Q&A: Dr. Rhonda Randall:

There is no ‘one size fits all’ approach to improving the health of our communities

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Dr. Rhonda Randall

Mon, Mar 2, 2020 (2 a.m.)

Since 1990, the United Health Foundation has helped create awareness of how states and the nation are faring across a wide range of public health measures through its platform America’s Health Rankings. Over the past 30 years, the understanding and science of public health has changed dramatically. Many health issues that were concerning in 1990 remain so today, and additional issues have arisen that require action now.

Dr. Rhonda L. Randall, D.O., senior medical adviser to the United Health Foundation and the America’s Health Rankings platform, talks about findings from the 2019 annual report and how Nevada fares nationally.

Tell us your background, how your career has evolved and about your primary duties in your current role?

I’m a fellowship-trained geriatrician and am board-certified in family practice, hospice and palliative medicine. Currently, I’m chief medical officer of UnitedHealthcare Employer & Individual, which serves the health coverage and well-being needs of nearly 28 million Americans.

I collaborate with U.S. employers who are looking for quality, cost-effective, long-term solutions to health benefits for their employees and retirees. I also lead the clinical strategy development for these businesses to improve quality outcomes, ensure affordability and improve health and well-being. Additionally, I support UnitedHealth Group’s clinical strategy through my work in the corporate office of Medical Affairs and as a senior medical adviser to the United Health Foundation and the America’s Health Rankings platform.

What is the mission of your organization?

America’s Health Rankings builds on the United Health Foundation’s work to help draw attention to the cornerstones of public health and better understand the health of various populations. The mission is to provide a wide variety of health and health-related information to help policymakers, advocates and individuals understand a population’s health in a holistic, inclusive manner.

What is the purpose and methodology behind the foundation’s annual report?

The model and measures used in the annual report have advanced as our understanding of public health has evolved. Today, measures cover health behaviors, community and environment, policy, clinical care and outcomes data, drawing from 19 publicly available data sources. The current model reflects a greater understanding of how broader determinants, such as education, air pollution and the supply of mental health providers, impact our overall health.

The United Health Foundation provides actionable insights in this report, along with the online database of more than 160 measures. America’s Health Rankings will continue to provide an evolving state and national snapshot to inform and drive action to build healthier communities. As the country continues to make progress and different health challenges arise, the report will lead important public health discussions and spark action.

How does Nevada rank nationally and in comparison to neighboring states?

Nevada is the 35th-healthiest state in the nation, which is up one spot from 2018. Since the inaugural report in 1990, Nevada has improved 10 spots. Nevada ranks lower compared with its neighboring states of Utah (No. 5), California (No. 12), Idaho (No. 16), Oregon (No. 22) and Arizona (No. 31).

Based on the report, what are Nevada’s biggest strengths, challenges and overall highlights?

Nevada’s strengths include a low prevalence of obesity, high HPV immunization coverage among adolescent males, and a low percentage of children in poverty. Nevada is challenged in areas related to its high violent crime rate, low rate of primary care physicians and high cardiovascular death rate.

Nevada has enjoyed a 36% increase in dentists since 2003 and a10% increase in immunizations among toddlers since 2012, but also a 46% increase in chlamydia since 2009 and a 20% increase in adult diabetes since 2012.

Nevada has one of the highest death rates due to cardiovascular deaths. What can be done on a state level to curb those numbers?

Interventions to reduce the burden of cardiovascular disease should focus on improving access to quality health care and addressing risk factors such as unhealthy diet, physical inactivity, obesity and diabetes.

The state has seen a continued drop of infectious diseases the past few years. What initiatives are in place on a local and national level to keep infectious diseases on the decline?

Nevada has one of the lowest rates of infectious disease in the country. Immunization is a cost-effective prevention method. Childhood vaccine programs in particular prevent millions of cases of disease and reduce health care costs. The Centers for Disease Control and Prevention tracks these and other infectious diseases through the National Notifiable Diseases Surveillance System. Monitoring infectious diseases helps identify, control and prevent outbreaks. In addition, careful surveillance can prevent the re-emergence of old diseases in addition to new infectious threats.

What can state leaders do to improve the overall health of residents?

We encourage policymakers, health officials and community leaders to engage in meaningful dialogue about the data we provide. The insights from this year’s report can and should encourage even greater cross-stakeholder collaboration and drive action in improving the lives of Americans and the health of their communities.

If you had the power to change one thing in our health care system, what would it be?

There should be a greater focus on health care prevention strategies such as immunizations and screenings. We can see that in the states that are ranked higher in the Annual Report, individuals are generally making better choices around their own health, and their communities are making strides to be more physically active, smoke less, finish high school, maintain healthy weight.

Prioritizing these issues sets you up for a lifetime of better health. Once preventable illnesses start to manifest themselves, the cost associated with diseases like diabetes, heart disease and renal failure come with an emotional and financial burden on the individuals, their communities, the states and the nation. We end up in a bigger problem than we can solve, and most cases were preventable if we would have intervened earlier.

What is the best professional advice you’ve received?

One of the physicians who trained me early on would tell us every day to “do good things.” I know it sounds simple and it’s probably akin to the oath we take to do no harm, but it’s a not-too-overcomplicated mantra that I keep top of mind.

Anything else you want to tell us?

America’s Health Rankings is more than just a report. It has developed detailed analyses on the health of key populations in the country, including seniors, women and children, and those who have served in the U.S. Armed Forces.

One of the key takeaways from the platform is to understand just how local health is. There is no “one size fits all” approach to improving the health of our communities. Community and environment, individuals’ access to care, as well as the engagement of public health officials and local officials, all play roles in building healthier communities.

The United Health Foundation is proud to lead this effort through America’s Health Rankings, providing insights for healthier communities. To learn more about America’s Health Rankings, visit www.AmericasHealthRankings.org.

This story appeared in Health Care Quarterly.

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