Health is a lagging economic indicator, making for a slower-moving but concentrated impact on the ability of people and the community at large to thrive.

Our recent Power Breakfast highlighted the state of Iowa’s health, including challenges with chronic illness rates and a significant health care workforce gap. We began to examine how current trends stand to affect business and community now and in the years ahead and steps to systematically approach solutions.

To watch the full event, visit businessrecord.com/video. 

Panelists:

• Dr. Richard Deming, medical director, MercyOne Richard Deming Cancer Center
• Laura Jackson, executive vice president, health improvement, Wellmark Blue Cross and Blue Shield
• Dr. Denise Jamieson, University of Iowa vice president for medical affairs and dean of the Carver College of Medicine
• Nalo Johnson, president and CEO, Mid-Iowa Health Foundation
• David Stark, co-chair, Capital Crossroads, and chief government affairs and philanthropy officer, UnityPoint Health

In addition to our panel, the event featured remarks from several additional speakers to provide insight around key health issues affecting community vitality and efforts to identify and implement solutions.

Speakers included:

• Steve Churchill, CEO, Iowa Medical Society
• Jami Haberl, executive director, Iowa Healthiest State
• Proctor Lureman, president and CEO Broadlawns Medical Center
• Kelly Wells Sittig, executive director, Iowa Cancer Consortium

Here are our reporters’ takeaways from the conversation.

Health is an economic issue

Iowa consistently ranks in the top half of the nation for health insurance coverage, access to care and overall health system performance, Jami Haberl, executive director of Iowa Healthiest State, said. However, when a deeper dive is taken into Iowa residents’ health, a worrisome picture emerges, she said. Iowa continues to see high and persistent levels of chronic diseases such as obesity, heart disease, diabetes, cancer and dementia. Compared to a decade ago, adults report having increased stress in their lives, poor mental health days and limitations in their ability to function daily. “These conditions don’t appear suddenly,” Haberl said. “They reflect years of accumulated risk, and from a business perspective, they also signal future pressure on the workforce, insurance costs and productivity. … The data we see today will tell us where Iowa will be in two, five, 10, 20 years from now.” When the phrase “state of health” is used, it really means risk management, workforce sustainability and long-term competitiveness, she said. “Health is not just a medical issue; it’s an economic issue.”

— Kathy A. Bolten

Chronic illness growing in Iowa

Dr. Denise Jamieson, University of Iowa’s vice president of medical affairs and the Carver College of Medicine dean, provided stark details about the Iowans’ chronic health issues. “The incidence of chronic diseases across the country – and in Iowa – are increasing,” she said. “People are sicker. … Caring for people with medical problems is more expensive and complex. … Younger people are getting chronic diseases earlier in life.” According to American’s Health Rankings, 37.8% of adults in Iowa are considered obese, ranking the state 41st nationally. The survey revealed that 21.3% of adults drink excessively, placing the state 46th nationally. Also, just 25.9% of Iowa adults exercise regularly, ranking the state 43rd in the country. “We have a real issue in Iowa [with] providing enough and high-quality care to people with chronic diseases,” Jamieson said. “We need to think of that from a system, statewide perspective.”

— Kathy A. Bolten

Physician shortage explained

The United States currently has a shortage of 64,000 physicians; the shortage is expected to grow to 86,000 by 2036, said Steve Churchill, CEO of the Iowa Medical Society. Currently, Iowa ranks 44th in the nation for the number of physicians it has per capita and 51st in the nation (below Puerto Rico) for obstetricians and gynecologists, he said. “It’s a critical issue for us,” Churchill said. “You can feel it as a patient with longer wait times to get an appointment; there’s fewer available appointments in general; and it’s more difficult accessing care in our rural communities.” A workforce study released in 1980 predicted a surplus of 70,000 physicians by the year 1990, he said. The fear of having too many doctors led to medical schools putting caps on class sizes, a restriction that lasted 25 years, he said. “We’re paying the price for that report because it failed to anticipate that the U.S. population would grow by 110 million during that time period; that people would live longer and be treated longer for their care.”

— Kathy A. Bolten

Addressing health disparities improves overall outcomes

Economic health and well-being is tied to positive health outcomes and that connection can help communities thrive, said Nalo Johnson, president and CEO of the Mid-Iowa Health Foundation. “I think the data continues to show those consistent disparities … within our communities across our state, and thinking about how we develop population-specific interventions to address those disparities is critically important in order to see those health improvements,” Johnson said. For example, during her time at the Iowa Department of Public Health, they recognized that maternal mortality rates among Black women were six times greater than those among white women in Iowa. “We partnered with our Title V maternal health and maternal child health clinics as well as community doulas and local public health departments in order to implement a community-based doula project as an evidence-based strategy that could help reduce some of those disparities in maternal mortality and maternal morbidity that we saw,” she said. She said while that effort targeted a specific population, the longer term goal was to “bring data forward in order to help inform and convince our insurers as well as Medicaid to include doula services as a reimbursable service that ultimately would benefit everyone in Iowa.” 

— Lisa Rossi 

Cancer’s complexity in focus

Cancer is not just a health issue, it’s a workforce and economic issue, said Kelly Wells Sittig, executive director of the Iowa Cancer Consortium, a statewide consortium dedicated to reducing the burden of cancer in Iowa. “Sixty-nine percent of cancer survivors miss more than four weeks of work. Thirty-nine [percent] miss more than three months. Eighty percent of employers rate cancer as their top driver of health care costs. And nationally, cancer is projected to cost the U.S. economy $5.3 trillion between 2020 and 2050. Likely Iowa businesses are already feeling this through productivity loss, talent retention and rising benefit costs,” she said. Generally, Wells Sittig said, when Iowans talk about cancer, they have two questions: Why is this happening and what can we do about it? “There is not one single cause of our high rates of cancer. Cancer is very complex, and it reflects intersections between genetics, environment, lifestyle and many other factors,” she said. Also in Iowa, there are “high rates of tobacco use and binge drinking, very low rates of physical activity and fruit and vegetable consumption, some of the highest … radon concentrations in the country, lower vaccination rates for cancer-causing HPV and serious concerns about environmental exposures like elevated levels of nitrates and water,” she said.

— Lisa Rossi

The environment’s contribution to cancer

There is no one cause for cancer in Iowa, but experts are beginning to also address not just modifiable risk factors like health behaviors, but environmental factors as well, said Dr. Richard Deming, medical director of the MercyOne Richard Deming Cancer Center. He pointed to a recent report from the Iowa Environmental Council and the Harkin institute that dives deeper into current research on the environment as a risk factor for cancer, including pesticides, nitrates, radon and PFAS, or forever chemicals. “It probably is less important than some of the modifiable risk factors related-behavior, but it is a cause that hasn’t been addressed significantly,” he said.

— Lisa Rossi