Kansas, like every other state in the nation, faces a wide variety of public health threats in the coming years. many threats lom on the horizon As a large portion of the state’s population ages and the health insurance industry faces growing challenges in cost and delivery, Kansans will need to shift the way they think about health. A focus on prevention will have to supersede the current emphasis on treatment. Kansans have to start thinking of health as something that extends far beyond the doctor’s office, and which includes everything from a healthy diet to sufficient exercise to quality early childhood care.

We asked four KU Medical Center professionals about their thoughts on the major public health challenges the state will face in the next few years.

Chet Johnson, MD, professor and chair of the Department of Pediatrics

Infants and children in Kansas face threats from several factors, but a few relatively simple steps can be taken that would rapidly improve the prospects for Kansas’ youth.

There are three things we need to do immediately to cause dramatic change for Kansas children. First, we need to make sure every woman is healthy during pregnancy. Second, we need to provide families with support and knowledge, especially during the child’s first five years. If they feel good about parenting, they will become loving and effective parents. Third, we need to provide excellent early education. Learning is a lifelong process, and we need to ensure that every child has the highestquality education possible.

It’s very simple. If you invest in kids early, you save money later. But we haven’t been doing this because we’re a society that tends to think of things only in the short-term. For example, if you don’t make sure that women have access to good prenatal care early in their pregnancy, there can be enormous societal and health costs down the line.

Russell Swerdlow, MD, professor in the Departments of Neurology and Molecular and Integrative Physiology

Thinking about the future of public health for aging Kansans means taking care of an organ often overlooked: the brain.

We have to focus on the elderly in Kansas suffering from Alzheimer’s disease. Everyone is at risk if they live long enough. It’s much more common than people think.

In order to help the elderly in Kansas avoid the onset of Alzheimer’s disease, we must stress the importance of staying connected and exercising the mind. We have to help people take care of themselves and age well. That means eating right, exercising, learning something new every day, and staying socially connected. You can’t just sit at home and watch TV to the exclusion of all else. You have to make sure you get out and engage with other people.

One of the challenges posed by the structure of western Kansas is the solitary lifestyle often encountered by the elderly, who may be miles from potential social connectedness.

Interpersonal communication is probably best for mental health and for creating a safety net. People in rural settings with limited opportunities for interaction need to take advantage of new technology, such as e-mail or Web cameras.

Belinda Vail, MD, professor and vice chair of the Department of Family Medicine

Solving the public health threats facing Kansas is going to require a whole new way of thinking about what a health care system should be.

We already have a shortage of family medicine doctors, and now we have fewer surgeons doing general surgery. We have this perfect storm brewing with obesity, smoking, diabetes, and health care costs increasing. These are all huge problems, and they’re easy to solve on paper but difficult in practice.

The shortage of family physicians is a major concern in a state with an aging population, and solving the problem is going to require a combination of incentives – salary increases, loan repayment, and the like – and the recruitment of students with an interest in rural practice. But this is not purely a financial issue. It’s lifestyle, infrastructure, and opportunity.

Of greater importance, though, is the need to shift the way we conceive medical care.

We need to start in schools, teaching nutrition and encouraging more exercise. This will help us avoid lifestyle burdens that come later, like tobacco use and obesity. We have to go back to focusing on preventive care, and not just care from doctors.

Lorene Valentine, director of Rural Health and Education Services

Our current rural health and education programs in Kansas span the health care spectrum, from loan forgiveness programs for students to finding the best replacements for retiring rural doctors.

Some of the most significant challenges we face are in recruitment and education. It can be difficult to recruit young health professionals in some of these rural areas, and local doctors can’t retire until we find their replacements. With the aging of the population, it’s not easy to find enough physicians to go around.

Improving and ensuring public health means making certain that rural doctors have the latest information and treatment options. To that end, the rural health staff holds continuing medical education classes for physicians throughout the state and helps streamline the paths of information from bench to bedside. +