Managing the Cost of Medications

Speaking up, being patient and using simple math can be the best medicine for your wallet.
Prescription medications are one of the most expensive and reoccurring costs you’ll face. Fortunately, many of them have generic counterparts that are available and less expensive. The U.S. Food and Drug Administration requires that generic drugs be as safe and effective as their brand-name counterpart. More than half of all prescriptions are for generic drugs. When your provider writes a prescription, ask for the generic substitute. If the provider gives you a sample drug, also ask for a generic prescription so you can use it for a refill if needed.
You also can call different pharmacies to find out their price for your prescribed medicine. In most cases, the prices will be similar. In others, you’ll be thanking yourself for making the effort.
If you have prescription coverage that includes a co-pay, it may be cheaper to pay the generic price of $10 of the medication versus the co-pay depending on your co-pay amount. For example, the co-pay on a prescription plan for a 90-day supply could run from $27 to $75. In this case, it is more cost effective to pay the $10.
Mail order also may be another option when the medicine is not needed immediately. Mail order usually is substantially cheaper and a 90-day supply is the usual order.
In some cases, over-the-counter drugs may be substituted for some prescribed medications. For instance, Claritin (Loratadine) can be purchased over the counter while its counterpart requires a prescription from a health care provider. The savings between the two can be substantial while the results are similar. Do yourself a favor and check with your health care provider or pharmacist.
Most of the time, the cost of medication does not depend on the dose. For example, a 100 mg Viagra tablet could cost the same as a 50 mg. Ask your provider or the pharmacist if the medication can be split. You may also find relative information on the Internet or through Consumer Reports about splitting drugs. If yes, you can save some money by getting a double dose of your prescription.
Using Pravastatin as an example, if your provider approves and your daily dose is 20 mg you can cut the 40 mg tablet in half and get a 180-day supply for $10. This is a substantial cost saving.
Those with numerous chronic illnesses may be in a situation where different providers prescribe a variety of medications. Ask your primary provider to review the medications and together you can determine which are needed. This could result in cost savings as well as the benefits to your health.
The pharmaceutical industry spends millions of dollars marketing directly to consumers. We are bombarded daily with television and print ads that promote numerous medications. The industry has found that their campaigns can direct patients to their specific product when other less costly options might be available.
Be careful about being persuaded that a heavily marketed medication is appropriate for you. A substitute drug for a 10th of the cost may be just as beneficial.
So be aware and speak up when it comes to your health. You’ll save money and not sacrifice quality medications.

Stimulus Plan A Potential Boost for UTEP's SON

With the signing of the American Recovery and Reinvestment Act, into law this week should provide a significant opportunity for UTEP and its health related disciplines and researchers to secure additional funding. Nearly $140 billion in funding for health care is targeted to support a number of healthcare activities that could significantly impact UTEP ‘s research agenda. The National Institutes of Health (NIH) will receive $10 billion with more than $8 billion targeted to fund research. The funding for NIH has been relatively flat for the past six years resulting in limited growth in the creation of new knowledge. The $10 billion will be on top of the existing $29 billion annual funding.

Currently NIH funds on an average 10% of the research proposals submitted. These new funds which must be spent over the next two years means that other competitive research applications that did not make the cut will now have an opportunity to be considered. This may mean that for UTEP researchers engaged in research such HIV/AIDs, environmental health, Hispanic health disparities, diabetes, obesity, Alzheimer’s disease, heart disease as well as other areas of investigations may be able to secure additional moneys.

While investigating important health issues the infusion of funds will also mean the creation of new jobs and opportunities for local vendors to provide supplies and equipment needed to conduct the research. It is estimated that nationally some 70,000 jobs can be created as a result of this investment in research. In the School of Nursing alone over 20 positions are funded in whole or part by either NIH or Health Service Resources Administration (HRSA) funds.

