Illinois health stats for women, youth show both decline and improvement
May 4, 2018

Photo courtesy UIC College of Dentistry
The America’s Health Rankings Health of Women and Children Report found that dental health among women has improved in Illinois.

By Igor Studenkov

Illinois has experienced more infant deaths, more suicides among teens, and more drug overdoses among women last year than the year before.

These rank as the major findings from the America’s Health Rankings Health of Women and Children Report, issued earlier this year. On the plus side, the report noted dental health among women has improved, teens are more likely to get immunizations, and maternity care quality is better.

Health professionals who spoke to Gazette Chicago said that, while the report paints a picture of the state as a whole, it misses some of the differences among different parts of the state—and even different communities within Chicago. Variations arise from factors such as economic development, access to jobs, and how many medical and social service providers exist in an area. Addressing those factors, they argue, will go a long way toward improving the statistics.

The United Health Foundation, a non-for-profit private foundation established by the UnitedHealth Group health care provider, publishes the America’s Health Rankings Health of Women and Children Report is annually. The report breaks down healthcare statistics by state and compares them to other states’ statistics and each state’s data for the preceding years.

Deneen Vojta, MD, a pediatrician, senior adviser to United Health Foundation, and UnitedHealth Group’s executive vice president for enterprise research and development, said the foundation does not focus on the causes of healthcare problems and successes. Rather, it collects information to help state and municipal governments make informed decisions about how they spend money on healthcare. Vojta noted the company understands states face differing budgetary realities but hopes they will use whatever funding they do have to improve health for all women and children in their jurisdictions.

According to the latest report, in 2017 several health indicators throughout Illinois decreased compared to 2016. The rate of drug-related deaths among women ages 15 to 44 increased by 23%, jumping from 9.8 to 12.1 deaths for every 10,000 women in that age group. Infant mortality increased by 2%, going up from 6.2 to 6.3 per every 1,000 babies. The suicide rate for teens ages 15 to 19 increased by 27%, going up from 6.3 to 8.0 per every 100,000 teens.

Dental visits, vaccinations up

In positive news, dental visits among women aged 18 to 44 increased by 7%. The number of teens ages 13 to 17 who have been vaccinated against meningococcal diseases such as meningitis went up from 77.1% to 83.9%. Illinois’s  Maternity Practices in Infant Nutrition and Care (mPINC) score, which measures maternity practice quality, increased from 77% to 81%.

When asked about causes for increased suicides, Vojta said United Health Foundation has been studying Adverse Childhood Experiences—children exposed to “physical, environmental issues such as home violence and divorce” as they grow up. 

“We know as the children are exposed to those elements, they have more physical behavioral issues,” Vojta explained. “We saw an increase of teen suicides across the nation, and Illinois was no exception.”

She added that Illinois numbers remain lower than the national average.

Vojta said medical professionals increasingly agree that, to understand health, one must look at external factors such as education, housing, and public safety.

Doctors working for the Cook County Health and Hospitals System (CCHHS) understand that truth. The system is composed of the Illinois Medical District’s John H. Stroger Jr. Hospital, Washington Park’s Provident Hospital, and various health centers throughout Chicago. It provides a wide range of pediatric services in Stroger Hospital around the clock and during weekdays in its health centers. It also provides care for women during and after pregnancy as part of its family medical services.

Because of its flexible payment policies and extensive charity care, CCHHS traditionally has served more low income residents than most other Chicago area hospitals and health systems. In 2012, it launched CountyCare, a Medicaid expansion program authorized by the Affordable Care Act, providing coverage to patients with low incomes but not low enough to qualify for Medicaid.

CCHHS CEO John Shannon, MD, said medical issues often are more severe in the minority communities, with non-medical factors contributing significantly to that severity.

Social determinants’ effects

“A lot of it is tied to access to care, but it’s also tied to social determinants in those communities—gun violence, opioid abuse, lack of employment,” he said. “We know that communities we serve are over-represented in factors affecting health ranking in communities. So all of these things together make for a kind of toxic environment to try to improve patient health statistics.”

Vojta said that fact creates statistical disparities for issues such as infant mortality and teen suicide, which can increase in communities that have less access to resources.

