The extremes in America’s health system are striking. In some U.S. communities, people live longer, healthier lives than the residents of Europe’s wealthiest nations. In America’s least healthy regions, premature death and disease are as common as in parts of Asia and Latin America.
President Barack Obama’s health law, which takes full effect this year, was designed to narrow some of the disparities by expanding coverage and providing new tools for improving quality. But with some states embracing the law and others resisting it, the gaps in health from one region to another are poised to widen.
What makes a community healthy?
Poverty and wealth are part of the answer. How much schooling people have, what they eat and whether they smoke also play a role.
But so do decisions by doctors, hospitals, business leaders and elected officials about what local health systems should do. A review of data from the nation’s 306 health care markets, as well as interviews with scores of experts and visits to communities from Maine to Hawaii, points to many common features of America’s healthiest places.
More people have health insurance. Doctors and hospitals cooperate more closely, ensuring patients get preventive care and don’t fall through the cracks. Civic and business leaders help drive community efforts to expand access to health care, measure results and improve quality.
Those ingredients are often missing in places such as Baton Rouge, where a poorly organized health system joins poverty, low education and bad diet to form a toxic mix.
“Nearly every day, I am seeing families who need the help of doctors, and it’s just not there,” said the Rev. Melvin Rushing, an engineer who left a career in the petrochemical industry to become a pastor. He leads two African-American congregations not far from the clinic.