Report shows lack of access to care, obesity top local health issues

By Michelle Dupler, Tri-City HeraldJanuary 15, 2013 

An assessment of Tri-City community health needs has zeroed in on obesity and a lack of access to health services as top local issues.

And a report released Monday listed access to prenatal care during a pregnant woman's first trimester as an area where Benton and Franklin counties lag behind the state -- at a time when the Benton Franklin Health District has cut programs to improve access to care for pregnant women.

Data collected for the report show only about 68 percent of Benton and Franklin county women receive prenatal care in their first trimesters compared with about 81 percent statewide.

The Benton Franklin Health Board's $8.9 million budget for 2013 calls for laying off a health services worker providing Medicaid outreach and a behavioral health worker in the First Steps program. Both programs were eliminated.

The Medicaid outreach person helped 1,200 people access payments for medical care each year, primarily through Medicaid or the state's Basic Health Plan.

The First Steps program offers education and referrals for assorted services, including in-home visits, to about 1,000 pregnant women in Benton and Franklin counties.

The district was able to replace some of those services with the Nurse Family Partnership program, paid for by an almost $700,000 grant, but that program will serve only 100 families in Franklin County, at least to start.

Jason Zaccaria, the health district's administrator, said making the decision to cut those programs was tough but necessary, given the district's shrinking pot of money.

The Medicaid outreach and First Steps programs were funded out of the district's general budget with no specific grant funding or other revenue sources attached.

Without the Nurse Family Partnership grant, the district would have been looking at further cuts, board members said when the budget was adopted.

"It is a balancing act in terms of money and resources and benefits to the community," Zaccaria said.

He added that he's hopeful the health needs assessment and resulting plan that will be drafted in coming months to tackle the most pressing needs will result in community partnerships that will fill some of the gaps left by budget cuts in the health district.

"Whatever we can bring to the table -- I think all of us around that table are very committed to making sure (the plan) goes forward," Zaccaria said. "We're very excited about it. This is really where things can happen."

The health needs assessment report contained highlights from the 18-month assessment process, including the issues residents rated the most important in a community survey over the summer.

About 1,800 people responded to the survey, and rated affordability of health care as their issue of top concern.

Being uninsured or underinsured was the second biggest concern, followed by patients using emergency rooms for routine health care, obesity and mental illness or substance abuse.

Top concerns were a little different for the 71 Spanish-speakers who responded. While they also ranked affordability as their biggest concern, that was followed by diabetes, dental health, being uninsured or underinsured and sexual health.

The 45 medical providers who answers also rated affordability as the No. 1 concern, followed by mental illness, coordination of care among providers, obesity and patients being uninsured or underinsured.

When it comes to health statistics, obesity is a significant concern for the group performing the assessment. The Tri-Cities has the ninth highest obesity rate among metropolitan areas in the country, according to a recent Gallup poll, with 31 percent of the population considered obese.

Obesity is defined by the federal Centers for Disease Control and Prevention as a body mass index of 30 or more. Body mass index is calculated from a person's height and weight.

A person who is 5-foot-9 and 203 pounds would have a BMI of 30 and be considered obese, according to a CDC example.

"This is a cause for concern due to the correlation between obesity and chronic disease, quality of life and lifelong wellness," a news release said.

People who are overweight or obese tend to be at higher risk for chronic conditions such as high blood pressure, diabetes, and high cholesterol, the CDC said.

Lack of access to health care encompasses a number of factors, including a shortage of primary care doctors, said Carol Moser, executive director of the Benton Franklin Community Health Alliance.

"We have to somehow overcome that shortage," Moser said. "When we live in a community with a lack of primary care providers, how do you expand access?"

The lack of primary care doctors may be a contributing factor in use of emergency rooms by local residents for health needs that aren't deemed true emergencies.

As part of the health needs assessment, officials discovered that more than 3,000 people walked into Tri-City emergency rooms in 2011 seeking attention not for heart attacks or broken bones, but for cough and cold symptoms -- symptoms that are better fit for a family doctor or an urgent care center than an emergency room.

In response, a coalition of local hospitals, clinics, doctors, health insurance providers, fire departments, educators and the United Way was formed to figure out how to direct patients not experiencing emergencies to more appropriate venues for treatment.

Officials said the next step in the health needs assessment process is to develop a plan to improve community health and bring statistics in Benton and Franklin counties in line with the state and nation.

Moser estimated that will take about four or five months.

-- Michelle Dupler: 582-1543; mdupler@tricityherald.com

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