June 18, 2017

Check-up reveals major problems: The health of West Virginia truly in crisis | Exponent Telegram

It might be easy to lose sight of this amid a state with a plethora of other problems, but West Virginia has a crisis in health.

Gov. Jim Justice ran his campaign last year by rallying West Virginians around a common disillusionment with a penchant for finishing last in measures of national success.

And though West Virginia isn’t in last place, many would likely find it disconcerting to know the state ranks 48th in mortality rate, according to a study by the Institute for Health Metrics and Evaluation (IHME).

Disturbing data

Various researchers with IHME, an independent population health research organization based out of the University of Washington, used death registration data in order to compile mortality rates for every county in America since 1980. The picture it paints of West Virginia is not a pretty one.

In 2014, the state had a mortality rate of nearly 997 deaths per 100,000 people (the flat rate used nationwide by the study), or roughly 1 percent of the population. For comparison, neighboring Ohio has a rate of about 868, and Virginia 783.

The problem is largely regional even within the state, though. Southern West Virginia and Eastern Kentucky share some of the highest rates in America. In fact, there doesn’t appear to be a similar conglomeration on the map, and few counties surpass the rates of these.

Consultation with the U.S. Centers for Disease Control and Prevention (CDC) gives a similarly stark view of the problems.

According to Jeff Lancashire, a public affairs officer and the acting associate director for communications science with the CDC’s National Center for Health Statistics, the mortality rate in 2015 for West Virginia was 943.4 deaths per 100,000 — more than 200 higher than the national rate of 733.1.

The data is alarming, and according to Dr. Lindsay Allen, an incoming assistant professor of health economics at WVU’s School of Public Health, the IHME study cannot be explained away by pointing to a large elderly population in West Virginia.

“The study in question took age into account, so we can be reasonably sure that the mortality rates stated can be mostly explained by health status,” she said. “Health problems in the area can be passed down through generations in ways that aren’t necessarily biological. Parental characteristics such as education, income level and insurance status all impact the health of children.”

Challenges in economy

Conventional wisdom would state that most businesses require a healthy populace in order to function at optimal levels. A dearth of that resource is likely a significant contributing factor, then, to the state’s economic struggles.

“One thing for certain is businesses won’t locate here if they can’t find the workers they need, and that means drug-free, healthy and trained,” said Dr. John Deskins, director of the Bureau of Business and Economic Research at WVU. “It serves as a major barrier to growing the economy, and it puts a major strain on government.”

The impact of the health crisis shows in a survey of the state’s population trends. According to the 2017-2021 West Virginia Economic Outlook prepared by Deskins’ Bureau, 40 of the state’s 55 counties saw population decline between 2014 and 2015, even as the United States continues to show consistent and rapid growth. The research also showed that most of the population growth in the state as of late was centered on Berkeley, Monongalia and Jefferson counties.

And the research did show that the state had a median age 4 years older than that of the United States as a whole at the time of data collection, certainly a contributing factor in high mortality rates.

“Our state has been in a bad recession in recent years,” Deskins said. “We’ve lost over 23,000 jobs, and that ignites a vicious cycle, especially in Southern West Virginia.”

“And who is going to leave for new jobs?” Deskins asked rhetorically. “The people who have the best education, better health outcomes, who are younger.”

Conversely, U.S. Senator Joe Manchin, D-W.Va., said that fixing the economy is key to improving the health situation in West Virginia, noting the importance of keeping youth in the state.

“Not only do we need to help people fight addiction so they can rebuild their lives and help rebuild our communities, but we need to bring meaningful job opportunities back to our state,” he said. “For decades, our state has faced a decreasing aging population, and we must find ways to keep West Virginians here and to attract young people to our state to raise families and grow communities.”

As a frequent speaker across the state, Deskins said he rarely addresses the state’s economy without discussing the need for human capital. Perhaps the most alarming representation of that deficit comes from the labor force participation rate for the state, or the share of the population seeking work or currently working.

“Nationally it’s 63 percent, and in West Virginia we’re dead last, and have been every year for 40 years,” he said. “We have 53 percent. And a lot of that deficit is caused by poor health outcomes and drug abuse, though there are other reasons.

“Why is West Virginia the second poorest state in the country? It goes hand-in-hand with the fact that we have the smallest share of our population in the labor force.”

A conglomeration of issues

There isn’t simply one ailment causing the health issues faced in West Virginia, Lancashire said, but there are a few key contributors.

“A few specific causes of death are certainly contributing to high mortality rates in West Virginia,” Lancashire said. “For example, cancer is the leading cause of death in West Virginia. In 2015, the mortality rate from cancer in West Virginia was 190.4 deaths per 100,000, significantly higher than the national cancer mortality rate of 158.5.”

Regarding cancer, Lancashire noted that lung cancer, in particular, is a problem in West Virginia, especially in the southern portion of the state, well-known for its mining tradition. That might be a significant factor, Allen said.

