Georgia health care disparity may be result of wealth gap

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Just weeks ago the US Census Bureau gave Atlanta the unwelcome title of the city with the widest income gap between the rich and poor.

Analysts say the widening gap is fueled by high unemployment, the development of affluent communities close to impoverished areas and the disproportionate number of college students living in the city with little or no income.

By contrast income levels in Metro Atlanta are less skewed. The region has a lower income level inequality than the nationwide average of metro areas, says the US Bureau report.
Georgia is geographically large and ranked the ninth populous state by the 2010 US Census report. Though, this comes with its own unique set of problems.

Dr Toni Miles, who has served on the US Senate Finance committee during the development of the Affordable Care Act, says Georgia has large rural areas with low population, living in “suburban poverty”, with problems accessing care and resources.

“Undermining Georgia’s health statistics are extreme poverty neighborhoods, particularly in the south,” says Dr Miles. “Pockets of the county have patchwork access to health facilities.”
In fact, it has been well-documented that poverty is one of the best indicators of overall health. Georgia is not the worst but certainly near the bottom nationally of many health indicators.

The disparities come, partially, from structural problems faced by the state’s health care system. Of the state’s 159 counties, 118 are rural, and have roughly half as many doctors per capita as, say, metro Atlanta.

In 2010, Georgia ranked 36th among the states on overall health performance, up from 43rd in 2009, according to data from 2010 America’s Health Rankings.

Georgia ranks low among states on several health indicators, including childhood obesity, infant mortality, infectious disease and cardiovascular deaths.

Around 30 percent of adults are considered obese, according to 2010 Behavioral Risk Factor Surveillance System data. In the past five years, the percentage of children in poverty increased from 19.9 percent to 23.3 percent of residents under age 18, shows data from America’s Health Rankings.
“Over the last 10 years, Georgia’s public health has declined,” Georgia Governor Nathan Deal said in a speech earlier this year to the Georgia Public Health Association. “We live in a part of the country where our lifestyles and our dietary habits have contributed to the cost of those health care issues that are associated with that.”

In a country still profoundly defined by race, there are huge disparities in health outcomes between racial and socioeconomic groups in Georgia, like in so many parts of America.

“African-Americans and other minority groups are in worse off position than their white counterparts in Georgia. Though neither is in a particularly good position,” says Phillip Williams, dean of the University of Georgia College of Public Health.

In Georgia, obesity is more prevalent among blacks at 36.5 percent than whites at 25 percent, according to America’s Health Rankings. The prevalence of diabetes also varies by race and ethnicity in the state; 12.8 percent of blacks have diabetes compared to 8.4 percent of whites.

“Racial and ethnic minorities make up roughly one-third of Georgia’s population, yet their disease burden is significantly higher. Georgia has well documented health disparities in cultural competence, cardiovascular disease, diabetes, kidney disease, cancer, stroke and HIV/AIDS” says the 2008 Georgia Health Disparities Report.

The situation is worse because Georgia has such a large African-American population. Some, though not all, are living in extreme poverty.

Dr Miles says Georgia’s poor rankings are multifaceted and come, in part, from cultural factors, the legacy of the civil war, a history of a lack of resources, obstacles to getting care and the inability of poor black families to pass on any wealth. She also points to research on food desserts, areas where there is limited access to fresh produce and nutritious food.

Historically southern states, including Georgia, tend to be at the bottom of the health rankings, says Dr Miles. So for instance, Georgia has the second highest childhood obesity rate, behind another southern state Mississippi.

Miles is upbeat. She says the growing trend of reverse migration, which has led legions of African-Americans to leave cities in the North to metropolitan areas in the South, will help boost the Georgia’s economy. But for Phillips, the best way to eliminate health disparities is for the state to place more emphasis on public health, backed up my money.

Though there seems to be a renewed level of optimism. Public health in Georgia has recently been restructured. In July, the state’s public health operations were moved out of the Department of Community Health to create an independent Department of Public Health reporting directly to the Governor Nathan Deal.

The legislation elevates public health to a Cabinet-level position, which supporters say will help the state address its wide-ranging health challenges. It is also seen as an acknowledgment of the poor health indicators.

The Georgia Department of Public Health also has a new director at its helm. The recently appointed Dr Brenda Fitzgerald has practiced medicine for 30 years and has an enviable professional reputation. All eyes will be on her to see how she improves public health in Georgia.

theGrio contacted the Georgia Department of Public Health but they were unavailable to comment.