Concerning the increase in drug-related deaths, Shannon explained that treatment for addiction requires resources—a tall order in underserved communities.

“Getting resources for opioid addiction [treatment] is challenging to those communities,” he said. “That treatment requires local community providers [and]… a health system that has depth and breadth to implement it. And it requires medical funding.”

Although Vojta said the research she has seen shows most opioid overdose victims are white, Shannon said the risk of opioid overdoses is greater in majority black and brown communities due to lack of resources.

Shannon added that the hospital system is training medical professionals and community members to use Nalaxon, a medication that blocks the effects of opioids and can reverse overdoses if administered on time. The CCHHS also works with the Cook County Jail population, not only ensuring inmates obtain treatment for addiction but connecting people to treatment providers once they have served their time.

Just as poverty and lack of resources can hurt health, something as simple as having jobs can improve it. When asked about increased dental visits, Vojta pointed to a correlation between dental visits and economic improvements.

“As the economy gets stronger, it seems like dental visits often increase,” she said. “We don’t have the whys, but it is terrific to see.”

“Access to care has many different issues,” said Clark Stanford, DDS, PhD, dean of the University of Illinois at Chicago College of Dentistry. “One is finding a provider you are comfortable with and second is cost. Since dentistry traditionally is not part of health insurance, the cost of care is borne by the patient. We are hopeful as dentistry becomes more and more a part of the primary care team that patients, providers, and policy makers will embrace the logical advantage that good oral health is good for health.” 

When asked whether Medicaid expansion programs such as CountyCare had any effect on women and children’s health, Shannon said that, in Illinois, the combination of Medicaid and the Children’s Health Insurance Program was generous to them even before the expansion, so mothers and children were not affected as much as other populations. Also, Shannon noted, access to resources made a difference.

Most Illinois Children covered

“Only about 3% of children in Illinois aren’t covered by insurance,” he said. “Having said that, when we go into certain impoverished environments, that proportion spikes up.”

To address this, CCHHS works with social service providers to see whether their clients are eligible for Medicaid, a Medicaid expansion program, or any affordable health insurance coverage.

Shannon said that, overall, the Affordable Care Act helped health outcomes in Illinois and other states that implemented it in full. At the same time, economic improvement would be helpful, too.

“Let me be very clear about that,” he said. “The best thing about improving communities [is that] health is a combination of access to healthcare and community development, so that people can have good jobs. Then, they don’t need to rely on Medicaid.”

Vojta said Illinois can do more to increase public access to women’s health services. While keenly aware that states and municipalities may not have as much funding as she would like, she hoped they will use the report to direct existing funding to address the issues it highlighted.

Illinois State Senator Mattie Hunter (D-3rd) represents much of this area, including significant portions of the Loop, West Loop, South Loop, Armour Square, Bridgeport, and Bronzeville, as well as neighborhoods further south. She serves on the Illinois State Senate’s Public Health committee. Hunter recognizes the resource disparities affecting many of her constituents.

“Minority communities are disproportionately experiencing higher rates of chronic illnesses such as diabetes, heart disease, stroke, and cancer, which are often linked to excessive amounts of sugar consumption,” she said. “Women and children need to be exposed to quality produce when shopping for nutritious and healthy meals. Residents also need access to quality health care services when they are ill and for regular check-ups.”

Stroger Hospital is located near the northern tip of her district. Hunter expressed gratitude for it and for the University of Chicago, whose campus is located closer to her district’s center and which agreed to develop a new trauma center.

“I am hopeful that the new center will save lives and provide services to those who need immediate medical attention,” she said.

Hunter believes the State should allocate more funding for research and prevention programs.

In addition, she said, “I have been fighting for higher wages for health care workers for years. Better wages and benefits would bring stability to a vital workforce that experiences high rates of burnout and turnover. We in the Senate have been urging the governor to sign onto major legislation that will benefit the health of our residents, and ultimately, the State’s economy.”

To learn more about CCHHS, log on to www.cookcountyhhs.org. For more about Hunter, log on to www.senatorhunter.com. For the United Health Foundation, see www.unitedhealthfoundation.org. For information about the UnitedHealth Group, see www.unitedhealth.com.