Valerie Strasburger and Professor Stephanie Fugal, Health Science
The majority of health disparities in Alaska are related to reliable and affordable access to health care. This is particularly relevant to the communities in southeast Alaska (SEAK) because many of them are isolated island communities. The purpose of my research was to determine the areas in SEAK with the most severe limitations to enable health professionals in this region to meet the goals set in Healthy Alaskans 2010.
Methods
The data I used was derived from two databases on the state of Alaska website: The Alaska Community Database Online and The Division of Occupational Licensing Database. In addition, other information was collected by personal communication via email sent by employees of the state of Alaska Department of Health and Human Services located in Juneau. The data were organized by city and by proximity to each other within the region. The most efficient analysis was to break the region of SEAK into areas surrounding the most immediate location of health care service. The nearest location was determined by comparing distances calculated by a longitude latitude calculator developed by CSG, Computer Support Group, Inc., which was accessed via the internet. The distances were calculated using the coordinates given for each city in the state database.
When comparing the ratio of health professionals to population, a percentage was calculated for each community. The percentage of health professionals in the region licensed in a particular community can be compared to the percentage of the population in the region living in that community. Creating a percentage ratio was deemed the best method of comparison for each profession because it illustrates the discrepancy between the percentage of the health care provider population with the percentage of citizen population in each community. This assumption also indicates that a 1:1 percentage ratio is ideal for the region because a 1:1 ratio means that there is an equal distribution of licensed health professionals to the population in the region.
Findings and Recommendations
Southeast Alaska has a unique geographical situation within the state of Alaska with one major population center, two smaller centers and a handful of significantly smaller communities throughout the region. The proportion of health professionals in the three major cities is either greater than the population, or very near the equivalence point with the population. The smaller communities are grossly underserved, with more than 50% of the communities in the region lacking a licensed health care professional. The large proportions of health care professionals in the larger cities distort the averages for the region, and require an individual analysis of each community to determine health care access and availability for the entire SEAK region. Juneau, Sitka and Ketchikan have easy access to a wealth of health care facilities and services and provide care for many of the outlying communities without immediate access to such facilities and services. Craig, Haines and Wrangell also serve as substations for many communities due to their minimal health care services and professionals.
Emergency services is also an area to be addressed in the SEAK region. The only paid EMS response unit is in Juneau, which leaves more than 50% of the population in the region to rely on volunteers to possess the knowledge and skills necessary to respond to a medical emergency. At least one of the hospitals in the region, the Wrangell Medical Center, has recently downgraded the services it offers, rather than becoming certified as a Trauma Center, and the others have yet to become certified. This is a critical goal for SEAK as so many communities are isolated. The more hospitals certified as trauma centers, the less distance between the isolated communities and critical emergency services.
The profession of nurse practitioner is severely underrepresented in comparison to the other levels of nursing care. Nurse practitioners are trained and licensed to perform many of the same functions as a primary care physician; it would be highly advantageous for communities throughout the region to encourage citizens and students to pursue this field and practice within their communities. Promoting this profession could be the single most effective way to combat the discrepancy in health care access in the communities of SEAK.
With only three years left to accomplish the goals set for 2010, increasing access to primary health care in SEAK remains a problem. While some physicians currently travel to outlying communities on a quarterly to yearly basis, this only offers up to four opportunities during the year to receive primary care in some isolated communities. An incentive for developing primary care practices in smaller communities, and for other existing practices to travel to nearby communities on a more regular basis, is necessary to increase the access of isolated communities to a primary care physician. Also, promoting the professions of nursing and physician assistant in smaller communities would increase the likelihood for students from these communities to receive the training necessary to return and serve their fellow citizens.
A further study on the health disparities within the SEAK region would identify whether specific communities, namely the communities without local access to licensed health care providers, have higher rates of health problems. Prevalence and incidence rates of specific diseases and injuries in each community would be a great resource in planning the future locations of health care centers in the region, as well as targeting the disparities for each community, enabling the state to reach the goals set in Healthy Alaskans 2010.
Another recommendation to increase the ability of the state to identify areas with the most limited access to health care is to track the primary residence of patients in the health care facilities located in Juneau, Sitka and Ketchikan. If the illness or condition of the patient was included in that information, it would be possible to recognize disease patterns and region specific susceptibility to injury or infectious disease, thereby enabling health professionals to target preventative behaviors.
Ultimately, the concluding recommendation to enable the state of Alaska to reach its goal of increasing access to health care is to set goals specific to each region within Alaska and require reporting of all patients. These reports should be compiled in a region-specific database that can then be utilized to identify trends, region specific disparities and eventually, possible solutions to the problems.