Author: Mat Reidhead, Vice President of Research and Analytics
Public health is a discipline aimed at improving the health of populations and communities where people “live, learn, work and play.” The population health paradigm and upstreamist movement in health care is weaving hospitals into the fabric of the communities they serve for the delivery of primary through quaternary care and public health. The community health needs assessments required of all 501c3 hospitals originate in the science of public health. John Snow, the grandfather of epidemiology, was arguably also the first upstreamist — during the 1854 cholera epidemic in London’s Soho district (a time when conventional scientific wisdom held that disease was caused by miasmatic airborne pollutants) he heat mapped the outbreak over time and literally went upstream to a well head at the center of the hottest spot. He removed the pump handle, the epidemic quickly ended, and the life expectancy statistics for working-class Londoners undoubtedly enjoyed an incremental, but lasting bump.
And so goes the story of public health — underappreciated (Missouri is ranked 46th in the country for public health funding), yet commonsense interventions on sanitation, disease surveillance, safety, preparedness, epidemiology, etc., have been the driving factor behind the life expectancy we enjoy today, which with the extreme exceptions of global war and pandemic, has increased with near monotonicity since the beginning of the 20th century. That is except for the last five years on record — the first five-year block since 1913-1918 where life expectancy in the U.S. actually decreased.
In 2015, the cause grabbed the national headlines. Two Princeton economists made a startling discovery that the mortality rate for middle-aged whites in the U.S. diverged sharply in the late 1990s from the downward trend of the previous decades. This was unique to the U.S. and not experienced by other racial and ethnic groups within the U.S. They also found that if the mortality rate for this cohort had continued the same downward trajectory during the previous two decades, a half a million deaths would have been avoided between 1999 and 2013. The primary culprit? What the authors later termed “deaths of despair” — leading the way was drug overdoses.
The May issue of HIDI HealthStats explores deaths of despair in Missouri and uncovers similar findings. Notably, 12,585 Missourians have died of drug overdoses since 1999, and they contributed to more than three-quarters of the 11 percent increase in the mortality rate for white males between 25 and 54. We also found that 43 percent of Missourians who died in a hospital last year from a heroin overdose had a history of hospitalization for prescription opioid misuse during the previous four years.
While the most common-sense public health solution — a statewide prescription drug monitoring program, unencumbered by draconian limits on the practical uses of the data — is stalled yet again in the state legislature, the opioid epidemic rages on. Arguably, Missouri would be better served by county-level efforts that would allow meaningful use of PDMP data compared to a statewide model that limits maturity of the data at 180 days — implying substance abuse is an acute condition. It’s clear that substance abuse is a chronic disease. What isn’t clear is how many more deaths of despair Missouri will see before our elected officials take the proverbial handle off of the pump by arming prescribers and dispensers with the tools required to stop them.