Another $1.1 million is targeted to fund comparative research that will support investigations that compare different treatment approaches against each other. For example, projects that compare newer drugs prescribed to manage elevated cholesterol with less expensive generic formulas are the type of comparisons that are anticipated to be funded. There is evidence suggesting that some existing treatments and medications may not be as effective as those that cost less. Pharmaceutical, medical supplies and equipment manufactures in a free market system have incentives to push their latest product even thought the effectiveness of such may be the same or less than a cheaper option. The Obama stimulus package will encourage investigations to evaluate alternatives so that any costs savings can be pass on the consumer without impacting outcomes of care. Potentially billions in cost saving can be achieved from the results of such comparisons.

With support provided in part by the Hispanic Health Disparities Research Center a NIH Center of Excellence and the Office of Research and Sponsored Projects, UTEP investigators from across the campus have been actively engaged in drafting new and refining prior submissions in anticipation of the opportunity to tap these new funds. UTEP’s School of Nursing ranks 28th in the nation (out over 700 bachelor and higher degree granting Schools of Nursing in nation) for the amount of its NIH funding.

The stimulus package also provides $500 million for health professional education. Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and the Health Professions Training Programs (Title VII) were allocated $300. This means your School of Nursing will hopefully receive additional funds to educate more nurses for our community.

What Would Obama’s Health Plan Do for El Paso?

In El Paso County nearly 40% of its’ population are without access to health insurance. In some colonias the rate of uninsured approaches 60%. Despite this high percentage of underinsured for profit healthcare systems have flag ship hospitals located in El Paso and our taxpayer supported Thomason Hospital reports they are in the best financial position than they have been in recent years. Clearly even with our high rate of underserved healthcare is big business in our community.

It is estimated in 2005 between the for-profit hospitals and the public sector facilities nearly $900 million in net patient revenues was generated. While the percentage of uncompensated care averaged 4.72% for the Tenet and HCA hospitals, Thomason provided 37.6% uncompensated care and still reported net operating income totaling for the past two years of nearly $70 million.

The Obama plan calls for coverage for all Americans. If an individual has insurance under his proposed plan individual premiums will decrease. Every individual will be able to buy into a health insurance plan similar to those provided to Federal employees including our enjoyed by our Congressional delegation.

No one will be turned away because of pre-existing conditions, employment status or ability to pay. No longer will an individuals’ health status or history be the basis for denial of health coverage.

Obama’s health plan will require a full range of services including mental health and disease management requirements. A significant component will be supporting health promotion and disease preventions strategies with proven effectiveness. Our public health system long neglected will see a revitalization to insure programs and surveillance systems are in place to protect our nation’s health. Hopefully this means we will no longer need to be concerned about clean water that is free of pollutants, or foods contaminated with salmonella.

A major initiative will be on supporting the continuing development of our infrastructure for disaster response. Katrina revealed the serious challenges that our existing disaster response system faces. While substantial progress has been made through a variety of Homeland Defense programs aimed to improving local, state, and national responses to both terrorist and natural disasters challenges remain. The Obama economic stimulus plan (being considered at press time) provides up to $100 million to prepare for a national health disaster.

Like plans in Japan small business will be able to purchase insurance from low risk pools and not have to pay high premiums because of the inability to purchase coverage at reasonable rates. The Obama plan will provide tax credits that will cover up to 50% of the costs. The secondary insurance pool will provide coverage for those with catastrophic health problems.

The free market insurance system will continue with individuals having the option of purchasing private insurance plans that will provide more options for those desiring such. This is similar to private plans in Australia and Canada. Individuals with these plans (depending on the benefit and payment options) can select plans that allow more flexibility.

Obama also promises to take on the big insurance, pharmaceutical and medical supplies/equipment companies in addition to other special interest groups who spend millions of dollars lobbying against reform of the healthcare system to maintain generous profits. No longer will the US subsidize the costs of developing new drugs, emerging technologies, and other innovations while the same products/drugs are sold in other countries sometimes for a less than 25% of the cost charged in the US.

High standards for quality will be required and will be achieved in part through implementation of electronic medical records and more efficiencies in the delivery of health services and in the administration of the health plans. Obama is already moving forward with his plans to encourage the adaption of IT innovations in health care. In the administration’s economic stimulus package (being considered at press time) allocates more than $20 billion for the implementation of IT enhancement such as electronic medical records.

