Health & Wealth Desk

Pippa Hull sits on her mother’s lap across the kitchen table in their Parkville home. She is an outgoing and talkative seven-year-old girl, who just happens to have a rare and severe form of epilepsy called Lennox-Gastaut syndrome. Pippa’s mother, Megan, said this form of epilepsy is characterized by its lack of response to treatments.

Hull said they have tried different medications, they have had a VNS or Vagus Nerve Stimulation device implanted in Pippa’s chest, and they have even tried a special diet to try and reduce the number of seizures Pippa experiences.

It’s generally known that women tend to live longer than men. But what’s less known is how the same longevity can be a  financial burden for women.

Last month, the Women’s Foundation of Greater Kansas City and the MU Institute of Public Policy released a report called Status of Women in Missouri. According to the report, women make up two-thirds of the Missourians aged 65 and older who are living in poverty.

“Their lives are much longer but then you couple that with the pay gap,” said Wendy Doyle, President and CEO of the Women's Foundation.

Aaron Banks, a Columbia native, spent more than a year investigating crimes by listening to phone calls from prison inmates to their friends, family and children. He said the conversations with children really struck a nerve with him. 

“They would be asking when am I going to see you again? why aren’t you at home? And that kind of stuff. It was just heartbreaking to hear that sort of thing," he said.

Banks said these overheard conversations began to affect his relationship with own children, so he began to spend more time at home and this made his craft beer hobby more difficult.

Hepatitis C is a virus that affects the liver, often causing liver cancer or cirrhosis. Although they share a name, it is completely different from hepatitis A or B so current hepatitis vaccines don’t guard against hep C.

The Centers for Disease Control and Prevention estimates that about 3.2 million people in the United States have hepatitis C. But Bruce Burkett, Founder and Director of the Hep C Alliance, said the disease often goes untreated simply because people don’t know they are infected.

Megan Oberg had a rough time after her first two deliveries. One moment she'd be happy, in another, not really. And she said that's pretty typical.

“Most women who have given birth can tell you some time during the first two weeks you tend to have some ups and downs as far as mood swings, as the hormones leave the system,” Oberg said.

For her third pregnancy she decided she wanted to try something new.

  It’s no secret that health insurance can be a confusing topic.

“There's not a ton of health insurance literacy,” said Aaron Swaney, Outreach Enrollment Specialist for the Family Health Center in Columbia. ”But that's true from people who have never had health insurance before to people who work in the healthcare field.”  

Prescription drug abuse can start with a routine problem, like lower back pain. A doctor will prescribe medication for the patient, but the pain doesn't go away. So the patient takes more medicine. 

And this behavior could lead to an addiction, said Len Paulozzi, an epidemiologist for the CDC. He finds patterns of drug abuse. 

There is a long list of to-do’s when applying for a medical license in Missouri. Applicants have to provide detailed verification of their degrees, residency and previous work experience. Tack on several months for the state medical board to review all these items, and the whole process can take a lot of time.

Most physicians go through this process when they are first applying for a medical license. But the Federation of State Medical Boards (FSMB) found that many doctors don’t stop at one license.

When Mary Ratliff moved to Columbia from Mississippi in 1959, she was leaving one of the epicenters of American segregation and the burgeoning civil rights movement. But that doesn’t mean she escaped experiences of racism and segregation in her new home.

“It was subtle here when I first came," Ratliff said. "In fact I've made the comment many times, that Columbia is 'Big Little Dixie.' It wasn’t a whole lot different from Mississippi.”

The Affordable Care Act included a temporary bump in the Medicaid fees paid to physicians for certain primary care services. The intention behind the two-year, federally-funded increase was to encourage more physicians to participate in Medicaid to accommodate an expanding pool of Medicaid patients anticipated by the law.

But a 2012 Supreme Court decision opened a window for states to reject Medicaid expansion – Missouri is one of 23 states that have chosen not to expanded coverage – and as of Jan. 1, the Medicaid fee bump is expired as well.

I spoke with Dave Dillon and Andrew Wheeler of the Missouri Hospital Association (MHA) about the impact the fee increase expiration will have on Missouri hospitals.

The Missouri Association of Local Public Health Agencies (MoALPHA) was founded in 1994 to support the  city and county public health agencies in the state. I spoke with the incoming chair of the association, Gary Zaborac, about the public health challenges facing Missouri in 2015.

As the use of telemedicine expands it is also growing the footprints of medical professionals, and when doctors licensed in one state begin consulting in another, it presents a problem for state medical boards. KBIA’s Hope Kirwan spoke with Jonathan Linkous, CEO of the American Telemedicine Association, about how states are regulating telemedicine.

If you’ve ever lived in - or even visited - a small town, you know they can be pretty quaint. And Milan, Mo, population 1,881, is no exception.

Milan’s local hospital, Sullivan Country Memorial, has been around since 1953. Joe McCarty, a local resident and now patient in Sullivan’s long-term care unit, has lived in Milan almost his entire life – he’s turning 100 this year. Joe made his living as a cartoonist and up until just a few months ago he worked for the local newspaper.

  Dr. Karen Edison is a dermatologist with the University of Missouri Health system. She has been using telemedicine for over 20 years to see patients at clinics in underserved areas of the state, and to follow-up with her rural patients in their homes. She can see photos of her patient’s skin, answer their questions through email, as well as talk with them through video calling.

Edison says telemedicine is a useful tool because it can save rural patients a trip to her office.

But rural patients aren’t only the ones looking to save time and money.

  Open enrollment for health coverage in 2015 is underway, and some Missourians satisfied with their current health insurance may be surprised to learn that parts of their plans, including premiums, are changed for the coming year. The Cover Missouri Coalition, a program of the Missouri Foundation for Health, is encouraging consumers to review their options during this year’s open enrollment period.

