Attention leaders: Make a plan!
At a tense moment late in the University of Tennessee at Chattanooga’s recent basketball game against Radford University, my 9-year-old granddaughter, Naomi, stood and let fly her first cheer of the contest: “Make a plan! Make a plan!”
Perhaps the players heard her because they achieved a two-point win.
As I review grim statistics in public health for Tennessee and surrounding states, Naomi’s words seem applicable in a new vein.
In almost every category of chronic illness, states of the Deep South rank near the bottom with high incidences of obesity, diabetes mellitus, cigarette smoking, heart disease and addiction to opiates. Rankings of all 50 states can be accessed at www. americashealthrankings.org. These rankings place Tennessee 43rd, Georgia 40th, Alabama 46th and Mississippi 49th in terms of overall health. The same states with high incidences of chronic disease also are among the most impoverished. In Tennessee, 18.3 percent of residents live in poverty. Almost 8 percent live in deep poverty, which for a family of four means an annual household income of less than $12,000. Twenty-six percent of Tennessee children live in poverty.
These are the forgotten people in our society. They can be found in cities, small towns and rural areas. They seldom make headlines. Political campaigns generally ignore them. End-of-year charitable drives may briefly
bring their plight to our attention.
What might happen if our elected officials — governors, legislators, city and county mayors — convened to formulate and enact a unified plan to address poverty and poor health among all our people? Leaders of a state’s philanthropies, social service organizations and health-related professions would be valuable participants in these discussions. A plan might resemble the following:
Poverty census: A county- by- county survey would identify each impoverished household, even those in remote locations. Elected officials who accompanied census-takers would meet some of their constituents for the first time.
Information: Each household identified as impoverished would be visited by a health or social worker to review all programs of public assistance for which they might be eligible. Immediate problems related to health would be identified and transportation provided to facilities to address these.
Assessment: A publicly sponsored health fair in each county would measure weight, blood pressure, blood glucose, adequacy of immunizations, as well as assessing nutritional status of residents. Information related to healthy lifestyles would be provided. Mobile units would bring these services to homebound individuals. Fairs would be staged annually.
Follow- up: This is the most challenging aspect of the plan because it is the most costly. But to reduce expenditures, new models for delivery of health care could be developed along the lines of military dispensaries. Either fixed or mobile health clinics would be accessible to people living in poverty to address problems identified in screening.
Schools would be a logical site for some clinics; National Guard Armories might be used for others. Primary- care providers could employ telemedicine for consultations.
Some illnesses, such as diabetes, would involve lengthy, even lifelong, management. Therapy for some diseases, such as malignancies, would be expensive. Prevention of illness and earlier identification of treatable disease would mitigate costs. The fundamental question for each policy-maker would be the worth of an individual life.
Long- term goal: Improved health, linked to job-training, would lift many families from chronic poverty.
There are obviously other scenarios to address the linked issues of poverty and chronic illness. Each will require the commitment of capital, energy and fresh thinking. I return to Naomi’s appeal: Let’s make a plan!
Contact Clif Cleaveland at ccleaveland@ timesfreepress.com.