Physicians who agree to participate in the IT enhancement would be eligible for higher reimbursement rates from Medicare and Medicaid as well as payments between $45,000 and $65,000 once they can prove they are using IT effectively. In addition, hospitals would also be eligible to receive millions of dollars for IT adaptations.

Image the impact on our local economy if the 40% of our citizens without insurance are suddenly eligible for health care. Assuming Obama’s health reform plan is passed or something similar by the end of 2012, El Paso will benefit from this tremendous growth that will occur when our large population of uninsured individuals are suddenly eligible for health care.

As a community we are already challenged with a having adequate numbers of hospital beds, nurses, physicians, and other health care providers. The impact of the growth at Fort Bliss has facilitated significant increase in the number of military personnel, their dependents, and retirees. With this growth alone we will need by 2012 another 2,300 nurses, a significant increase in the number of physicians, and other healthcare provider.

The existing infrastructure is not ready for the current growth let alone the increase demand that could come from increasing health care coverage for all citizens. Schools of Nursing and Medicine will need to significantly increase their capacity. The number of residency positions for new medical school graduates will need to be increased to assure the new physicians will stay in El Paso. Other health professionals including ancillary health related occupations will also need to gear up to help meet the workforce needs.

The existing practice acts particularly for advance practice nurses, optometrists, podiatrists, physical therapists, pharmacists, psychologists to name a few must be updated and scope of practice enlarged. The restrictions while in the past perhaps were warranted are no longer justified given the current educational preparation of these non physician health care providers, The demands for high quality health services are going to be unrelenting and the practice acts for non physician providers will need to amended to insure the public will receive quality care.

The economic impact of forthcoming health care reform will have a significant impact on El Paso in the near future. We must plan now to insure we are ready for this new growth. High school students need to be encouraged to seek health career so they can be academically prepared for health care professional education. Fast track educational preparation for health care professions needs to be incorporated into early college programs that are available to high school students.

We will have an unprecedented demand for hospitals beds, home health care, primary care, and specialty care. Unfortunately as with most countries with universal coverage longer waiting times for elective procedures as well as delays in obtaining appointment from specialists will probably be the norm. Those who purchase the private insurance options will most likely have quicker access to care due to their ability to pay the higher fees associated with private care.

The bottom line is that El Paso will experience substantial growth in its healthcare industry. Significant economic opportunities will emerge given our pent up demands for health care. The growth will come with challenges and perhaps a change in how those who now have health insurance will be able to obtain such in a timely manner.

As a community we need to be aggressive in our planning to insure our citizens will have the health resources needed. This means an active engagement in strategic planning to assure we ready to meet this challenge. Are we committed?

Ensuring Quality Nursing Care

Ever wonder how nurses and physicians learn to manage medical emergencies? In many health care professional educational curricula the age old apprentice model of “See One, Do One, Teach One” is a common methodology. This in essence means that nurses and physicians rely primarily upon learning how to care for patients in clinical settings after they have had a period of “book learning” that theoretically prepared them to provide competent care. Given the infrequent occurrence of emergencies (with the exceptions of those seen in emergency rooms) only a few students may actual be on the unit to participate in an emergency. Thus learning how to manage life threatening emergencies is taught primarily in the classroom. This model of education does not assure providers’ competency.

Can you image an airline pilot learning how to handle emergencies solely through classroom instruction? Given the significant risk to the public, airlines are required to include simulation training in the education of pilots. Commercial pilots must demonstrate competency in managing flight emergencies via simulators at least every six months. Further safety protocols include check rides with expert flight instructors to assure that the pilots are competent.

One would think that perhaps in health care when a person’s well being is often dependent upon the expertise of a provider’s competency there would be a similar quality process in place. Unfortunately, preventable medical errors are so frequent in a 1999 report “To Err is Human” issued by the Institute of Medicine, it was estimated that up to 98,000 people in the U.S. die annually from medical errors. This is equivalent to 245 Boeing 747’s crashing each year in which 400 passengers die. Imagine the public outcry if the flying public was subject to such a high death rate.

