Measuring Mississippi’s Health-Care Progress

Too many times, Mississippi ends up on the bottom of nationwide health rankings. Our health care problems stem, in part, from poverty, lack of education, the state’s rural nature and even the foods we traditionally eat.

Recently, the Mississippi State Medical Association and the Mississippi State Department of Health collaborated on a list of health-care rankings. Their “Public Health in Mississippi Report Card” indicated how Mississippians have fared in health status.

Health-care providers and educators work every day to change Mississippi’s status. As the state’s only academic health sciences center, the University of Mississippi Medical Center engages directly with medical challenges and works with community, private, state and federal partners to improve the lives of Mississippians.

Here’s a summary look at the state’s largest health-related issues, what’sbeing done and what headway we’re making.

18th  in cancer mortality

A 2009 report from the Centers for Disease Control and Prevention listed Mississippi fourth cancer mortality.

According to Dr. Ralph Vance, professor of medicine and former president of the American Cancer Society, there will be 2,290 new cases of lung cancer in Mississippi in 2009, and 2,030 will die from lung cancer in the state.

Tobacco use is responsible for 30 percent of all cancer deaths and 90 percent of all lung-cancer deaths. It’s associated with a host of other cancers and illness.

“It’s almost easier to name the medical conditions not associated with tobacco use,” he said.

Vance leads state efforts to increase taxes on tobacco that could save $11.4 million in medical treatment for heart attack and stroke over five years and $7.7 million for costs associated with smoker-affected pregnancy and birth.

Dr. Karen Crews, professor of otolaryngology and communicative sciences, is the founder and director of the tobacco cessation program, the ACT Center. Now in its tenth year, the program has one of the best quit rates of any cessation program in the country.

All the services of the center are free, including any medications. Many states have modeled their cessation programs on the ACT Center.

–         J.Q.

49th in docs per capita

As one of the poorest and most rural states, Mississippi just doesn’t have enough doctors to go around and many residents can’t get access to health care.

“Mississippi is at the bottom of almost every list on physicians per capita,” said Dr. LouAnn Woodward, associate dean for academic affairs in the School of Medicine. “The AAMC (American Association of Medical Colleges) called for medical schools to expand their enrollments by 30 percent. But we must go beyond that to move up the list.”

UMMC School of Medicine class sizes stayed at 100 students a year since the mid 1980s. That jumped to 105 in 2005 and 110 the following year. Woodward said this fall’s goal is 120 students.

“These increases have happened without changes to the budget structure. This speaks to the excellence of our teaching faculty and their awareness of the urgent needs in Mississippi. The goal is 120-to-150 students by 2014,” she said.

Fortunately, Mississippi retains 60 to 65 percent of UMMC-produced physicians. Anywhere from 50 to 60 percent of UMMC School of Medicine graduates stay in Mississippi for their residencies and, of those who leave, about 60 percent return.

–         J.M.

Health disparities

To improve access to quality care for rural and minority populations, the Medical Center in 2006 founded the Mississippi Institute for Improvement of Geographic Minority and Health Disparities.

So far, it has partnered with 42 organizations across the state: other universities, health-related professional associations, the Mississippi Department of Health and community organizations.

It uses those relationships to fund, advise and support good-health missions, from data acquisition to technology changeover. It acts as a central clearinghouse for grants, providing partners with ways to leverage staff, finances and equipment.

“We also help people who have unique ideas but need enough money to do a proof of concept,” said Dr. Warren Jones, institute director and a distinguished professor of health policy. “Through the years, Mississippi has received millions and millions of dollars to help health disparities. But it’s been in fits and starts, hasn’t been focused.” 

A $5 million annual federal grant founded the institute. Though it’s still in its youth, Jones said he’s beginning to see dramatic impact.

A program with the University of Southern Mississippi engaged with African-American churches about mental-health issues. And the institute recently helped rural hospitals switch to electronic health records and demonstrated to institute partners ways to economize during a recession.

–         J.M.

No. 1   in infant mortality

Although Mississippi consistently has the highest infant mortality rates in the country, the state’s numbers are actually in line with national rates.

Across the United States, infant mortality rates for African-American births are twice as high as the rates for Caucasian births. However, the numbers skew higher for Mississippi, placing the state at the top of the list because approximately half of all births in the state are to African-American women.

According to Dr. Glen Graves, professor of pediatrics, the problem is intergenerational. Women in poor health with limited access to health care give birth to children who become unhealthy adults, and the cycle is repeated. He believes the problem cannot be managed by simply providing prenatal care to high-risk mothers.

In March, the Inter-Pregnancy Care Project began to address the problem. A collaboration between several Medical Center departments, the Mississippi State Department of Health and Dr. Alan Brann, professor of pediatrics at Emory University, the project’s preventive-care approach attempts to break the intergenerational cycle, resulting in healthier pregnancies.

‑ J.H.

No. 1 in adult obesity

That Mississippi is the heaviest state in the nation is no secret, but the state’s second-place ranking in the number of adults with diabetes may be less widely known.

