Report: Oregon health gains undermined by social issues

Oregon has made gains on important measures to improve health in the state, including reducing rates of opioid-related deaths and HIV infections, a new report released Tuesday finds. But social factors such as housing affordability, food insecurity and educational outcomes are undermining improvements in health outcomes.

The State Health Assessment, published every five years, says Oregon has made strides by pursuing state health improvement efforts aimed at priority health problems, as well as by expanding Medicaid and launching coordinated care organizations. Yet it says Oregon “lags far behind many other states in measures of the social determinants of health, which are social factors that influence health.”

The State Health Assessment is the first step toward updating Oregon’s State Health Improvement Plan, which guides state and local public health interventions.

Katrina Hedberg, MD, state health officer and epidemiologist at OHA’s Public Health Division, says Oregon has made strides in addressing its opioid crisis and tamping down HIV infections, teen pregnancies, and smoking rates among adults and teens.

But those advances are being stymied by low standings in education, housing affordability and food insecurity that contributed to a decline in the state’s relative rank in national scorecards of health measures, she says.

“What we know is that a person’s health is inextricably tied to educational outcomes, employment and wages, and access to affordable housing,” Hedberg says. “These are all areas where we found Oregon falls short.”

Since Oregon published its last State Health Assessment in 2012, Oregon has made progress on key measures, including:

Reductions in opioid-related deaths–from about nine deaths per 100,000 population in 2011 to six deaths per 100,000 in 2016. Reduction in rates of HIV infection–from about eight diagnoses per 100,000 in 2006 to five per 100,000 in 2016. Lower rates of teen pregnancies–from 32 pregnancies per 1,000 females ages 15 to 17 in 2001 to 10 per 1,000 in 2016. Lower smoking rates among adults and youths–from 20.7 percent in 2010 to 17.1 percent in 2016 among adults, and from 12.3 percent in 2011 to 3 percent in 2017 among eighth-graders.

In addition, Oregon reduced the uninsured rate and launched Medicaid reforms that enrolled nearly 900,000 Oregon Health Plan members in coordinated care organizations (CCOs), which are rewarded for providing better quality care and lowering Medicaid costs.

However, some measures of health in Oregon have worsened, including rates of obesity, diabetes and suicide. In addition, Oregon’s low standing in education, housing affordability and food insecurity have contributed to a decline in the state’s relative standing in national scorecards of health measures. According to the United Health Foundation’s Annual Health Rankings, Oregon was the 20th-healthiest state in the country in 2017 (Massachusetts is first and Mississippi is 50th). This is down from 13th in 2012 and eighth in 2011.

The assessment provides a comprehensive, data-driven description of the health of people in Oregon. The assessment is a tool for anyone interested in improving population health in the state, including governmental and community public health agencies, CCOs, hospitals, health systems, private insurers, businesses, and social service agencies.

The SHA describes health within five categories: social determinants of health, environmental health, prevention and health promotion, access to clinical preventive services and communicable diseases. It also highlights health disparities–differences in health among people in Oregon–for people of color, people with disabilities, people with low income, people who identify as LGBT, and people living in rural and frontier areas of the state.

The State Health Assessment can be viewed on the OHA website at http://www.healthoregon.org/sha.

Paul Virtue serves on the community advisory council of the Intercommunity Health Network, a CCO serving Benton, Lincoln and Linn counties. Virtue co-chaired the State Health Assessment Steering Committee that helped develop the report, and said he appreciates that the 2018 report highlights the effects of social issues on health.

“The 2018 SHA is very focused on social determinants of health,” he said. “I was so excited to see these areas moved from secondary focus to becoming the foundation of how we assess our state health. Instead of focusing just on crises like outbreaks or cost of health care delivery, we are moving the emphasis upstream to create healthier residents and environment in Oregon.”

The SHA will inform the development of the 2020-2024 State Health Improvement Plan. To determine the priorities that will be addressed in the next plan, OHA will make mini-grants available to eligible agencies so they can solicit feedback from communities most affected by health disparities. More information about the State Health Improvement Plan is available at https://www.oregon.gov/oha/PH/ABOUT/Pages/HealthImprovement.aspx; more on the mini-grant process is available at http://www.healthoregon.org/2020ship.