Have you heard a protest about the unnecessary deaths and injury that occur daily in our nation’s hospitals? Given the deaths and injuries occurring in hospitals all over the country, the reporting in aggregate numbers does not occur. The extent of the problems with quality of care and the prevalence of medical errors have not drawn the national attention that they deserve. Thus our system of “sick care” has not had the same degree of public accountability.

The National Quality Forum and the Joint Commission on Healthcare Organizations (accrediting agency for hospitals) as well as other national professional groups have launched major efforts to improve the quality of care provided in our nation’s hospitals. “To Err is Human” and a follow up report also by the Institute of Medicine “Crossing the Quality Chasm” are the driving forces for the Institute of Healthcare Improvement’s 100,000 Lives Campaign. This 2006 initiative claims to have saved an estimated 124,000 lives in an 18-month period through care improvement activities conducted in over 3,000 of the counties 7,569 hospitals.

Where does the fault lie? As Harry Truman would say, “The buck stops here!” And in this case it appears to be our nation’s hospitals and their quality monitoring processes used to ensure safe care to patients. The shortage of registered nurses, inefficiency of existing care delivery models, lack of electronic medical records that can be programmed to alert staff to potential errors, health care providers who have not keep current in their practice, and economic pressures have contributed to these quality challenges. Health care provider education is certainly a critical factor in this mix. Registered nurses, physicians and others on the health care team must be educated to be critical thinkers, problem solvers, committed to lifelong learning, and taught how to assess and improve the care they provide.

Fortunately, the apprentice model of educating nurses at the University of Texas at El Paso is a thing of the past. The School of Nursing is 100 percent committed to improving the quality of care provided to our citizens through changing the paradigm of educating tomorrow’s nurses.

A major feature of this new shift is the use of scenario based education. In this model students learn how to care for complex patient conditions without ever stepping foot in a hospital. Through the use of “life like” computerized mannequins students are taught how to assess the most common conditions of patients found in hospitals, to implement an evidenced based plan of care, and to evaluate the outcome of the interventions. The mannequins are programmed by the faculty to simulate a variety of conditions and to introduce complications to teach the students how to manage safely even the most complex patients. The simulated patient’s condition changes depending on the interventions implemented.

By doing this the student is able to learn how to safely provide nursing care in the safety of the Simulation Center. The student can practice repeatedly procedures, assessments, interventions, etc until achieving competency in safely managing the condition or conditions presented. The UTEP students before graduating must demonstrate competency in managing emergencies and the most common diagnoses. This is one method used to insure students are safe and competent nurses thus hopefully contributing to the reduction of medical errors and resulting unnecessary deaths.

Just like the airline industry UTEP’s School of Nursing is rapidly incorporating into its program the use of technology. Such a move provides a rich learning environment for students while not placing any patients at risk. In the near future we will also be using standardized patients who are actors that use a faculty developed script designed to teach the student to interact with a “real live” person. The student is provided lab data and other assessment information. Thus the technique provides another means to teach students how to competently managed selected patient conditions.

Thus, in creating the new health professionals building for the School of Nursing and College of Health Sciences, designers have created spaces and infrastructure that can be adapted to changes in curriculum as they emerge. Our existing simulation centers, currently located on the UTEP campus as well as at Sierra Medical Center and Del Sol Medical Center, are our central hubs of learning activities. The centers are becoming a focus of credentialing not only for UTEP students, but also for health professionals in our Far West Texas region and potentially in Central and South America.

In the immediate future, our primary focus will be educating more BSN and graduate prepared nurses. By 2017, the Upper Rio Grande Workforce estimates El Paso County will need nearly 2,400 new nurses, of which at least 80 percent should be prepared at the undergraduate level. We will continue to expand our traditional and Fast Track BSN options, and offer an LVN to BSN program beginning in summer of 2009, that incorporates online and other instructional technology. The five-year goal is to increase by 125 percent of our existing number of BSN graduates from our 2006-07 baseline of 159 students.

