It isn't a strong economy that produces healthy people. It's healthy people that produce a strong economy." Peter Johnson is standing in a meeting room at a Memphis hotel paraphrasing an idea he picked up from Harvard University economist David Bloom. It is an idea that Johnson, who is the federal co-chairman of the Delta Regional Authority, is putting into practice. And he is telling Medicaid officials from eight states about it -- they are in Memphis at his invitation -- because he wants the DRA, which is a federally financed economic development agency, and state Medicaid programs to work together on the diabetes epidemic in the Delta.
In its first five years, the DRA did -- and continues to do -- the usual stuff: helping to finance sewer and water lines and coordinating federal-local economic development activities. But the region the DRA oversees -- pieces of eight states stretching from Mississippi and Louisiana on the Gulf of Mexico up to Missouri and the southernmost edge of Illinois -- not only has a weak and failing economy, it's also home to some of the poorest, least educated and sickest people in the country. Johnson points to one indicator of poor health that is particularly striking: The rate of diabetes in the Delta is 30 percent higher than in the overall U.S. population. And that disease, Johnson points out, "is keeping thousands of people from being able to work and support their families."
Johnson, who was appointed co-chair of the DRA by President Bush, pushed the commission to make the diabetes crisis its chief mission. As the DRA started looking at what it could do to control the disease, agency members were struck by another point: The Medicaid directors in the eight states with counties or parishes in the Delta probably know a whole lot more than the DRA does about health care and outreach.
That led to another atypical move for an economic development agency: the convening of the Memphis get-together. "It's pretty unusual to get eight Medicaid directors together for a meeting like this," says Ray Hanley, a former Arkansas Medicaid director who chaired the December roundtable. For Hanley, the session highlighted "the power of Medicaid to do good. When you pull a group like this together to tackle this issue, you'll leave with a sustainable infrastructure. There'll be a process in place. The dialogue will go on."
The DRA started that dialogue by describing the first step it has taken in its Healthy Delta program: a toll-free number that residents throughout the Delta can dial to find where to get tested for the disease and how to gain access to care. The Medicaid directors then looked at ways their programs could dovetail with the DRA effort.
Some state health officials also pointed to lessons -- both positive and negative -- to be learned from some of their new initiatives. Tennessee, for instance, is investing $15.6 million in a mandate for schools to target obesity through physical activities and nutritional changes. The underlying message was this: "If you want to change the health status of the state or region," said Susan Cooper, of the Governor's Office in Tennessee, "you have to invest in prevention instead of cure."
Kentucky's Glenn Jennings suggested setting up a diabetes registry, similar to immunization registries that have been very successful in several states. Since diabetes patients tend to drop in and out of programs, Jennings said, "when they drop back in, it would be nice to know you touched them before." To which Cooper noted that a registry had come up in her state and gotten a lot of pushback. Some of it was over privacy issues but some, she said, came from associations for other diseases. They were worried that a diabetes registry would in some way cause their funding to go down.
At the end of the day, the DRA made plans to continue the dialogue -- in person or virtually. "This is important," says Hanley, who now works for the technology company EDS. "This is about targeting the most impoverished region in the U.S. with the highest incidence of disease. If people aren't aware that they have the disease and don't get treated, they'll cost the system more money than if we intervene early. It's a strategic investment."
It's also a reminder of the importance of inter-agency and inter-governmental cooperation and coordination. There's no other way to change the health status of a region.