The barriers to creating a more healthy Butler County are many, generational and require a coordinated effort at all levels of community and government to create significant change, members of the health care and services community shared this week with state officials.
Missouri is in the process of conducting listening sessions across the state to complete its first full Missouri State Health Assessment since the start of the COVID-19 pandemic.
A report is expected to be available to the public by spring 2024, said Brian Houston, chair of the Department of Public Health at the University of Missouri. Houston
“That state health assessment will help inform programming and funding decisions in the subsequent years,” said Houston. “So this is an important process in terms of really identifying what needs there are across the state of Missouri.”
Houston led the discussion with more than two dozen individuals, comprised of area providers, government officials, program leaders, service organizations, volunteers and community members.
There are 18 listening sessions like this scheduled across the state, held in coordination with the Missouri Department of Health and Senior Services. The most recent DHSS State Health Assessment was completed in 2019, using 2018 data. Due to COVID, it did not include the extensive public listening sessions taking place now.
“Missouri ranks 42 out of 50 in terms of states regarding overall health,” Houston shared with the group before opening the meeting to discussion.
The ranking is based on data from 2018-2020 regarding length and quality of life, health and mental health, as well as low birth weight in newborns.
“The number of premature deaths ... (and) poor health days is higher on average than for the U.S.,” Houston said. “Overall, when we think of the health of Missouri from a state perspective, there’s opportunities for improvement.”
Butler County and the Southeast region of Missouri also face more challenges than other parts of the state in areas of social determinants of good health, such as income, level of insurance, education level, employment and other factors, Houston continued.
“The rate of poverty for this region is higher than the Missouri average. The rate of folks who are uninsured or don’t have health care insurance are higher,” he said.
At the county level, Butler, Carter, Ripley, Wayne and Dunklin all rank lower on overall health outcomes than much of the state.
“Butler is in the lowest 25% in terms of overall health compared to other counties in Missouri,” said Houston.
Stoddard was the only county in the region that rose above that level, falling at between 30-58% on the ranking.
“For many indicators, Butler County has more health challenges on some of these issues than Missouri does on average and the U.S. does on average,” Houston said.
Butler County sees 20% of its population in poor or fair health, compared to 15% at the state level and 12% nationally, according to information presented by Houston as part of a series of County Health Rankings prepared by the DHSS.
The data points did not surprise most of the participants at the meeting, who shared they not only know what the barriers are to creating a healthier community, but have given this information many times before to various levels of government officials.
Lack of services, inability to afford care, lack of transportation and lack of education are problems that have been around for decades in this region of the state, and have been discussed just as long, members of the group said. As part of the process of the meeting, they were asked to speak freely and told by organizers their names would not be shared as part of the public reporting process.
“We have these meetings and discussions, but has anything changed,” asked one participant.
“We’ve normalized so many things that we don’t even realize its an issue anymore,” another said.
It can create a feeling of helplessness and hopelessness, members of the group said.
They shared stories of serving those in need only to find two or more government programs won’t communicate with each other to provide a secondary service that is crucial to a primary service. In other situations, the application process can be so confusing and complicated, many in need have difficulty accessing the services.
Others have found so little is publicized about a program, those services are dramatically underutilized compared to the need.
“Obviously what we’re doing is not working, not the way we need it to,” said one provider.
“Unfortunately, (lack of) health equity is the majority of our counties in this area. We have systemic poverty,” said on individual.
Fixing that requires strong education opportunities and access to good jobs, they said.
“We can’t fix health without providers,” said another individual, as members of the group discussed strained systems they said often can’t help people at the time they are in crisis, particularly in the case of mental health needs or providing Medicare-funded dental care.
There is a growing lack of people interested in entering medical fields, shared one participant. It’s going to continue to create problems in finding providers, and in finding providers willing to relocate to rural areas, where income levels are low and health outcomes are poor.
One solution to that is encouraging youth to enter these fields, the individual said.
“If we want providers in the future, we have to do a better job of selling that to our kids,” the person said.
There are people who are trying to better themselves and improve their situations, but the barriers that exist can be overwhelming, and in many cases, insurmountable, the group said.
“The amount of people that are in need and want help, but can’t get it because it’s not there,” is a problem, said one person, adding that if it is overwhelming or difficult for a provider to understand the process to apply for certain government programs, how must that be for those in need.