Secession Fever

There’s a new disease this year along with the winter flu.  It is called Secession Fever. 

Secession Fever has reached epidemic stage across the south.  As of Monday, there were more than 25,000 cases in each of eight southern states – North Carolina, South Carolina, Georgia, Florida, Alabama, Tennessee, Louisiana, and Texas.  A ninth, Arkansas, had over 23,500.  Collectively, these states had almost 402,000 cases, and the number was still growing.

Secession Fever is a self-reportable disease.  People who have it signed a petition on the White House website.  Secession Fever is characterized by the irrational belief that the federal government does more harm than good, and that states would be better off if they seceded from the Union.

So what if these nine states did secede and form a new Southern Confederacy?  Would their citizens be better off?  Some data from the Kaiser Family Foundation and the Central Intelligence Agency suggest not.

In forming the Southern Confederacy, approximately 86 million people would find themselves living in the 14^th most populous country in the world, just behind Vietnam.  (The rest of the United States would drop from 3^rd to 4^th in population, trading places with Indonesia.)

They would find themselves worse off than they think they are.

The percentage of people living in poverty in the Southern Confederacy would be 17 percent, comparable to that in Trinidad and Tobago, Jamaica, and Turkey.  Meanwhile, the percentage living in poverty in the remaining United States would drop to 14 percent, comparable to the rate in the United Kingdom.

Life expectancy in the Southern Confederacy would also take a hit.  It would decline immediately to 77.7 years, 61^st in the world and comparable to life expectancy in Libya.  In the remaining United States, it would be almost 79 years.

That’s not all.  The health status of Southern Confederacy citizens would decline, too.

One in five residents in the Southern Confederacy would be uninsured, versus only 14 percent in the remaining United States. 

Even that high percentage would grow dramatically without the federal Medicaid and Medicare programs.  Without the federal share of Medicaid dollars, the percentage of uninsured in the Southern Confederacy would grow by at least 9 percent more, to close to 30 percent.  And without Medicare providing insurance for 16 percent of its population, the Southern Confederacy’s uninsured rate would approach 50 percent, killing off nearly every hospital and long term care provider.

Infant mortality would go up, too. 

For every one million births, 1100 more babies would die in the Southern Confederacy than in the remaining United States.  The infant mortality rate in the Southern Confederacy would be 7.5 per thousand – comparable to that found in Chile.

Disease prevention would also take a hit. 

The percentage of overweight adults in the Southern Confederacy would be over 65 percent, pushing ever higher the prevalence of diseases like diabetes, hyperlipidemia, and hypertension.

Public health would suffer, too.  The AIDS rate would grow, and the proportion of people infected with HIV in the Southern Confederacy would be similar to that found in Somalia.

Mental health services would not be spared, either. 

Nationally, we currently spend around $120 per capita on mental health services.  But in the Southern Confederacy, state mental health spending would be half that – just $61 per year.

It isn’t that people in the Southern Confederacy have better mental health status and need fewer services.  Just over one-third report being in poor mental health, just as in the rest of the country.  They’re just more likely to be ignored, neglected, or maltreated.

If there were ever a compelling argument for why we need a strong federal government, life in the Southern Confederacy is it.

Aspiring to the health standards of Somalia, Chile, Libya, Trinidad and Tobago, Jamaica, and Turkey – all nations with much to offer, to be sure – is hardly the stuff of “American Exceptionalism.”  But these nations turn out to be the real role models for those with Secession Fever.

These harsh health conditions reflect the realities of life in these southern states today.  We can argue that we can do better than this, but not if we can’t accept this reality – people are worse off in these states than in the rest of the United States.

Those with Secession Fever – and the political leaders who have fanned the flames of anti-federal sentiment for years – must be living in an alternate universe.

If you would like to schedule Paul Gionfriddo to speak to your group or organization, please email gionfriddopaul@gmail.com.

To Be Healthy, Live Among the Wealthy?

If you want to be healthy, then be wealthy. Or at least live in a wealthy county.

That’s the obvious message you get from combining the recently released County Health Rankingswith poverty and income data from the 2010 U.S. Census.

Source: US Census and County Health Rankings, 2012

But if you look closer, you see something else.  It’s not just that poorer people are less healthy than their wealthier counterparts. 

People are less healthy where too few resources are invested in public health.

Earlier this month, the 2012 County Health Rankings were released by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.  In the release, Dr. Risa Lavizzo-Mourey, President and CEO of RWJF, said that “where we live, work, learn, and play has a big role in determining how healthy we are and how long we live.”

She’s right.

The poorest counties – as measured by the percentage of people living below the poverty level – are usually home to the least healthy people.  And the wealthiest counties – as measured by income – are home to the healthiest.

That much isn’t news.  We’ve known for a long time about the relationship of poverty to poor health. 

But we usually think about that relationship in terms of individuals – the poorer the individual, the worse his or her health status is likely to be.

The county-level data suggest that we look at the relationship in another way – as a community problem.

Then we discover something more.

The poorest counties often have both the least healthy residents and some of the poorest public health infrastructures in their state. 

Consider these examples from three different states.

• The three poorest counties in America – Ziebach (the only county in America where over 50% of the population lives in poverty), Todd, and Shannon – are in South Dakota.  Of the 59 South Dakota counties in the County Health Rankings, they are at the bottom, placing 53^rd, 58^th, and 59^th, respectively.
• Owsley County, Kentucky, is also one of the nation’s poorest counties.  It is the poorest county in Kentucky, and it ranks last in the state’s county Health rankings.
• South Carolina’s Allandale County is one of the poorest counties in America.  It, too, ranks last in its state county health rankings. 

What do they share besides poverty and poor health?

The North Dakota communities are worst off.  They have very limited governmental infrastructure and services.  All are Native American reservations.  Two don’t even have a County Seat. 

Owsley County shares its health department with six other rural southeastern Kentucky counties.  The regional health department covers a geographical area larger than some states, and its central office is located over an hour away from Booneville, the Owsley County Seat.

Allandale County also lacks its own dedicated public health infrastructure, sharing public health services with several other South Carolina counties.

Is it poverty or poor public health infrastructure that matters most? 

That’s hard to say, but poorer public health infrastructures are common in relatively poorer counties in wealthier states – even when those counties are well-off compared to the nation as a whole.

• Windham County, though relatively wealthy by national standards, is Connecticut’s poorest county.  It also ranks 7^th of Connecticut’s eight counties in health. 
• And Washington County, Maine, is Maine’s poorest and least-healthy county. 

What about their public health infrastructures?  Unlike many Connecticut cities, none of Windham County’s fifteen towns has its own public health department.  Public health services are delivered through three regional health districts shared by several communities. And in all of Washington County, there are just two district offices of the Maine Health and Human Services Department.

So it appears that poor health may go hand in hand with poverty because economically disadvantaged communities often don’t take care of their public health infrastructure – not just because poorer individuals often don’t take care of their health.

Florida is home to one of the exceptions that may prove the rule.  DeSoto County is Florida’s poorest county.  But DeSoto ranks in the top half – 28^th – of Florida’s 67 counties in health.

Why?  It may be because of DeSoto County’s strong public health infrastructure.  Its residents have better-than-average access to diabetes screening and better-than-average low birth weight numbers.  Behind these achievements are a diabetes screening program housed in a county-run primary care clinic and a county-run women’s health clinic.

Living well isn’t always about how much wealth an individual has to spend for a healthy life.  It’s often about how much a community is willing and able to spend for healthy lives.