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Low Ranking on Par with Other Southern States

In a state-by-state comparison, the people of Florida ranked 6th least healthy in the nation, according to America's Health Rankings, a report put out annually by United Health Foundation. The results squared Florida on par with its Southern-state contemporaries ranked most unhealthy as a region.

The scores were based in part on 2007 levels of obesity, binge drinking, preventable hospitalizations and the uninsured. Other indicators of healthiness were infant mortality, premature deaths, air pollution, violent crime rates, occurrence of infectious disease and disparities by race and geography.

Overall, Louisiana ranked least healthy state, with Mississippi close behind, while Vermont earned the highest distinction as healthiest state in the nation.

Florida slipped from its ranking in 2007 as 10th least healthy state, according to the study, because of a high incidence of infectious disease, a high rate of uninsured at 20.7 percent, a high violent crime rate and a high geographic disparity within the state.

"Access to healthcare varies significantly by race and ethnicity in Florida; 43.8 percent of Hispanics lack health insurance compared to 17.9 percent of non-Hispanic whites," according to the report.

In Orlando, conditions are generally worse than other regions of the state. Parts of Orange County have higher rates of uninsured and experience greater disparities in access to healthcare, said Yolanda Martinez, PhD, director of Orange County Office of Community Health.

"The Central Florida economy is based so much on services, primarily part-time jobs," Martinez said. "Most of those jobs are served by minority communities. With that comes not having access to health insurance."

The county has embarked on a $650,000 per year program for three years – through state Low Income Pool funding – to educate communities with higher rates of emergency room usage. They want to enroll people for public services and stress the importance of prevention. Preventable hospital visits were a factor the Health Rankings survey.

"Some of the disparities are based on providers and lack of coverage," said Karen Wint, director of the Office of Health Disparities. "A lot, though, is based on individuals themselves who may wait too long to seek medical treatment. I feel we've been successful at creating an awareness."

Positives for the state include decreased levels of smoking and infectious disease as well as a low level of obesity at 24.1 percent – which speaks more to overall high rates of obesity throughout the country. Challenges include a 23 percent increase in the percentage of children in poverty, which points to the economic downturn as a key factor toward worsening health conditions.

"The increase in uninsured is the primary cause (for Florida's low ranking)," said Randy Kammer, vice president of regulatory affairs of Blue Cross Blue Shield of Florida. "It points out the need for really significant initiatives to address health concerns in Florida. For one thing, you have a situation where kids aren't getting physical exercise. People haven't made the connection between good health and better learning."

For its part, the Blue Foundation for a Healthy Florida, funded and run by Blue Cross and Blue Shield of Florida, has invested $8 million over four years in programs with community groups across the state to attack obesity, diabetes and heart disease.

America's Health Ranking survey came in December just as the state released a new set of data on infection rates at www.FloridaHealthFinder.gov. The report by the Agency for Health Care Administration expresses a rate of infection per hospital discharge. While not meant to directly compare hospitals, the report lists facilities for each of the largest hospital systems in Orlando with rates "higher than expected."

Dr. P. Phillips Hospital had a 6.11 percent complication/infection rate – state average is 2.04 percent – for postoperative sepsis, a bacteria infection associated with surgery. Florida Hospital East Orlando had a 5.89 percent rate in the same category.

Halifax Health Medical Center logged higher than expected rates of general infection due to medical care at 0.54 percent at its Port Orange facility and 0.42 percent in Daytona Beach.

"Personally I think that kind of data is totally worthless," said Richard Duma, MD, director of infectious disease and infection control for Halifax Health. Duma's main contention is that the data uses hospital discharges rather than patient days as a factor to determine the rate. In doing so, the number fails to adequately account for larger hospitals that do more complicated procedures even though some "weighting of the data" has already been performed.

"You really can't compare one hospital to another," Duma said. Based on the hospital's own experience and other reporting programs to which Halifax reports, such as the Center for Disease Control's National Healthcare Safety Network, the hospital system is managing its rate of infection as expected, Duma said.

"Everyone wants a zero tolerance for no infections when they come into the hospital," Duma said. "That's wonderful but you'll never get them down to zero. Often infections are due to bacteria the patient carries in."

Some problems can't be avoided, but it's the larger issues of health that the next generation of professionals will have to tackle. Aaron Liberman, PhD, a professor of health management and informatics at University of Central Florida said the state's dismal health ranking is not surprising.

Liberman's students are the ones heading into the field, charged with fixing the delivery system to be less costly with better outcomes. It's a tough job, one Liberman chuckles and says, "Buckle up and get ready for a rough ride. This is a very unforgiving profession. It's not going to get any easier."

Tags:

America's Health Rankings, binge drinking, Blue Cross and Blue Shield of Florida, of obesity, United Health Foundation

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