Possible solutions: Improving health care

Hundreds showed up at the Marion County Technical Education Center for a job and health fair in Mullins last June. Marion County has among the highest unemployment rates in the state, which has the 11th highest rate in the nation.

Problem: Two out of every three adults in South Carolina are overweight or obese. And children are quickly catching up: About one-third of high school students are overweight or obese. Among blacks it’s two out of five.

Obesity, which affects about one-third of the adult population, has been declared the state’s No. 1 health issue. It prompts numerous other health issues, such as diabetes and cardiovascular disease. More than $1 billion a year is spent in the state due to problems caused by obesity, and the state projects that to rise to $5.3 billion a year by 2018.

Solution: Attack obesity in school with nutrition and physical-activity education and healthy school meals. Getting to the children through school offers the quickest avenue to stem the problem. It also provides the opportunity for children to take the lesson home and change unhealthy family lifestyles.

Return physical education and health as regular functions in schools. Make it easier for those on food-subsidy programs to purchase fresh produce at farmers markets. Mount a statewide wellness and anti-obesity publicity campaign to promote healthy lifestyles, such as the federal government’s anti-smoking campaign, or even Georgia’s controversial campaign to stop sugar-coating childhood obesity.

Direct more state money to anti-obesity efforts. Currently the state spends none of its money on the effort, relying instead on federal grants and nonprofits.

Problem: Depending on who is estimating, some 500,000 South Carolinians lack health insurance. This often causes them to delay treatment until a condition reaches a crisis and they go to an emergency room, where treatment is expensive.

Many avoid preventive care or early treatment until they can no long function effectively, creating a further drain on the economy.

Solution: Take the federal government up on its offer to extend Medicaid to the uninsured. At most, the extension would cost South Carolina $1 for every $9 the federal government puts up.

Extend state monetary assistance to the 20 regional, federally financed comprehensive health care clinics.

Tony Keck, the state’s Health and Human Services director, advocates instead that as a partial solution the state could train “community health workers” to provide walk-in service, perhaps in pharmacies, for most preventive and minor care not requiring a physician. They would work under the general supervision of physicians.

Some state Republican legislators are proposing a state alternative to the Affordable Care Act extension. They want to spend $62 million to basically expand aid to hospitals and federally financed health clinics to serve the uninsured.

Opponents say the Republican plan provides nowhere near enough money to provide proper care to the uninsured and leaves most of the uninsured without a consistent physician who knows their medical history.

Problem: Many poor South Carolinians lack access to a regular doctor, a so-called “medical home,” who is familiar with their background and manages preventive health care.

Solution: Again, one solution would be to take the federal government up on its offer to extend Medicaid to the uninsured. Previously uninsured South Carolinians could then get a medical home through physicians accepting Medicaid.

Problem: South Carolinians, and those in the I-95 Corridor and Mill Crescent in particular, continue to practice unhealthy lifestyle options, such as smoking, overeating, poor diet, driving without a seat belt and lack of exercise. The 2011 report “America’s Health Rankings” places the state near the bottom nationally at 39th in adult smoking, 47th in obesity, 45th in diabetes and 43rd in premature deaths.

Solution: Many health problems are caused by unhealthy lifestyles, and those in poverty or on the edge have a greater tendency toward bad diets and habits. If the state accepted the federal government’s offer to extend Medicaid to the uninsured, thousands of people would have access to a regular doctor, and the likelihood of preventive care that might stem their unhealthy lifestyle choices.

Also, state health officials should begin a major statewide healthy lifestyles promotion with a focus on schools.

Problem: Many rural counties lack sufficient numbers of physicians, especially specialty physicians.

Solution: Expand a state grant program for new health professionals to spend three years in an under-served area. Provide tax credits to doctors in rural areas. Expand a pilot program at MUSC to connect rural health care providers with specialists at MUSC by teleconference. Initiate a state program to provide loans for medical school that will be forgiven if the physician works a certain number of years in an under-served area.

Problem: Health officials often view infant mortality rates as an indicator of overall health in a community. South Carolina has made considerable progress at reducing a stubbornly high infant mortality rate, achieving one of the nation’s biggest reductions since 1990.

However, the state still trails most other states in infant mortality and received a rank of 46th in the 2011 report “America’s Health Rankings.” Among blacks, the state’s infant mortality rate remains markedly higher at 10.9 per 1,000 live births, double that of whites. It is even higher in many rural areas of the state.

Solution: Focus more of the state’s efforts to stem unhealthy prenatal behavior onto pregnant minority women. Encourage them to avoid smoking, secondhand smoke, alcohol consumption and improper diets. Promote prenatal care, infant care and breast-feeding. “America’s Health Rankings” ranks the state 42nd in early prenatal care.