Director of health gives R.I. B-minus health score

In speech, state director of health discusses initiatives to lower incidence of smoking, AIDS, drug overdose

Contributing Writer
Tuesday, March 4, 2014

Smoking rates in Rhode Island fell by 2.6 percentage points in the last year, but smoking remains an important health issue in the state. “I’d love to see students agitating to make Brown a smoke-free campus,” said Michael Fine, director of the state Department of Health.

Michael Fine, director of the R.I. Department of Health, gave the Ocean State a B-minus rating in the State of the State’s Health address Wednesday.

The score was determined by compiling rankings from national health organizations.

The rating is “a little bit subjective,” Fine said. “At the same time it gives us a chance to see where we are.”

Rhode Island ranks 19th nationally, according to a report from the United Health Foundation. While Rhode Island ranks well for its relatively low prevalence of obesity and its access to primary care providers, the state’s health scores are negatively affected by high rates of drug overdose and unequal health outcomes based on socioeconomic status, according to the United Health report. There remains room for improvement to Rhode Island’s health score, Fine said.

Fine said he would like to see 20 fewer cases of HIV and lower rates of smoking by next year. He also said he wants two or three additional neighborhood primary health centers built by the end of 2014.

Fine said implementing widespread HIV testing and treating patients who test positive will result in a decrease of HIV cases.

Smoking remains an important health issue in Rhode Island, Fine said. Rates of smoking fell from 20 percent to 17.4 percent of adults in 2013, but Fine said he would like smokng rates to drop an additional two percentage points by next year. And Fine said he wants colleges and universities in the state to enact smoking bans on their campuses. “I’d love to see students agitating to make Brown a smoke-free campus,” he said.

The federally funded Prescription Monitoring Program, which was implemented to help providers monitor the number of prescriptions, will help reduce the rates of drug overdose in the state, Fine said. The program was introduced last year to prevent fraud associated with the overprescription of controlled substances, The Herald previously reported.

Overdoses from opiates are a major part of the state’s drug problem, with over 20 fatalities from opiate overdoses reported in 2014, The Herald previously reported.

“If someone comes to see me as a doctor, saying they have a bad back and asking for Vicodin, I will be able to look up what medications they’ve had from other doctors,” Fine said.

Fine also listed several long-term goals for improving the state’s health. These initiatives include eradicating smoking by 2030, eliminating incidence of HIV in Rhode Island by 2018 and developing more primary care centers in communities of fewer than 10,000 residents by 2020.

The implementation of the Affordable Care Act may improve health scores, but the outcome of the new program is unpredictable, Fine said. “We know that not having health insurance puts people at greater risk for disease,” he said, adding that effects of the Affordable Care Act on health outcomes for currently uninsured individuals remain to be seen.

“Many determinants of health are social, not medical,” Fine said in his address. Social factors such as income inequality and education have an effect on health outcomes, he added. “For example, in the United States, the African-American population’s life expectancy is about five years shorter than the rest of the population.”

“Most people believe that the majority of health outcomes are not determined by general health care, but by social determinants,” said Ira Wilson, professor and chair of the Department of Health Services, Policy and Practice. These social determinants can have as significant an impact on health outcomes as the presence of adequate health care, he added.

The solution to improving health outcomes and care is to leverage spending on health care dollars, Fine told The Herald. “We spend about $2 trillion as a nation on health care and medical care. About 30 percent of that figure is wasted. We have to figure out how to spend this extra money on education and housing and safe streets and the environment. That is the way we can make everyone healthier,” he said.

Wilson said he sees opportunities to improve the state’s health score. “If the grade of a B minus or a C plus leads to beneficial change, that’s all I can ask for,” he said.

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