Stately healthcare: The role of state governments in building world-class healthcare

State governments often perform an indispensable role in providing vital healthcare for the residents living within their districts, in areas such as funding, innovation and healthcare delivery. However, the activities they perform are often unknown to the general public. This essay will discuss the five key activities that the state government performs for healthcare, which include the monitoring of communities to identify health problems, the diagnosis and investigation of health problems, the provision of education about health issues, the development of policies to support community health, and the enforcement of laws and regulations to promote health and safety.

Foremost, states are responsible for monitoring the citizens in the districts under their charge, in order to ensure that information on the health status of these citizens is readily available to the federal government. The states, and their subordinate cities, counties and districts, are responsible for monitoring statistics such as birth rates, death rates, population health risk factors, infant mortality, and the prevalence of specific diseases such as tuberculosis, cancer, heart disease and Alzheimer’s.[1] For example, agencies such as the New York State Department of Health and the Boston Public Commission are charged at the state level with compiling health information on the populations of New York and Massachusetts, respectively. [2]

Secondly, states are responsible for diagnosing and investigation key health problems. For example, the government of the state of Michigan was held responsible for the water pollution crisis in Flint Michigan, which was caused by the change in water source from Lake Huron and the Detroit River to the Flint River, and caused the water of 100,000 residents to be exposed to elevated lead levels and higher rates of Legionnaires’ disease. The incident sparked widespread national outrage and led to calls for stronger regulation and reform of water providers on the part of the Michigan state government.

Thirdly, states are responsible for provision of information about key health issues. States are responsible for disseminating information about population risk factors, health insurance coverage and key health issues, in order to ensure that the general public is aware of health issues and health factors, and can take preventative action accordingly.[3] For example, cities with higher rates of air pollution often issue advisories to citizens living nearby, in order that they may take preventative measures such as the use of N95 filters and air purifiers.

Fourthly, states act to develop policies which support community health. These include initiatives such as Live Well San Diego, Healthy San Francisco and Boston Moves for Health, which respectively sought to promote overall community health, health coverage, and lower rates of obesity.[4] These state programs used a combination of state provided incentives, community outreach programs and social media campaigning to encourage their residents to pursue healthier behaviors, such as lowering their consumption of saturated fats and sugar, or exercising more frequently. The New York State Innovation Health Plan was another initiative that supported community health, by promoting the use of advanced technologies such as AI scanning, telemedicine and bio-diagnostics. [5]

Finally, state governments are charged with enforcing laws and regulations to promote health and safety. These can range from laws governing food safety and hygiene standards, to laws regarding patient treatment, prescriptions and handling.[6] For example, to fight against the federal opioid crisis, several states have passed stricter laws aimed at restricting the prescription of unlicensed opioids by hospitals, pharmacies and healthcare practitioners. Furthermore, Texas recently launched an initiative aimed at ensuring that all patients are handled in a safe and efficient way by healthcare practitioners such as nurses, in order to lower the risk of falls and lower back injuries from inappropriate patient handling.[7] State governments are also responsible for enforcing laws and regulations to ensure that federally implemented food safety regulations are implemented at the state level, and that stakeholders such as supermarkets and fresh food retailers comply to FDA standards for hygiene, genetically modified organisms and food safety.

In conclusion, the state government plays a vital role in the healthcare system, by monitoring community health problems, investigating and diagnosing health issues, providing health education, developing community health policies and enforcing health-related laws and regulations. It may be observed that state governments go a long way to ensure that federal health agendas are implemented at the local level.

Endnotes

[1] County of San Diego Health and Human Services Agency Division of Public Health Services, ‘San Diego County Local Public Health System Assessment.’ June 1, 2018. Accessed February 25, 2019. https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/documents/Local_Public_Health_System_Assessment.pdf

[2] Katz, Mitchell H., and Tangerine M. Brigham. “Transforming a traditional safety net into a coordinated care system: lessons from healthy San Francisco.” Health Affairs 30, no. 2 (2011): 237–245.

[3] Gebbie, Kristine M., Linda Rosenstock, and Lyla M. Hernandez. “Who will keep the public healthy?: educating public health professionals for the 21st century.” (2003): 340–345.

[4] Mays, Glen P., Megan C. McHugh, Kyumin Shim, Natalie Perry, Dennis Lenaway, Paul K. Halverson, and Ramal Moonesinghe. “Institutional and economic determinants of public health system performance.” American journal of public health 96, no. 3 (2006): 523–531.

[5] Ibid.

[6] Gusmano, Michael K., and Frank J. Thompson. “An examination of Medicaid delivery system reform incentive payment initiatives under way in six states.” Health Affairs 34, no. 7 (2015): 1162–1169.

[7] Poon, Eric G., Ashish K. Jha, Melissa Christino, Melissa M. Honour, Rushika Fernandopulle, Blackford Middleton, Joseph Newhouse et al. “Assessing the level of healthcare information technology adoption in the United States: a snapshot.” BMC medical informatics and decision making 6, no. 1 (2006): 1.

[8] Ibid.

References

County of San Diego Health and Human Services Agency Division of Public Health Services, ‘San Diego County Local Public Health System Assessment.’ June 1, 2018. Accessed February 25, 2019. https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/documents/Local_Public_Health_System_Assessment.pdf

Gebbie, Kristine M., Linda Rosenstock, and Lyla M. Hernandez. “Who will keep the public healthy?: educating public health professionals for the 21st century.” (2003): 340–345.

Gusmano, Michael K., and Frank J. Thompson. “An examination of Medicaid delivery system reform incentive payment initiatives under way in six states.” Health Affairs 34, no. 7 (2015): 1162–1169.

Katz, Mitchell H., and Tangerine M. Brigham. “Transforming a traditional safety net into a coordinated care system: lessons from healthy San Francisco.” Health Affairs 30, no. 2 (2011): 237–245.

Mays, Glen P., Megan C. McHugh, Kyumin Shim, Natalie Perry, Dennis Lenaway, Paul K. Halverson, and Ramal Moonesinghe. “Institutional and economic determinants of public health system performance.” American journal of public health 96, no. 3 (2006): 523–531.

Poon, Eric G., Ashish K. Jha, Melissa Christino, Melissa M. Honour, Rushika Fernandopulle, Blackford Middleton, Joseph Newhouse et al. “Assessing the level of healthcare information technology adoption in the United States: a snapshot.” BMC medical informatics and decision making 6, no. 1 (2006): 1.