Guest Column: The 2010 Agenda: Public Health

Texas ranks forty-sixth among all states in health care and first in its percentage of uninsured citizens; one in five Texans has no health insurance. The top four diagnosed causes of death among Texans are heart disease, cancer, stroke, and respiratory diseases such as emphysema. In addition to killing us, smoking and obesity cause preventable diseases that are very expensive to treat and a significant loss of workforce productivity, including increased absenteeism and disability.

Meanwhile, two trends will soon strain our medical care system. The first is that Texas is aging. If roughly one in ten Texans today is over age 65, in 2050 one in six will be over 65. The second is that the rates of childhood and adult obesity here continue to rise; with the shifting racial and ethnic profile of the state, they rise faster here than in many other parts of the country. The demand for care and the cost of care for seniors will compete with the demand and cost of care for the increasing number of Texans who are obese and, as a result, have also been or will be diagnosed with heart disease, cancer, diabetes, or some forms of arthritis. All of these conditions are treatable, but they’re expensive to treat and occupy the attention of a physician workforce that is in short supply.

While the national health reform debate of late has centered on universal insurance coverage and cost control, let’s be clear: Whether we’re talking national health reform or Texas-specific health reform, the prize is optimal health for all, which, among other positive benefits, will surely reduce the demand for medical care of preventable diseases. The Texas health agenda for 2010, then, should help Texans stay or become as optimally healthy as possible and provide access to preventive, chronic, and acute care  — when appropriate and necessary.

Three strategies can move Texas in the right direction: a statewide indoor smoking ban, statewide universal K-12 coordinated school health programs, and the serious consideration of all available options to reduce the number of uninsured Texans.

I'll start with the last one first. There is no doubt that insuring more Texans will be an expensive proposition; however, for a state that takes pride in its Christian values and sensibilities, as it well should, universal insurance is a moral imperative in the spirit of The Good Samaritan. Furthermore, the cost associated with increasing the number of insured Texans could be lessened by banning indoor smoking in all public places and assuring that all schools have coordinated health programs that improve the quality of food in the schools, make physical education a daily expectation, and incorporate healthy lifestyle lessons into the daily curriculum.

Smoking tobacco increases the likelihood of premature disease, disability, and death from heart disease, lung cancer, and emphysema. Indoor smoking bans are associated with a fairly immediate reduction of admissions to hospitals for myocardial infarctions, or heart attacks. Fewer myocardial infarctions are good for families (there’s less grief and anguish), good for employers (less sick leave, disability, and medical care costs), and good for medical care systems (less of a cost to the public system and less demand for care in sometimes overcrowded emergency room settings). Smoking bans make it easier for those who want to quit smoking to do so and more difficult for those who want to start to do so — particularly adolescents. A statewide indoor smoking ban is a relatively inexpensive way to reduce medical care utilization and cost and improve the health of Texans.

Coordinated school health programs hold the promise of reversing and preventing childhood obesity. Not only do they improve children’s health, but they’re associated with improved academic performance and decreased disciplinary problems. High school graduation (and some college education) is associated with better adult health status. Childhood obesity is on the rise. It threatens the health of children when they're children and when they become adults.  The cost of universal coordinated school health programs is on the order of $10 to $15 per child per year, in contrast to a cost of approximately $1,000 per year for medical care. Better health and better academic performance make this a must-do.

The ultimate goal is the best health possible for each Texan and for all Texans. A healthy workforce and healthy Texas children mean a state that competes effectively for business. The 2010 health agenda for Texas, therefore, should be about the public’s health, the health of 24 million Texans. A physically healthy Texas is a fiscally healthy Texas. 

Eduardo Sanchez, M.D., M.P.H., was Commissioner of the Texas Department of State Health Services from 2004 to 2006 and the Texas Department of Health from 2001 to 2004. He is currently a vice president and chief medical offer for Blue Cross and Blue Shield of Texas.