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Experts Gather to Discuss Ways to Improve Public Health in Texas

Posted: May 16, 2012

What is driving the rapid rise of health care spending and is it possible to reign in costs without compromising public health? These questions are on the minds of health care providers, consumers, and government and community leaders across the nation.

They also took center place at the St. David’s Center for Health Promotion and Disease Prevention Research in Underserved Populations (CHPR) research conference at the University of Texas at Austin this spring.

Dr. David Lakey addresses CHPR audience

Dr. David Lakey addresses CHPR audience

In his keynote address “Health Status in Texas — Challenges and Initiatives,” Dr. David Lakey, commissioner of the Texas Department of State Health Services, noted that not all strategies for improving public health are equal. Behind many of the state’s health challenges, he said, is a gaping disparity in education, income and employment.

For instance, 35 percent of Texans with only some high school education experience fair to poor general health while approximately 8 percent of those with college degrees do. Those earning less than $25,000 a year are also more likely to experience fair to poor health (30 percent) compared to those earning $50,000 or more (less than 10 percent).

Lakey highlighted six public health challenges currently facing Texas: HIV, mental health, substance abuse and smoking, infant mortality and prematurity, health care quality, and obesity. None of these have easy “fixes,” and all of them have the potential for costing taxpayers millions of dollars over the next several years.

The figures for infant mortality and prematurity in Texas, along with their financial implications, alone are sobering. Mortality rose 5 percent from 2000 to 2009, and the state’s preterm birth rate is 13 percent, compared to 12.3 percent nationwide.

“Fifty-five percent of all Texas births are paid for by Medicaid, and 70 percent of Medicaid costs for hospitalized infants are tied to prematurity,” Lakey said. Costs during the first year for a preterm infant are $16,124 compared to $404 for a normal-term baby, he added.

Dr. Lakey with Dean Alexa Stuifbergen

Dr. Lakey with Dean Alexa Stuifbergen

To close this gap, the Texas State Legislature has appropriated $4.10 million to fund Healthy Texas Babies, an initiative with the goal of decreasing preterm birth rates by 8 percent over two years and saving $7.2 million in Medicaid. Toward this end, the state will establish local partnerships and coalitions and task them with shaping programs in their communities and adapting strategies to reach out to local populations with education and resources.

Other promising strategies for dealing with disparities

In his presentation “eHealth Solutions for Health Care Disparities,” Dr. Chris Gibbons, associate director of the Johns Hopkins Urban Health Institute, described current converging trends in health care, including the prevalence of chronic disease; a burgeoning senior population; increased longevity; rising health care costs; and the growing population of minorities, immigrants and the underserved.

A purely clinical or medical approach cannot achieve sustained improvements when faced with these challenges, he said. For that reason, technological interventions, such as e-consultations, telemedicine and remote monitoring, will increasingly become part of many health care arsenals.

Dr. Chris Gibbons presents “eHealth Solutions for Health Care Disparities

Dr. Chris Gibbons presents “eHealth Solutions
for Health Care Disparities

“For the first time in history, more Americans are going to electronic and online sources for health information than they are to their health care providers,” Gibbons said. As startling as that seems today, the reality may herald a major boon in the delivery of health care to tens of thousands of people who would otherwise be unable to access — or afford — more traditional care in doctor’s offices and hospitals.

To successfully turn the tide of rising health care costs and deteriorating public health will take a village, perhaps an army, of elected officials; urban planners, developers and architects; health care providers and hospitals; community groups; those in the food industry, public health and higher education; work sites and schools; and a catchall of nontraditional partners.

But according to many of the researchers and scientists attending the St David’s–CHPR research conference, the effort will be worth it. This brave new age could result in less delay in seeking care, fewer medical errors, and more accessible health information for both providers and patients.

“Over time, there exists real potential to make significant strides toward the goal of reducing and eliminating disparities in health and health care access, utilization and outcomes,” said Gibbons. “And ultimately in improving public health.”


Since 1999, the St. David’s–CHPR has sought ways to improve the health of underserved people through theory-driven, efficient and culturally competent health promotion and disease prevention research-based interventions. The annual conference is one way the group disseminates methods and findings to scientists, clinicians, policymakers and consumers.

In addition to Drs. Lakey and Gibbons, speakers included Kathleen Gaffney, professor at the School of Nursing, George Mason University; Mary Steinhardt, professor in the Department of Kinesiology and Health Education, and Sharon Horner, associate dean for research with the School of Nursing, at The University of Texas at Austin; and Dr. Roberto Rodriguez, senior program officer at the St. David’s Foundation.