“In the study by Dwyer-Lindgren et al. (the iHME study), the authors found that more people died from chronic respiratory disease in southwestern West Virginia than almost anywhere else in the country,” she said. “This is likely due to higher exposure to coal dust in these areas, where there is a lot of coal production. Previous studies have found a direct link between coal dust exposure and chronic respiratory diseases.”

And cancer isn’t the only problem Lancashire listed.

“Also, drug overdose deaths have become a major problem nationally over the last several years, but particularly in certain states, including West Virginia,” he said. “In 2015, the mortality rate from drug overdoses in West Virginia was 41.5 deaths per 100,000, significantly higher than the national drug overdose mortality rate of 16.3.”

Manchin drew attention to the fact that, as would be expected, West Virginia is also “the most addicted state.”

“In order to begin combating this problem we need to dramatically increase funding for substance abuse treatment,” he said. “That is why I introduced my LifeBOAT bill to require pharma companies to pay a 1 cent fee per milligram to fund substance abuse treatment.”

On top of that bill, which congressional records show was last referred to the Senate Committee on Finance and which was co-sponsored by 10 Democrats and one independent, Manchin said a plethora of other action needs to occur. That includes improvement of drug abuse education, improvement of state prescribing practices and the protection of Medicaid funding in the state.

“Of the 175,000 West Virginians who have gained health insurance coverage through the Medicaid expansion, 50,000 of them were diagnosed with a substance abuse treatment disorder in 2016,” Manchin said. “The state received $112 million in federal funding through the Medicaid expansion to provide services and treatment to those individuals. We desperately need to maintain funding for treatment, not cut it.”

For his part, Deskins said he thinks more effort needs to be channeled in-state towards finding innovative solutions to the drug abuse problem.

“If I were the (West Virginia) Legislature, I would be parading in front of me every expert I could get on overcoming drug abuse,” he said. “I don’t know if they are doing that or not, and I don’t hear a whole lot personally about them doing much to find new ways to combat the drug abuse problem.”

The office of U.S. Sen. Shelley Moore Capito, R-W.Va., pointed to her work chairing the subcommittee that oversees funding for programs such as the Office of National Drug Control Policy (ONDCP), which was among those programs they say she helped save from cuts by the administration of President Donald Trump.

“Keeping our communities healthy and safe in West Virginia has always been a top priority of mine,” Capito said. “But there is no single solution. Instead, this requires a collaborative effort from state and federal officials, residents and professionals. As a member of the Appropriations Committee, I have worked hard to make sure our medical professionals are equipped with the support needed to do their job, while also making sure our anti-drug programs have resources to not only help with recovery efforts, but also to keep these harmful substances out of the wrong hands.

“Healthy communities make strong communities, and I will continue working together to develop solutions to problems that threaten our state’s well-being.”

The uncertain future of health care in America

More than half a decade has passed since the Affordable Care Act passed under the pen of President Obama in 2010. The act appears to have gained popularity as of late, with a majority of Americans approving of the ACA in most polls taken in 2017.

Despite the newfound popularity, however, repeal of the act was one major promise made by Trump on the campaign trail. And though the Republican-sponsored American Health Care Act (AHCA) replacement failed in its first attempt to pass in the House of Representatives, another iteration of the bill is currently awaiting consideration in the same body.

Allen concurred with Manchin in noting the impact of ACA on Medicaid expansion, calling a future in which the ACA is repealed “unclear” for those who received coverage from the expansion.

Other issues, such as a decrease in government subsidies for care and the likelihood that healthier individuals might not buy care without an individual mandate (contained in the ACA but not the AHCA) could serve to drive up premiums and impact affordability for the less affluent, Allen said.

“Rural counties, such as those noted in the (IMHA) study, tend to have lower median incomes, and a primary aim of the ACA was making health insurance coverage possible for those who previously could not afford it,” she said. “Replacing the ACA with the AHCA will make health insurance much more expensive for low-income populations.”

Manchin said he stands opposed to the AHCA in its current form, commenting that “we cannot repeal the Affordable Care Act unless we have human legislation to replace it with.”

“West Virginians would suffer if the House repeal plan was passed today,” he said. “In fact, one estimate shows that the House Republican bill would kick more than 120,000 West Virginians off of their health insurance. It would also reduce federal funding through Medicaid for seniors who need nursing home care, students who get health services through their schools, and — as I mentioned before — significantly reduce funding for substance abuse treatment.”

Manchin also said that those he has spoken with in rural hospitals fear they might be forced to close their doors if large numbers of their patients lose insurance as some predict.

To move forward, he suggested continued support for community health centers, among other initiatives.

“I have also pushed for funding for programs that encourage healthcare providers to work in medically underserved communities,” he said. “And I will continue to work to improve healthcare literacy and education to give West Virginians the knowledge and tools that they need to make healthy decisions.”