I spoke with Ryan Barker, Missouri Foundation for Health’s Vice President of Health Policy, about changes in this year’s health insurance marketplace.

  Last week marked the beginning of open enrollment for the federal health insurance marketplace, and on the surface it appears not much has changed. By some measures premiums before tax credits are just as affordable as last year - decreasing on average by about one percent according to a report by the Kaiser Family Foundation. But to be a savvy shopper, many consumers should give the marketplace a second look.

Obesity is the number one public health issue in Missouri – it affects more than 30% of adults and nearly one in seven children between the ages of ten and seventeen.

The Healthcare Equality Index is a national benchmarking tool that ranks hospitals based on whether their policies and practices include equal treatment for the LGBT community. Missouri’s standing in this index jumped from 37th  in the nation to 6th in just one year.

I spoke with Andrew Shaughnessy, Public Policy Manager of the Missouri LGBT advocacy organization PROMO, about why this ranking is so important and what it means for Missouri. 

  Last month, the Human Rights Campaign called on the Centers for Medicare and Medicaid Services to address LGBT discrimination in healthcare.

Sarah Warbelow is the Legal Director for the Human Rights Campaign, a national LGBT advocacy organization. She said many LGBT individuals are hesitant to seek care based on a history of discrimination by healthcare providers.

It’s a well known fact that fast food contributes to poor overall health. But what about the receipt that comes with those yummy French fries?

I sat down with MU researcher Dr. Fredrick vom Saal, whose recently published work shows how fast food receipts expose us to a dangerous endocrine disrupting chemical called BPA.

When people think of the United States Department of Agriculture, they of course think about things related to agriculture - farms, crops, livestock.

But Secretary of Agriculture Tom Vilsack said the USDA is about much more than that. It’s really about improving the quality of life in rural areas.  

“It's important I think because of the people who live in rural America and the contributions they make to the rest of the country," Vilsack said.

In partnership with the Institute of Public Policy at MU, the Women’s Foundation of Kansas City is collecting information about Missouri women for a public database, including things like income and employment, education, childcare and health.  I spoke with Wendy Doyle, President and CEO of the Women’s Foundation, about how the project could have an impact on women's issues in Missouri.

Studies have shown that students who went to preschool have higher rates of achievement later in school. It's also believed that preschool has a positive effect on children’s social and emotional development.

But the Missouri Department of Elementary and Secondary Education has identified several areas of the state where families don’t have access to quality preschools. The state has applied for a grant through the U.S. Department of Education to expand the state’s program in these high-need areas. Missouri is competing with 16 other states for the Preschool Development grant, which will be awarded by the end of December.

KBIA’s Hope Kirwan sat down with Stacey Preis, Assistant Commissioner for the Office of Early and Extended Learning, to talk about Missouri’s need to expand preschool education.

Matt Gibbens has been riding all-terrain vehicles, or ATVs, for a long time, but he’s never taken a safety course.

“I know there's a lot of them out there but I've just grown up on them,” Gibbens said.

Gibbens grew up on a farm and said he’s used ATVs for both work and play. But despite his experience with the machine, he’s still dressed from head to toe in protective gear, including a helmet, goggles, and chest protector.

Gibbens said he thinks about safety every time he gets on his ATV.

This is the fifth story in a series from the Health & Wealth desk on Healthy Nevada. 

All this week we’ve been talking about the population health experiment that the health technology company Cerner is conducting in the town of Nevada, Missouri. But there are still a lot of unanswered questions. Will Cerner’s message and grassroots approach resonate with people in this rural community? Can small changes like new playground equipment and a community garden really have an impact on Nevada’s poor health rankings? And, more simply, will this program work?

To help forecast what may come from Cerner’s efforts in Nevada, I spoke with Dr. Keith Mueller, the Director of the Rural Policy Research Institute at the Center for Rural Health Policy Analysis. 

This is the fourth story in a series from the Health & Wealth desk on Healthy Nevada. 

The TV show “Parks and Recreation” chronicles civic life in the small fictional town of Pawnee, Indiana. Rural Pawnee is depicted with broad brushstrokes for comedic effect – ordinary town hall meetings frequently turn violent over small issues, soft drinks come in outrageously huge sizes, and a dedicated idealistic city hall employee named Leslie Knope will stop at nothing to help her community.

But in Nevada, Missouri, that parody of a rural town isn’t too far from the truth, right on down to that idealistic, dedicated civic leader.

Around 1950, cities in the U.S began adding fluoride to the water supply as a way to reduce tooth decay. And ever since, water fluoridation has been a debated issue. Despite evidence that fluoride treatment is beneficial to oral health, the town of Waynesville, Mo. recently voted to stop adding fluoride to its water system. 

But ending water fluoridation in Waynesville didn’t involve activists, budget cuts or a heated debate.

This is the third story in a series from the Health & Wealth desk on Healthy Nevada. 

Dr. Kristi Crymes is a family medicine doctor at the Nevada Medical Clinic. Crymes came up from Springfield three years ago to work in Vernon County, which has some of the state’s poorest health rankings. In 2010 the obesity rate in Vernon County was 30 percent. The incidence of adult diabetes has hung around 11 percent for the past 3 years. 

This is the second story in a series from the Health & Wealth desk on Healthy Nevada. 

The town of Nevada, in southwest Missouri, is changing in very subtle ways. To see it you really need to know where to look. For example, Walton Park, on Atlantic Street, used to be one of the town’s less popular parks for kids – just a small slide, a merry-go-round, and two swings. But today Walton Park is where all the cool six-year-olds go, thanks to one new piece of playground equipment.