The writer is dean of the College of Public Health at the University of Nebraska Medical Center.
Nebraska is ranked 10th in the nation in health — and we have the talent among the populace, civic organizations, health care and public health practitioners, and elected officials to make Nebraska the healthiest state in the union by 2020.
In the past year, Nebraska has seen increases in high school graduation rates and child immunizations, as well as decreases in child poverty. Yet Nebraska still faces many challenges:
Twenty percent of the adult population in Nebraska consumed four or more (women) or five or more (men) alcoholic beverages on at least one occasion in the past month, ranking Nebraska 44th in the nation in binge drinking rates.
Nebraska has a high incidence of infectious disease, including whooping cough and certain types of food poisoning and sexually transmitted infections.
Obesity rates in Nebraska are an increasing problem, with 29.6 percent of the adult population having a body mass index of 30.0 or higher (normal is 18.5 to 22).
The most disturbing of these measures is that Nebraska is ranked 46th in health equity — only four states have more disparities in health among their populations. These disparities create a financial burden on the state because of high hospitalization rates among the uninsured and underinsured.
I prescribe three things to my patients when they feel overwhelmed from the myriad of options to improve their personal health: Stop smoking, exercise for at least 150 minutes each week, and eat seven fruits and vegetables a day.
But public health is not just a physician's treatment of individual patients; it is the actions we take as a community to protect the health and prevent disease for everyone in our community — through the social and physical environment in which we live, work, learn and play.
Studies show more than $4 in reduced health care costs for every $1 we invest in prevention.
So here are three actions that would help Nebraska become the healthiest state and reap the health, economic and social benefits of healthier communities.
Starting with costs and cancer, the first thing we can do is reduce Nebraska's cancer deaths (and heart disease) by increasing the cigarette tax by at least $1; we already have 260,000 too many people who smoke in this state. And smoking-caused state Medicaid program spending each year is $162 million. Our current excise tax on cigarettes of 64 cents per pack is lower than 74 percent of other states. As it stands, smoking-caused health care costs in Nebraska are $9.64 per pack.
Increasing the cigarette tax by just 10 percent would reduce youth smoking by 6.5 percent and adult smoking by 2 percent. In addition, increasing the cigarette tax by $1 per pack would increase our state's annual revenue by an estimated $61.5 million.
The second item is to increase health care coverage in Nebraska so nobody falls through the gap of our Medicaid programs and federal health exchanges. There are almost 77,000 low-income Nebraskans who need health insurance to get preventive care (such as cancer screenings), manage their chronic conditions, reduce costly trips to the emergency room and prevent unnecessary deaths.
This is another example of where we can not only improve the health outcomes for Nebraska's working poor but also boost our state's economy. A recent study conducted by professors at the University of Nebraska at Kearney revealed that this health care model would spur $5 billion in economic investment, sustaining thousands of jobs and easing the strain on our rural hospitals to close.
And finally we need to embrace more innovative public health strategies and invest in public health research and prevention. We need to seek innovative public-private solutions and look outside our traditional health systems for solutions to our most difficult problems.
We can adopt Health Enterprise Zones to bring primary care providers and other essential health care workers and services to underserved communities to reduce health disparities among minority groups and geographic areas and reduce health care costs.
We can consider Social Impact Bonds to finance public health programs to improve health outcomes, reduce health care spending and reduce government spending. With these bonds, private investors pay for interventions to improve social outcomes and are paid back in financial returns by the government if the outcomes improve.
Another option to finance these prevention programs would be to create a Prevention Fund to develop, monitor and identify the best new interventions for the state.
Taking these collective actions is Nebraska's prescription for a healthier state. After all, our communities are only as healthy as we make them.