On the latest episode of the Iowa Economy Podcast, three health care and public health experts outlined how health challenges across the state are affecting Iowa’s economy, from rural access to care and smoking rates to nursing home closures and workforce shortages.

The conversation, hosted by BPC President Chris Conetzkey, featured Andrea Harding, vice president of population health at MercyOne; Jason Semprini, assistant professor in the department of public health at Des Moines University Medicine and Health Sciences; and Hari Sharma, associate professor in the department of health management and policy at the University of Iowa.

Their discussion pointed to a central theme: Health issues in Iowa are not just clinical concerns. They have direct and growing implications for employers, workforce stability and long-term economic growth.

Rural-urban health disparities remain a key challenge

One of the most pressing issues raised was the gap in health outcomes between rural and urban populations, with access to care at the center of that divide.

“We actually see a fairly large disparity in our outcomes, both quality and the total cost of care, between our urban and our rural populations,” Harding said. “… The employees who represent and serve our rural communities might have larger struggles getting access to health care. They have a lower general adherence rate to getting their cancer screenings, to managing their chronic conditions, and they have a larger prevalence of some of those socioeconomic factors.”

For many rural Iowans, barriers go beyond distance. Work schedules, income limitations and access to basic resources all play a role.

“Having access, from a financial perspective, to medications is a huge concern. Having access to nutritious food, it really all compounds into the greater health and well-being of our communities,” Harding said.

Those challenges carry economic consequences for employers, particularly when untreated conditions lead to more serious and costly health issues. Harding said collaboration between providers, businesses and insurers is critical to closing the gap.

“Our goal as a provider is to help close that gap and to partner with the businesses in our community, the nonprofits in our community, community agencies and our payers as a whole, to work toward closing it,” she said.

Smoking continues to drive health and economic costs

While smoking rates have declined nationally, Iowa continues to lag behind, creating ongoing health and economic challenges.

“For the first time, really in our nation’s history, our cigarette smoking rate has fallen below 10%,” Semprini said. “However, those negative trends have not been as strong, in fact, the trends have been pretty stagnant or flat in Iowa.” Iowa’s smoking rate remains higher than the national average at 14%, Semprini said.

That gap matters because smoking remains a significant driver of disease.

“Smoking causes 80% to 90% of lung cancers, 30% of all other cancers,” Semprini said.

He noted the economic impact is often underestimated when viewed only as an individual behavior.

“The lack of improvement in Iowa affects our businesses by driving up our health insurance premiums,” he said. “They drive up our health care costs because they’re contributing so much disease. There’s a loss of productivity for people who maybe have to retire early or experience some type of disability.”

He added that the issue can be less visible today, but no less prevalent.

“There’s a lot more social stigma … so you don’t see it, but the people who still are smoking, they’re finding ways,” Semprini said. “It’s just they’re kind of more cast in the shadows, and that makes it harder for us to support them to quit.”

Closures of care facilities reshape communities

Sharma highlighted the growing number of nursing home and hospital closures as a major concern for both access to care and local economies.

He said Iowa has lost more than 40 nursing homes since 2018, a decline of about 10%. The closures have ripple effects beyond health care access.

“When a nursing home closes, the health sector employment goes down in that community or that area by 3% to 4%,” he said. “When a hospital closes, it’s 10% to 14%, so they are big employers of individuals in these communities.”

Residents, particularly in rural areas, often face longer travel distances for care, which can affect both health outcomes and quality of life.

“When you think about our grandparents or parents … and they have to go 25 miles away, that means I’m not going to have time to visit them on a regular basis,” Sharma said. “For older parents, they need that connection to have a quality life.”

The underlying causes are complex, including workforce shortages and financial pressures.

“Sometimes we’re seeing places that have 50% occupancy … but they don’t have people that can actually provide services,” he said. “They still need to pay for the building expenses, the fixed costs are still there, you still need a receptionist if you have five residents or 20 residents,  so there are challenges on both ends.”

Looking ahead, Sharma said communities may need to rethink how care is delivered.

“We will see more nursing homes closing. We’ll see hospitals closing. We can’t stop it,” he said. “But what we can do is come up with ways to address the access challenges in ways that are feasible in our rural communities.”

Workforce pressures are intensifying across sectors

Workforce challenges remain a central concern, particularly as employees balance work with caregiving responsibilities.

“We’re all trying to think about workforce and how to make sure that workers are being productive,” Sharma said. “If you’re not addressing the underlying issues that are bothering people, then you’re not fixing it with just one or two things at the workplace.”

He pointed to broader social pressures affecting workers’ ability to stay engaged.

“Someone might have a child at home that they need to take care of … or having to take care of your parents who need help,” Sharma said. “When you’re stressed out, you’re not going to be productive.”

In health care, those pressures are especially visible. Harding said many workers are adjusting their schedules or leaving full-time roles altogether.

“I can’t tell you how many frontline staff … wanted to decrease their [full-time equivalent] to part time because they either couldn’t afford their child care, or they were a 50-year-old individual who has a grandchild who is going to help out their daughter by caring for them one or two days a week so that they could work,” she said.

Retaining workers may require more flexibility in how jobs are structured, she said.

“I think we really have to think about how we challenge the way that we deliver our business and meet our multigenerational workforce where they’re at,” Harding said.