A healthy population is a great asset not only to the individual members of that population but also to the state in which they reside. A healthy population is more productive and less dependent on state resources. It is also more stable, more creative and more able to help others in need of assistance. As a result it is clearly in the best interest of state government to do all it can to raise the level of health and well being of the residents of the state.

Improving the health of a population involves actions on a variety of fronts. It requires that the environment in which people live be free from both toxins and safety hazards. It requires that the population be educated about life style choices which contribute to better health and longer life. It requires that the population have access to quality health services. These services must include public health and preventive services, acute and emergency services and effective care for the multiple chronic diseases which are increasingly prevalent in our society. Responding to this broad range of challenges will be a major responsibility of the next governor and his administration.

NUTRITION / OBESITY

One of the most challenging public health problems we face is the emergence of obesity as a threat to the overall health and longevity of our citizens. This is especially true for those in the first 2 to 3 decades of life – a time when we would expect health problems to be at a minimum. We have witnessed over the last several decades a rapid rise in the prevalence of obesity brought on by easily available, tasty and relatively inexpensive high calorie fast foods and high sugar drinks. These changes are coupled with a reduction in energy expenditure by our youth as entertainment options have been increasingly dominated by television and video games and incentives for physical activity whether at school or at home have declined.

To combat this trend we need a broad based approach which should include nutrition education for both parents and children through our educational system and public health agencies. Options for healthy meals and snacks though school systems should be increased and food assistance programs should include incentives for healthy eating.

The obesity epidemic has major implications for health care costs for state government. As the incidence of diabetes rises among the young – as it is now doing – so too does the incidence of kidney failure, heart disease and long term disability, all of which impair the productivity of our population. All these add directly to the costs of state supported health care programs – especially Medicaid.

MEDICAID

Medicaid is a vital program which provides much needed health care services to needy and disabled citizens in South Dakota. Financial support for the program comes from a joint state/federal partnership with the federal government contributing approximately 2/3 of the funding. Even with the large component of federal input the cost of Medicaid is a huge burden on the state budget and it threatens to become even larger as health care costs increase and health system reform legislation mandates an expansion of Medicaid eligibility. To maintain this vital program it is essential that both the clinical effectiveness and the fiscal stability be improved. Analysis of these programs by health care researchers and pilot programs in other states have shown that changes in delivery system and payment structures can be successful in improving both clinical outcomes and fiscal efficiency. Most notable among these new models is the “medical home”. In this arrangement enrollees are linked with a primary care provider or clinic that accepts responsibility for education and preventive services as well as care coordination activities in addition to direct clinical services. There is strong evidence from a number of different settings that these structures both improve care and save money. We need to develop similar approaches in South Dakota.

SERVICES FOR THE AGING

A healthy and engaged retired population is a great asset to any community. Retired citizens bring to a community outside sources of revenue as well as energy for volunteer and leadership functions. It is in the best interest of both local communities and the state to support this segment of our population to every extent possible. Area councils on aging have been highly successful in other states in providing coordination and planning support for senior citizen activities and projects. South Dakota has a high percentage of seniors in our population. Providing support and encouragement through mechanisms like this allows us to tap the energy and expertise they have to offer. It also is an effective way to combat the isolation which too often afflicts seniors who have lost a spouse and whose children have moved away – isolation which damages health and can be devastating to overall quality of life.

Access to health services, traditional clinical services as well as in-home rehab services and home care for chronic disease, are very important contributors to health status. However, maintaining such services can be a challenge especially in the sparsely populated areas of our state. It is vital that we make every effort to see that those who live in our rural communities have access to these services which contribute greatly both to longevity and to quality of life. In so doing we reduce the demand for costly nursing home care and give seniors the opportunity to maximize their independence and their ability to continue to contribute to their communities.

By supporting this segment of our population we serve the best interests of the state but more importantly provide decent and respectful treatment to our older citizens who have contributed so much to the development of South Dakota.

HEALTH PROFESSIONS EDUCATION

South Dakota is fortunate to have high quality health care services and, at least compared to national benchmarks, reasonable health care costs. However, we still face many challenges. One of the most immediate of these is assuring that we will have the health care provider workforce which is needed to care for the current population as well as the baby boomer generation as they move into the phase of life when utilization of health care services increases. Accomplishing this means not only that we provide adequate general support for our health professions schools but also that we provide the incentives to attract students into areas where current shortages exist and where shortages are projected to become much worse in decades to come. With regard to physicians our primary care doctors are aging. We are not producing the numbers we need for their replacement let alone the greater numbers needed to deal with increasing numbers of elderly as well as those that are needed to staff the proposed new delivery models such as the medical home. In addition to primary care there are emerging shortages in general surgery, geriatrics, psychiatry and urology. Similar challenges exist in multiple other areas including nurse practitioners and physician assistants, nursing, physical therapy and a number of other professions.

Responding to these needs will require creative thinking and a willingness to change. We need to adjust curriculum offerings so that professionals in training receive the preparation necessary to feel comfortable moving into these professional roles. We also must have a willingness to restructure delivery systems to provide the support necessary to attract young professionals.

CONCLUSION

In many ways South Dakota is fortunate with regard to health care issues. We have a relatively healthy population, generally good health care outcomes and progressive health care provider systems. Nonetheless, we face many

challenges if we are to maintain and improve on the accomplishments from which we now benefit. Doing so will require hard work, creative thinking and a willingness to accept new structures and new ways of providing care. We must face these challenges with the clear thinking pragmatism which has characterized our state in the past. We must also have an open mind and a willingness to change. Only such an approach will allow us to implement the most promising of the new ideas while protecting the best of our accomplishments from the past.