Your School of Nursing is committed to educating the nurses needed for our community to ensure the highest quality of care available is being given. Increasing the number of registered nurses, with a BSN degree, at the bedside ensures a higher quality of care. You can rest assured that the UTEP School of Nursing is committed to its vision of becoming the premier Hispanic-serving School of Nursing in the nation thus contributing excellence in its graduates.

What Would Obama’s Health Plan Do for El Paso?

In El Paso County nearly 40% of its’ population are without access to health insurance. In some colonias the rate of uninsured approaches 60%. Despite this high percentage of underinsured for profit healthcare systems have flag ship hospitals located in El Paso and our taxpayer supported Thomason Hospital reports they are in the best financial position than they have been in recent years. Clearly even with our high rate of underserved healthcare is big business in our community.

It is estimated in 2005 between the for-profit hospitals and the public sector facilities nearly $900 million in net patient revenues was generated. While the percentage of uncompensated care averaged 4.72% for the Tenet and HCA hospitals, Thomason provided 37.6% uncompensated care and still reported net operating income totaling for the past two years of nearly $70 million.

The Obama plan calls for coverage for all Americans. If an individual has insurance under his proposed plan individual premiums will decrease. Every individual will be able to buy into a health insurance plan similar to those provided to Federal employees including our enjoyed by our Congressional delegation.

No one will be turned away because of pre-existing conditions, employment status or ability to pay. No longer will an individuals’ health status or history be the basis for denial of health coverage.

Obama’s health plan will require a full range of services including mental health and disease management requirements. A significant component will be supporting health promotion and disease preventions strategies with proven effectiveness. Our public health system long neglected will see a revitalization to insure programs and surveillance systems are in place to protect our nation’s health. Hopefully this means we will no longer need to be concerned about clean water that is free of pollutants, or foods contaminated with salmonella.

A major initiative will be on supporting the continuing development of our infrastructure for disaster response. Katrina revealed the serious challenges that our existing disaster response system faces. While substantial progress has been made through a variety of Homeland Defense programs aimed to improving local, state, and national responses to both terrorist and natural disasters challenges remain. The Obama economic stimulus plan (being considered at press time) provides up to $100 million to prepare for a national health disaster.

Like plans in Japan small business will be able to purchase insurance from low risk pools and not have to pay high premiums because of the inability to purchase coverage at reasonable rates.

The Obama plan will provide tax credits that will cover up to 50% of the costs. The secondary insurance pool will provide coverage for those with catastrophic health problems.
The free market insurance system will continue with individuals having the option of purchasing private insurance plans that will provide more options for those desiring such. This is similar to private plans in Australia and Canada. Individuals with these plans (depending on the benefit and payment options) can select plans that allow more flexibility.

Obama also promises to take on the big insurance, pharmaceutical and medical supplies/equipment companies in addition to other special interest groups who spend millions of dollars lobbying against reform of the healthcare system to maintain generous profits. No longer will the US subsidize the costs of developing new drugs, emerging technologies, and other innovations while the same products/drugs are sold in other countries sometimes for a less than 25% of the cost charged in the US.

High standards for quality will be required and will be achieved in part through implementation of electronic medical records and more efficiencies in the delivery of health services and in the administration of the health plans. Obama is already moving forward with his plans to encourage the adaption of IT innovations in health care. In the administration’s economic stimulus package (being considered at press time) allocates more than $20 billion for the implementation of IT enhancement such as electronic medical records.

Physicians who agree to participate in the IT enhancement would be eligible for higher reimbursement rates from Medicare and Medicaid as well as payments between $45,000 and $65,000 once they can prove they are using IT effectively. In addition, hospitals would also be eligible to receive millions of dollars for IT adaptations.

Image the impact on our local economy if the 40% of our citizens without insurance are suddenly eligible for health care. Assuming Obama’s health reform plan is passed or something similar by the end of 2012, El Paso will benefit from this tremendous growth that will occur when our large population of uninsured individuals are suddenly eligible for health care.

