Women in a number of counties located primarily in the South and West have higher mortality rates than those in other regions, and the reasons extend beyond access to medical care, according to research published in the March issue of Health Affairs.
According to the authors of the study, government, business and healthcare organizations will need to support and finance population health strategies, despite the current pressures to cut spending. These strategies are aimed at improving not only individual healthcare, but public health, behavioral change and the social and environmental determinants of health.
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"It's not like there's a single silver bullet to solve this in a time of restraint," said David Kindig, MD, University of Wisconsin at Madison population health sciences professor, and one of two authors of the study.
Some resources could come from the savings the healthcare system captures as it becomes more efficient. For example, the thinking on shared savings in accountable care organizations (ACOs) is that it will be split between providers and payers. "But a number of us are talking about if there could be a third share of the savings that goes into broader community investments," he said.
Although mortality rates are falling in most counties in the U.S., female mortality rates increased in 1,224 counties compared with a rise in 108 counties for men. Living in counties in the South and West was associated with a 6 percent higher mortality rate than living in the Northeast. Smoking rates were a key factor.
The higher female mortality rates were not the result of medical care factors, such as rates of primary care providers. What had much greater impact were behavioral factors, such as diet, exercise and smoking, and socioeconomic considerations, such as college education and rate of children living in poverty, Kindig said.
"Even though it's a time of spending restraint, government and foundations are still making investments, and many are finding ways to change the pattern of those investments," he said.
Funds could also come from additional government health-promoting policies in other areas, such as education and housing.
For example, voters in a referendum in San Antonio, Texas, recently passed a tax increase of one-eighth of a cent, or one mil, to the sales tax to help fund expansion of pre-kindergarten education, according to his research.
Besides providing for preventive care, the Affordable Care Act (ACA) requires that nonprofit hospitals work in partnership with public health agencies to develop a community health needs assessment every three years as a condition of the hospitals' maintaining their tax-exempt status.
"Particularly as charity care requirements fall under ACA, could some of those be directed into some broader community health improvements? ACA does not specifically tie community benefit dollars to what they find, but the hope is that over time there will be some movement on that," he said.
Businesses are beginning to understand that they also have a stake in healthcare outcomes in their communities both from the perspective of reducing healthcare costs and increasing the productivity of their workforce. An increasing number of businesses are supporting local and state policies for investments in education and smoking cessation, Kindig said.