Photo by Mannal Mekdad.
Is Birmingham healthy? Sure, there are plenty of hospitals in Birmingham, but does that equate to having a healthy community?
According to an annual report released in 2014 by the Robert Wood Johnson Foundation, Jefferson County ranked 26th out of the 67 counties in Alabama in terms of public health.
On Wednesday, the new report will be released and county officials are hopeful that Birmingham has made enough strides in the last year to move up in the rankings. After all, Birmingham is home to several world-class hospitals and healthcare systems.
Weld sat down with Dr. Mark Wilson, the healthcare officer for Jefferson County and the CEO of the Jefferson County Department of Health to discuss some of the healthcare challenges in Birmingham and what is being done to help the large percentage of people in Jefferson County who are uninsured.
Weld: In terms of healthcare, what are some of the biggest challenges that Birmingham faces?
Mark Wilson: I’d like to make a distinction about healthcare and public health. We here at the Jefferson County Health Department focus on the big picture and the health of the population. The challenges that we face, and have been facing for a long time, are issues stemming from tobacco-related illness and obesity and all the illnesses related to that. From a public health standpoint, those are the top two issues.
You can then talk about a whole string of different illnesses that come out of those two and that starts to get into the list of the top causes of mortality and reasons why people get put in the hospital, things like heart disease, cancer, stroke and diabetes.
There’s a whole list of things, but the things we are focusing on in public health is underlying things that lead to these problems. We’re trying to address how do we help the community as a whole be healthier to prevent some of these things.
Weld: The new county health report is going to be released on Wednesday. Could you explain what that is and where Jefferson County stands?
MW: The county health rankings are going to be released by the Robert Wood Johnson Foundation, which comes out annually. Amazingly, they gather information from every county in the United States.
They give a report, which you can look up on the Internet, which is a combination of data that is already available. For instance last year Jefferson County ranked 26th out of 67 states in Alabama. I don’t know how it will be this year. What’s nice about the study is it talks about more than just healthcare. It factors that in, but it weights it against things that determine health in a county. It’s a great model and helps educate us and focus our thinking on what are the things that matter. It includes things like a county’s unemployment rate, high school graduation rates, housing problems, air pollution and the amount of children living in poverty. That’s in addition to things like obesity rates, teen births and things like that.
We hope to be able to change and improve some of these things. But a lot of these issues are rather challenging to address. A take home message is that none of these things can be changed by just one sector of the community. For instance, hospitals are important but in the grand scheme of public health… in terms of what determines the health of a community, hospitals impact is rather small. Things like the environment, however, and our behaviors, that’s what’s really important.
Our behaviors are more than just me telling you to eat right, exercise and don’t smoke. It’s our whole community and how it’s built. It’s the policies we have in place. But that requires more than just the [JCHD] but everyone; city government, nonprofits and other organizations.
Weld: Jefferson County is the only county in Alabama that supports its own healthcare system. Why is that?
MW: Every county in the state by statute has some responsibility for its citizens. But Jefferson County is unique in that it has its own indigent funds set aside using sales tax money. It is earmarked specifically for that. That doesn’t mean that other counties don’t in someway support healthcare but we are unique in that way.
Weld: What is the status of Cooper Green? Is it still in danger of closing completely?
MW: I can say that things have kind of stabilized there and I feel encouraged by some of the steps they are taking. The leadership at the county level and the leadership at Cooper Green does seem to be interested in moving it forward and making it a good outpatient system.
Weld: How important is having a place like Cooper Green to provide healthcare to the uninsured, indigent population in Birmingham?
MW: I think it’s very important. There are a couple of things worth noting. I think the latest statistics are that about 15 percent of our population is still uninsured. And we will see what those new statistics are on Wednesday when the new report comes out. Part of it has to do with whether or not the state decides to expand Medicaid. We still have a large adult population that is uninsured in spite of the health insurance exchange which is if you live below poverty level, and you don’t have Medicaid, you don’t qualify for anything under the current system. And that is a big part of the population.
The other thing is that even if Medicaid is expanded at some point in Alabama, it’s important to have a dedicated system in place that is geared towards low-income families because there are special challenges that come along when dealing with healthcare for these people. The more that we can get towards a system where it doesn’t matter how much money you make or where you get your healthcare. Everyone will be welcomed. But right now that’s just not the way it is.
If we expanded Medicaid tomorrow we would still need a workforce in place and people focused on helping this part of the population.
Weld: What are some of the complications that have arisen from Governor Bentley deciding not to expand Medicaid?
MW: Regardless of how it’s done, to have some kind of universal healthcare coverage would no doubt be beneficial. I was a proponent of the single-payer system of health care several years ago before Obamacare. I think Obamacare was kind of a grand compromise in order to get something passed.
I think a lot of it is if you don’t have access to primary and preventative care, bad things happen. You end up going to an emergency room for your default for healthcare, and that is not a good place to be. It is if there is an emergency, but not for getting preventative care, like vaccinations or [getting] your cholesterol checked or … a mammogram.
So a lot of very basic care that could make the simple, basic things that don’t cost much but have a huge impact, simply aren’t done without this type of universal coverage, even if you do have access to an emergency room. So that ends up costing all of us a lot of money as a community and what ultimately becomes high-cost acute care. Also what happens, you have a substantial number of people who ultimately become disabled and unable to work or become bankrupt because of hospital bills they can’t pay and that just has a real negative effect on local economy and the health of the society. A very large percentage of personal bankruptcy is related to healthcare cost.
Weld: Birmingham is essentially a giant hospital complex. Since it’s so big, is there a way that the community could have better access to some of the healthcare opportunities?
MW: There are a couple of paradoxes here. The argument for Cooper Green closing in the first place was just that, there are plenty of other hospitals in the community and some of them have empty beds. That’s not always true. There are often times when there are no intensive care beds. UAB is often full, but they are serving a large population. That was the argument for shutting down the inpatient services at Cooper Green. And I think it was a reasoned argument.
But the bigger challenge is the primary care/preventive care and all of the health care systems that we have here — UAB, St. Vincent, Brookwood and the Health Department — all of us are struggling to supply an adequate number of primary care providers. That’s where the challenge lies. It’s not so much about the big, tall hospital buildings and having access to high tech care. Birmingham is very well situated in that regards. It proves that you can have some of the best hospitals in the world and still have poor health outcomes. Part of it is preventative and primary care and the rest of it is public health. If you still have a large part of the population that is obese and smoking cigarettes, not eating right, not getting vaccinated, then you’re not going to move the needle very far.
Weld: Do you think being an example of how a healthcare system should operate will be Birmingham’s new legacy?
MW: I think so. Part of it is because we are well situated with hospitals here. And UAB is a huge driver in research and innovation that’s going to be part of the legacy. We’re starting to see spin-offs from that with new businesses being started around that. This is a national trend because of health care reform. There is a need to innovate in the area of population health. The hospitals and clinics, like ourselves, are driven to keep the population healthy and keep them out of the hospitals. We have an opportunity to do that better. I think we are starting to see a refocus of our energies to keep people healthy in a cost effective way. And then paying more hospitals and clinics based on how well they do that rather than just doing more procedures and putting more people in the hospital. And that is slowly changing. Frankly we are in a transition right now. It’s a great time of opportunity.
From my perspective, for Birmingham and Jefferson County, one of the good things that’s happening around that is that we are talking to one another, we are partnering together. Birmingham should be proud of that given our history.