As a community we are already challenged with a having adequate numbers of hospital beds, nurses, physicians, and other health care providers. The impact of the growth at Fort Bliss has facilitated significant increase in the number of military personnel, their dependents, and retirees. With this growth alone we will need by 2012 another 2,300 nurses, a significant increase in the number of physicians, and other healthcare provider.

The existing infrastructure is not ready for the current growth let alone the increase demand that could come from increasing health care coverage for all citizens. Schools of Nursing and Medicine will need to significantly increase their capacity. The number of residency positions for new medical school graduates will need to be increased to assure the new physicians will stay in El Paso. Other health professionals including ancillary health related occupations will also need to gear up to help meet the workforce needs.

The existing practice acts particularly for advance practice nurses, optometrists, podiatrists, physical therapists, pharmacists, psychologists to name a few must be updated and scope of practice enlarged. The restrictions while in the past perhaps were warranted are no longer justified given the current educational preparation of these non physician health care providers, The demands for high quality health services are going to be unrelenting and the practice acts for non physician providers will need to amended to insure the public will receive quality care.

The economic impact of forthcoming health care reform will have a significant impact on El Paso in the near future. We must plan now to insure we are ready for this new growth. High school students need to be encouraged to seek health career so they can be academically prepared for health care professional education. Fast track educational preparation for health care professions needs to be incorporated into early college programs that are available to high school students.

We will have an unprecedented demand for hospitals beds, home health care, primary care, and specialty care. Unfortunately as with most countries with universal coverage longer waiting times for elective procedures as well as delays in obtaining appointment from specialists will probably be the norm. Those who purchase the private insurance options will most likely have quicker access to care due to their ability to pay the higher fees associated with private care.

The bottom line is that El Paso will experience substantial growth in its healthcare industry. Significant economic opportunities will emerge given our pent up demands for health care. The growth will come with challenges and perhaps a change in how those who now have health insurance will be able to obtain such in a timely manner.

As a community we need to be aggressive in our planning to insure our citizens will have the health resources needed. This means an active engagement in strategic planning to assure we ready to meet this challenge. Are we committed?

