode Island, the proposed budget policy to eliminate dental care to adults with Medicaid – and the resultant dependence on emergency room care – promises to exacerbate the growing burden of uncompensated care by hospitals. In 2011, charity care rose to $102.59 million from $90.67 million in 2010, according to the Hospital Association of Rhode Island. •

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