Extending Iowa's Healthspan

It's Time for a Meaningful Measuring Stick

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Gov. Reynolds caught my attention when she proclaimed in her Condition of the State address this week that Iowa ranks # 4 nationally in health care. Whoa! What measuring stick is she using?

Later in her address the Governor added, "We rank #1 for lowest health care costs . . . We rank ninth for health care access."

I was stunned, however, when Reynolds went on to say Iowa has been named the #11 best state to have a baby. Iowa ranks #44 for physicians per capita, according to the Iowa Medical Society, and dead last in OBGYNs per capita in a recent American College of OBGYNs report.

Maternity Health Care Deserts are a growing problem in Iowa. More than 40 Iowa hospitals have eliminated maternal care in the last two decades. A total of 66 of 99 Iowa counties no longer provide labor and delivery services. The Kaiser Family Foundation lists Iowa at 20 in maternal deaths per 100,000 live births from 2018-2022, up from 14.7 In 2007.

When I called to ask the sources of these rankings, I was referred to U.S. News and World Report. After checking, I found Iowa listed as #21 in health care in the latest U.S. News and World Report ranking, and I saw the #9 rank for health care access. After additional searching, most of Iowa's top rankings are from WalletHub, a consumer financial app and website.

Is there a better yardstick than these disparate rankings to measure the health of Iowans and whether our state is investing enough resources into health care?

Roadblocks to Longevity

How about using life span as a measure? The average lifespan in the U.S. in 2025 is 79.4 years, far below other developed countries. In 1990, Iowa ranked #4 in life expectancy. In 2024, Iowa is #17. Does this seem like Iowa is headed in the right direction?

All states suffered Pandemic drops in life expectancy. In fact, 24 states haven't regained their pre-Pandemic levels. But Iowa's vital signs are troubling: Iowa has a higher death rate per 100,000 for heart disease, cancer, Covid-19, chronic lower respiratory diseases, and suicide than the U.S. average. We have an obesity rate of about 37%; more than one in three Iowans fall into this category. (Our population skews older, but it's similar to neighboring states).

in her Condition of the State address, the Governor highlighted one number she's not proud of: Iowa's #2 rank in new cancer cases over the past two years. She pledged to spend an underwhelming $1 million to jumpstart a partnership effort to study this trend. (Note: Fewer Iowans are dying from cancer.) The Iowa Cancer Registry's effort to host meetings to deliver county-by-county findings in 2025 earns a first rate ranking, in my view.

We know radon-related lung cancer is high in Iowa, due to radon's natural occurrence in the soil. We also know the annual Cancer in Iowa report points a finger at high alcohol consumption. (I wrote about this in my March 2 column, A Sober Message for Iowans.) The U.S. Surgeon General also recently delivered a warning shot across the bow. Skin cancer is elevated in Iowa, especially melanoma.

Now new research from Des Moines University shows a significant spike in HPV-related cancers in rural Iowa. For 20 years, urban and rural rates were comparable. This raises questions about whether information about sexually-transmitted diseases and the HPV vaccine is reaching rural Iowans. Planned Parenthood provides STS testing, cancer screenings, and birth control education. Is the HPV increase due to forced clinic closures, or vaccine hesitancy?

Inadequate health insurance and poverty also work against achieving robust longevity. But in her Condition of the State address, the Governor announced her intention to apply for a Federal waiver to add work requirements for "able-bodied adults" receiving Medicaid health coverage.

We know early childhood experiences impact life expectancy. Yet the Governor plans to re-submit a waiver to exempt Iowa from the Federal Summer Nutrition (EBT) program. The $29 million would provide $40 per child per month to eligible families (about 245,000 children), with Iowa paying half the administrative costs. She wants to substitute a $900,000 state program funded by competitive grants providing three monthly boxes to families at distribution sites.

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In rural areas and inner cities, a lack of grocery stores harms families. Our local Dayton Leader recently featured a front-page open letter from the Dayton Community Grocery Board warning of the store's imminent closure. Half of Iowans who experience food insecurity are obese, and Iowa's obesity rate jumped more than eight points in the past decade. An estimated $50 billion in U.S. health care costs attributed to heart disease, diabetes, stroke is associated with poor food choices.

Another factor is Iowa's declining rate of childhood immunizations, including whooping cough (pertussis). This decline is largely caused by vaccine misinformation following Covid-19. Where is Iowa's public health campaign to reverse this anti-vax trend?

I haven't heard Gov. Reynolds voice concern about Iowa's Pharmacy Deserts and the stranglehold of pharmacy benefit managers (PBMs). Yet a survey reveals that 10% of Iowa's independent pharmacies closed between 2008 and 2022. A total of 40% said they expect to close. Legislation reining in PBMs has failed to pass in Iowa for two years, due to PBM lobbyists.

What about stricter gun storage laws? Children are killing others or themselves because of unsecured guns in the home.

Proposed Legislation and Funds

The Governor mentioned the need for legislation requiring drivers to use hands-free phones. In 2023, Iowa showed a 12% rise in fatalities involving at least one distracted driver, resulting in the deaths of 3,522 people. The Iowa Senate passed it last session, but the House did not. Twenty-five states have outlawed hand-held cells. In those states, traffic deaths, crashes and insurance rates have dropped.

I'm glad the Governor is proposing new initiatives on childcare and pre-school, and maternal health care. She'll use $150 million in federal funds to create 115 new residencies at 14 teaching hospitals. (OBGYNs may not take the bait, due to Iowa's restrictive abortion law and malpractice cap.)

She'll add $10 million in loan repayment programs for physicians who practice in rural Iowa for five years, and tap more money in grants for employers to train more nurses, CNAs, and LPNs. She wants to pay hospitals and physicians more in cases of complex maternal care.

A New Rx for Increasing Health Span

If only Governor Reynolds and legislators would understand that investment in medical care alone is insufficient to improve health outcomes. The solution is more complex than Iowans skipping on servings of fruits and vegetables or spending too much time in the Barca Lounger. It stretches beyond the obvious shortfalls of the health care system.

It requires shifting our mindset from a focus on increasing life span to a new push for expanding health span, defined as "the period of life that's free from serious disease." By some estimates, age 63 is our average health span---before onset of most chronic conditions.

Shrinking the gap between a lifespan with 20 years of chronic conditions and a health span prioritizing years of healthy, productive, active life requires legislators to write policy prescriptions involving:

• Food and nutrition access

• Higher education as a link to good health

• Poverty and inequality's inverse relationship to good health

• Prevention of pharmacy deserts

• Cleaner water and air

• Safety from physical violence

• Child labor protections

It's hard to escape the through line from a declining life expectancy in the U.S. to our stubborn individualism, worship of free enterprise and de-regulation, and mix of religion and politics.

Add to that our unhealthy fixation on the God almighty, "What's in it for me?" argument. When the Governor said Iowa "needs to be lean at the local level," she wasn't talking about reducing our BMI. Truly, our core values are reflected in state and federal budget decisions.

"In just a few short years," Reynolds told Iowans this week, "we've turned our state into a national model for bold-get-it-done government." She probably didn't have Iowa's #38 ranking in Health Care Quality, or #24 in Public Health rank in mind. (U.S. News and World Report)

The beginning of a New Year is marked by our resolutions to focus on good health. We set benchmarks to accurately measure our progress. We measure what matters. But a smoke-and-mirrors exercise isn't the answer.

"Iowa is #6 Best State overall, but always #1 in my mind," the Governor said. Rah, Rah. Iowans deserve more than a "We're Number 1" pep rally chant. We need a governor who will call for a BOLD, get-it-done playbook to create a new clean bill of health for all Iowans.

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