Investing in Health Disparities

I am tired of attending funerals and hearing of the needless deaths of individuals who have died unnecessarily from conditions that could have been cured if treated or prevented in the first place.
This holiday season reminds me of twelve-year old Deamonte Driver, a young African American who died in the shadows of our nation’s capital last February from a toothache that progressed to a brain abscess.
Deamonte’s mother was repeatedly refused dental services for an $80 tooth extraction that could have saved the life of this young boy. He died because he had no insurance and no dentist would pull his rotten tooth without payment up front.
Another tragic death from a treatable cancer occurred with one of my student’s father, a retired El Paso fireman whose retirement left him without insurance. He was too young for Medicare and had “too much” income to qualify for Medicaid. No one would give him the potential life saving chemotherapy he needed without putting money up front.
My father, a sailor in the Pacific front during World War II, survived the sinking of his destroyer by a Japanese submarine, and somehow escaped death or injury in the insuring kamikaze suicide attacks; lived only to be killed 50 years later from an addiction to nicotine that the tobacco industry knew would kill people.
Our current health care system is a “sick care system” with over 70% of the health costs occurring in the last year of life. In 2007, as a country we spent over $2.3 trillion dollars on sick care or over $7,600 for each person living in our nation. What do we get? We have one of the most sophisticated sick care delivery systems in the world, yet we rank 37th when our health outcomes are compared against others such as Cuba at 39th and Costa Rica at 36th.
According to the Paso del Norte Region Health Report of 2007-2008 our local health indicators are some of the worse in the nation. Among USA counties, El Paso has the highest rates of cancer, stroke, and diabetes. Otero County has the highest rates of heart disease, chronic lung disease and injuries. Doña Ana and El Paso counties have the highest rate of death from cancer and heart diseases. Juarez has the highest rates of death from influenza, diabetes, and AIDS.
We have fewer registered nurses, physicians, dentists and other health care workers than in any other part of Texas except for the Lower Rio Grande Valley. Outside of the metropolitan area the rest of the county is considered medically underserved. The number of primary care providers to serve our population is half of the average found in the rest of Texas.
The majority of the causes of death such as diabetes, heart disease, stroke, and cancer are the result of smoking, obesity, and lack of physical activities. In fact depending on where you live your chances of dying is influenced by access to health care, healthy foods, transportation, quality education provided to you and your children, air quality and other environmental hazards.
The proportional importance of factors shaping health is determined 40% on behavior, 20% related to environment, 20 %t on genes, and 10 % on health care.
Where we are in our social structure is the highest predictor of health. Those at the bottom of the social economic ring are unhealthier and die younger. In comparison those at the upper end of the economic spectrum even when they smoke and are obese are healthier and live longer.
According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50% higher chance of dying sooner than those on the top. Furthermore, those in the lower economic sector are 400% more likely to die sooner than the upper economic sector.
El Paso ranks as the 7th poorest county in the nation with 26.4% of our population considered poor. We have over 32% of the population without health insurance and in some colonias the rate exceeds 60%. In El Paso 68% of our residents have a high school education and dropout rates in some of our public schools are as high as 50%.
However as a city and county we can take action now to start addressing the other 60% of the other determinates of health. A health population equates to an educated and healthy workforce.
Our schools must be held accountable for their outcomes. New and innovative teaching methods must be implemented to insure that no child, particularly boys, are left behind. A young boy who cannot read by the third grade is at substantial risk to be a high school dropout. Charter schools that are not hampered by bureaucratic restrictions should be financially supported and encouraged to locate in our poor communities. A child with an education insures opportunities for more economic security and the ability to make informed decision about healthy options.
Access to healthy foods for those areas without easy access to grocery stores is critical. Food desserts that exist in many of our poor neighbors must stop. We need to insure, in collaboration with our local government and private sector, local markets are given recognition for being a good neighbor. This recognition would only be awarded when fresh fruits, vegetables, meats, and other products are made available at rates found in more accessible communities. The creation of public garden plots, support for farmer markets, financially supporting local grocery vendors to sell fresh produce, diary products door to door as was once common practice will all assist in making healthy foods available. In other parts of the nation where this approach has been used the health of community members improved as well as the profits of the local vendors who offered the service.
Public transportation must be improved. Our city does not seem to have a transportation plan that encourages the use of public transportation. People without transportation particularly in the rural and in some of our poor areas are left with few options. Our sister city of Juarez has public transportations that serves their entire city. New transportation models must be developed and a long term strategy for transportation must be implemented.
Parks and recreational facilities for our youth must be a high priority. We must demand that physical education is taught in our schools along with curriculums that teach children how to be healthy. Food selections in our schools must include healthy options. Highly addictive food containing high sugar content and Trans fats must be completely eliminated from the school lunch menus. The Women’s Infant and Children program must include access to fresh fruits and vegetables.
A child who is obese will in most cases be an obese adult. We know that obesity kills. In fact the progress made in extending the life expectancy of our citizens may be lost through premature deaths due to health problems associated with obesity. The obesity epidemic will kill our children in their prime of life.
We are surrounded by environmental pollutants that may come from our proximity to smelters, refineries, asphalt plants, auto emissions, pesticides, lead both naturally occurring and as result of paint and other industrial activities, and polluted water. Studies to better understand these environmental hazards and solutions to minimize their impact are urgently needed. The economic impacts to our community from these industries must be balanced with their impact on the health of our citizens.
As a community we must muster the political will to say “enough is enough”. Our communities must be empowered to find solutions. We create through a shared vision solutions to these challenges. We can work with both our elected officials and the private sector to insure we have adequate number of health care providers, more Federally Qualified Health Plans, that our schools take action so they become part of the solution to create a healthier community, that we begin to believe that access to healthy food is a right, that parks and recreational activities means a stronger workforce, that public transportation means more opportunities to create a more educated labor force and enhances access to health services, and that our environment must not be a contributor to poor health no matter how much the economic benefit.
The Obama election may mean that perhaps the “stars” are aligning so that healthcare becomes a right and as a nation we may have finally place significant emphasis on health promotion and disease prevention activities that can improve our health and assure quality health care is available to all individuals living in our country. Maybe such an investment will mean that young people like Deamonte Driver won’t die from a tooth ache.
References
Portions of this article were inspired by a speech given by US Representative Elijah Cummings, (D-ND) Key Note Address on December 18, 2008 at the National Health Institutes, National Center for Minority Health Disparities conference on the Science of Eliminating Health Disparities. Representative Cummings gave a very moving speech about health disparities.
Regional health status data was taken from Paso Del Norte Health Foundation: Strategic Health Intelligence Planning Group Assessment of Determinants of Health in the PdNHF Region: A Review of Select Health Indicators for the counties of El Paso and Hudspeth in Texas; the counties of Doña Ana and Otero in New Mexico; and the city of Ciudad Juárez, Chihuahua, Mexico. Retrieved from Internet on December 19, 2008 from http://www.pdnhf.org/documents/659PdNHFRegionalHealthAssessment5-6-08Revised.pdf
And references from Unnatural causes taken from Unnatural Causes: Is inequality making us sick? Retrieved from Internet on December 19, 2008 from http://www.unnaturalcauses.org