While 32 percent of Mississippians are obese, about 238,658 adults in the state were diagnosed with diabetes in 2007, according to the Mississippi State Department of Health.

The way forward is to approach obesity as a public-health issue, says UMMC endocrinologist Dr. Gabriel Uwaifo, an associate professor of medicine.“About 75 percent of the burden of type 2 diabetes is driven by obesity,” he said. “The big problem to attack is obesity. If you tackle that, then you can tackle a significant portion of diabetes.”

Uwaifo said obesity “has to be acknowledged as a chronic medical condition like hypertension, diabetes or depression,” and it must he caught earlier. If at-risk patients can be spotted in the “pre-diabetic state,” he said, then they can cut their risk for developing type 2 diabetes.

Dr. Lani Greening, associate professor of psychiatry, is part of a collaboration working to prevent obesity and related illnesses among children. The partnership between UMMC and the Office of Healthy Schools at the state Department of Education worked with an elementary school and designed a year-long intervention program to foster healthy habits.

Dr. John Hall, director of the Department of Research, says plans are in the works for a Center of Excellence in Obesity and Metabolic Diseases Research. The center will take an interdisciplinary approach to studying obesity and diabetes to devise treatments and prevention.

–         M.W.

17th in stroke deaths

Start with the fact that Mississippi sits in the “Stroke Belt,” eight southeastern states with a 40-percent higher rate of stroke than the rest of the country. Researchers don’t know why.

Throw in Mississippi’s high obesity rate. Mix in rampant cardiovascular disease, hypertension and diabetes, and add Mississippi’s status as a rural state with a dearth of physicians. The result is a toxic stew that makes Mississippi 17th in the nation for cerebrovascular deaths, according to a Mississippi State Medical Association report.

Dr. Hartmut Uschmann, interim chair and assistant professor of neurology, said UMMC is addressing the problem by educating patients and primary-care providers about stroke risk factors and by sharing the Medical Center’s expertise.

The launch of a Telestroke System in the next several weeks will help. Through a Delta Health Alliance grant, the Medical Center will link, initially, with four Delta hospitals to consult with health-care providers who suspect a patient has had a stroke, using the Telemedicine network. Long-term plans are to expand TeleStroke to 12 hospitals.

Hospitals in the state are talking more about how to work together. An example is the Feb. 25 education program at the Norman C. Nelson Student Union sponsored by the American Heart Association and the American Stroke Association. Speakers from Gulfport have been invited to present information.

—      P.S.G.

No. 1 in teen births

The teen birth rate in Mississippi is the highest in the nation, according to a recently released report from the U.S. Centers for Disease Control and Prevention.

The report showed teen birth rates were highest in the South and Southwest, with the highest rate recorded in Mississippi (68.4 births per 1,000 women age 15-19), followed by New Mexico (64.1) and Texas (63.1).

Dr. Harriette L. Hampton, professor of obstetrics/gynecology and director of the Division of Women’s Health at the University of Mississippi Medical Center, says many of Mississippi’s teenagers fit the profile of adolescents at the greatest risk for engaging in early intercourse.  Among those risk factors are feeling unconnected at school, poor communication with parents and family, and living in a rural area with limited access to family planning services.

“Immediate efforts are needed in our state to provide sexuality and family-life education in an age-appropriate fashion,” Hampton said.

UMMC currently offers primary and preventive services to adolescents through a joint effort between the Department of Obstetrics and Gynecology and the Department of Pediatrics.  A contraception clinic focusing on newer, long-acting contraceptive methods such as intrauterine devices and subdermal implants is trying to alleviate a common compliance problem for teens using traditional oral contraceptives.

Teenage pregnancies carry extra risks for the child, including premature birth and low birth weight, both conditions at the root of another health issue Mississippi leads the nation in – infant mortality.

-          J.H.

1/3rd of adults have hypertension

For years, health-care professionals have warned that a high-fat, high-calorie diet, coupled with decreased daily physical activity, is the ideal recipe for obesity.

Unfortunately, what all too many Mississippians have come to realize is the wages of obesity are hypertension and cardiovascular disease.

And according to Dr. Jimmy Stewart, associate professor of medicine and pediatrics, there is no “quick fix” to the state’s hypertension problem.

“Because of the magnitude of the obesity problem and its interaction with social and behavioral issues, there are no simple solutions,” Stewart said. “The Medical Center has concentrated its efforts in several different areas, such as understanding how obesity contributes to hypertension and cardiovascular disease at the cellular and tissue level.

“Finding ways to increase access to medical care, patient and provider educational efforts and partnerships with national cardiovascular disease organizations such as the American Heart Association also are areas of ongoing research at UMMC.”

By partnering with national organizations like the AHA, state hospitals, physicians and other health care providers, the Medical Center has been able to find more effective ways to battle the state’s hypertension “epidemic,” said Stewart.

“We have been able to pool our resources to look for ways to apply what we already know about cardiovascular disease and hypertension to the patients that need it most, particularly in underserved areas,” he said. “We still have a lot to learn about how to prevent cardiovascular disease in the earliest stages of development.”

–         B.C.

2009-02-17 00:00:00 18846