Annual health forum looked at connections between health and the economy

The relationship between health and the economy in creating healthy communities was the focus of the 14th annual Howard L. Bost Memorial Health Policy Forum in Lexington Sept. 19. The theme of the Foundation for a Healthy Kentucky conference was "Health as an Economic Driver."

Through a series of TED-style talks, breakout sessions and a keynote address, the forum explored the relationship between health and the economy, offering insights on how anchor institutions can contribute to local economies; the high cost of health care and the lack of price transparency for consumers; and how racial inequities affect the cost of health care.

Health systems as employer and purchaser

Health systems can work as economic drivers in communities through buying local, hiring local and helping employees to live local.

Robert Eckardt

That's what three anchor institutions in Cleveland, Ohio, have done with the help of The Cleveland Foundation, Robert Eckardt, executive vice president of the foundation, said during his TED-style talk. The institutions are Case Western Reserve University and its School of Medicine, University Hospitals of Cleveland and the Cleveland Clinic.

The neighborhoods around the highly profitable anchor institutions are among the poorest in the state, Eckardt noted. His foundation asked the institutions to become stronger partners with the communites through a three part strategy: "Buy local, hire local and live local." The institutions have changed their hiring protocols to hire locally, adding a six-month training program to make it possible, and have agreed to work with three worker owned co-operatives.

Eckardt said foundations can be a "safe space" to help institutions think about their role in the community, noting that many of them have never even considered this an option or a responsibility. "I encourage you to think about how anchor institutions can change their perspective from an internal one to an external one," he said. 

Health care costs

High-deductible, consumer-driven health plans are designed to encourage patients to become more active consumers of their health care by seeking out best price and value, but often this information isn't readily available, said AJcScheitler, manager of stakeholder relations at the UCLA Center for Health Policy Research.

AJ Scheitler

Scheitler said an analysis of health-care costs in Los Angeles found the cost of a circumcision varied between $175 at a reputable clinic that does 20 to 30 circumcisions a day and $3,000 at a local hospital.

She said the cost of care in the U.S. is much higher than in other countries, citing an article by David Lazarus of the Los Angeles Times that told the story of a woman's experience getting a four-shot treatment for rabies in four different facilities that costs less than $20 overseas, and ran more than $5,000 in the U.S.

She mentioned a Reuters analysis of drug prices that found Americans pay seven and a half times more for their insulin than people in Great Britain, and a study published in the Journal of the American Medical Association that found the average cost of insulin in the U.S. more than tripled between 2002 and 2013, jumping to $736.09 from $231.48.

"We have no idea what we are paying for," she said, and though there is beginning to be some price transparency, it is not enough to be effective yet. 

Social justice, health and the economy

Adewale Troutman

Dr. Adewale Troutman, who identifies himself as a social justice and human rights activist, pointed out during his TED-style talk that poor communities with no employment or educational opportunities have poor health outcomes.

"It has been proven quite clearly that the most important number in your (health) profile is not your blood pressure, not your blood sugar or any of that," he said. "The most important number is your zip code. Where you live is the most important factor in your health outcomes."

Among other things, Troutman is the former president of the American Public Health Association with ties to Kentucky as a former associate professor in the University of Louisville School of Public Health and Information Sciences and former director of the Metro Louisville Department of Public Health and Wellness.

Troutman also noted how health inequities increase the cost of care, citing a study by Thomas A. LaVeist of John Hopkins University that examined the direct and indirect costs of providing health care to a sicker and more disadvantaged population.

The report says, "More than 30 percent of direct medical costs faced by African Americans, Hispanics and Asian Americans were excess costs due to health inequities, more than $230 billion over a four year period. And when you add the indirect costs of these inequities,the tab comes to almost $1.3 trillion."

"When you look at the issue of economics and health, it is quite clear that the relationship is very, very strong," he said.

Gail Christopher

Dr. Gail Christopher, a national expert in holistic health and diversity, also emphasized the importance of improving racial inequities as a way to improve health outcomes and to create savings in health care.

"The lions share of the cost savings that this country would experience if we were to achieve racial equity . . . are health care cost," she said in her keynote speech.

Christopher, vice president for program strategy at the W.K. Kellogg Foundation, said that the unifying factor that connects racial inequity to poor health outcomes is exposure to adversity and to stress.

"People who have access to education, people who have access to income, people who are not subjected to discrimination and adversity have better health outcomes," she said. "And when they have better health outcomes, they have fewer interactions with the health care system and therefore they spend less."

The forum is held in memory of Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental-health services in Kentucky and created the vision for the foundation.
Co-sponsoring partners with the Foundation for a Healthy Kentucky were Kentucky Educational Television, Health Enterprises Network, Kentuckiana Health Collaborative, Kentucky Center for Economic Policy, Kentucky Chamber of Commerce, Kentucky Hospital Association and the Federal Reserve Bank of Cleveland.