This story first appeared in El Paso News Paper Tree on December 22, 2008.

Social Determinates of Health - More than health Care

Positioning El Paso as a major center for medical care is an admirable goal and yet is only part of the solution to create a healthy community. What has not received much attention from our policymakers and funders is a comprehensive plan to address the social limitations of health.

Many health problems can either be eliminated or their impact markedly diminished through addressing the root cause of many of these challenges.

The proportional importance of factors shaping health is determined 40 percent on behavior, 20 percent related to environment, 20 percent on genes, and 10 percent on health care.

Proximity to health care does not mean that our community will have improvement in their health status.

The strongest predictor of health is where we stand as individuals in our social structure. Those at the top have the most power and on average live longer and healthier. Those at the low end of the social pyramid are unhealthier and die younger.

According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50 percent higher chance of dying sooner then those on the top. Furthermore, those in the lower economic sector are 400 percent more likely to die sooner than the upper economic sector. This is true despite unhealthy behaviors such as smoking and obesity.

The choices that we make are based on what is available to us. For example, does our zoning regulations require parks, walking paths, playgrounds and grocery stores located within walking distance of residential areas. Or do we see more fast food outlets, liquor stores and lack access to affordable fresh foods? Public transportation that is inconsistent, has limited routes and runs at inconvenient times can mean many are unable to access healthier options.

Are our schools held accountable for educating graduates who can compete in our modern world? Are extracurricular activities, such as after school programs, music, art and gym, made available to all students? If we improve access to preschools, community college and universities, and create jobs that are “green friendly” we can enhance the health of our community.

As “Unnatural Causes” illustrates it is not the CEOs that are dying of stress-induced illnesses, it those with low paying jobs who have limited access for housing, food, health care, inadequate public transportation and unsafe living conditions who are suffering the most.

When we do not have money, a sense of control in our lives and an education to allow access to greater economic security then no health insurance, poor health and premature death are the norm. It is this kind of stress that kills!

Social policies such as minimum wages, improved working conditions, mandatory schooling, civil rights laws and improved housing have contributed to an increase in our life expectancy. But more must be done.

We are paying the price by our lack of commitment to address the social determinates of health. Many of us are obese, have cardiovascular diseases and diabetes. In many cases these conditions can be directly related to the limitation of our social status.

The cost of treating our health problems is the highest in the world and will continue to escalate if we do not address these other factors that contribute to disease.

We must also provide resources to tackle these issues. Continuing to educate more nurses, physicians and other members of the health care team—while urgently needed—must also be done in tandem with developing community-based solutions to address these social determinates. We need to invest now or our health disparities and inequities will continue to grow.

Martin Luther King once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This statement is still true 40 years after this death.