State health status

UND issues seventh biennial report on health issues for the state of North Dakota

The 7th Biennial Report on Health Issues for the State of North Dakota updates both lawmakers on the state’s current health care system and suggests next steps for North Dakota to ensure that all residents can receive high-quality, affordable health care. Web screenshot of report cover.

As the North Dakota Legislature continues its 68th session, the UND School of Medicine and Health Sciences and its partners have released the Seventh Biennial Report on Health Issues for the North Dakota State Report.

This report, required by the school under the North Dakota Century Code, updates lawmakers on the current health status of North Dakotans and their health care delivery system, along with an analysis of steps the state can take to to ensure that all North Dakotans have access to high-quality, affordable health care now and in the future.

“Our first biennial report was produced during the 2009-11 biennium and was released just before the start of the 62nd Legislature,” recalled Dr. Joshua Winn, dean of SMHS and vice president for health affairs at UND. “A total of six reports have been published every two years since then, with the just-released update being from 2023.”

Health Workforce

According to Wynne, this latest report, coming on the heels of the worst global pandemic in a century, comes at a pivotal time for health and health care in North Dakota.

“It goes without saying that COVID has put our nation’s health and healthcare system to the test over the past two years,” he continued. “Not only in the way it has affected our population and their access to care, but also our health care workforce.”

For a state already struggling not only with a shortage of health care providers but also with the misallocation of those providers, Winn said, COVID has hit many rural hospitals and clinics especially hard. As the report notes, the pandemic has exacerbated “burnout” among the health care professions, leading to early retirements and resignations among some providers — thus greater shortages overall — while increasing workloads for those doctors, nurses and therapists who remained in their professions.

The need for health care workers is particularly important in rural and western North Dakota, where there has been a chronic shortage, particularly of primary care providers, for many decades, the report’s summary notes: “Without direct intervention, the difficulty of providing adequate health care in North Dakota will deteriorate in the coming decades due to an aging population (including the aging and eventual retirement of the health care workforce), which will increase the demand for health care services in these areas.”

Still, the health workforce news is generally good for North Dakota, said the report’s lead author Mandy-Lee Peterson, a senior researcher at UND’s Center for Rural Health.

“North Dakota’s efforts to train our own seem to be working,” Peterson said. “In previous reports, North Dakota had fewer physicians per capita than our Midwestern and U.S. counterparts. While this is still true, we have narrowed the gap in provider-to-population ratios. Another area where we are moving in the right direction is that we have seen an increase in the number of health professionals in the state. The number of graduates in the state practicing in the state has also increased.”

Population health

Such positive trends impact the overall health of North Dakotans, Peterson continued. This latest report suggests that regardless of COVID, the health of North Dakotans appears to be improving.

“Prior to the pandemic, North Dakota showed distinct trends in health behaviors, with improvements over time in areas that suggested positive behavior changes,” Peterson said. “And according to national data, North Dakotans are now more likely to report good overall health than the U.S.”

For example, the percentage of respondents who reported smoking, drinking excessively and driving under the influence decreased from 2019, according to the report. And in the past few years, the percentage of North Dakotans who wear a seat belt regularly has increased.

Accordingly, the percentage of North Dakotans reporting merely “fair” or “poor” health has decreased by nearly two percentage points since 2019.

Health education

One notable takeaway from the report, Peterson added, is the university system’s stunning response to the pandemic. SMHS, UND’s College of Nursing and Professional Disciplines, and NDSU’s College of Pharmacy made massive programmatic and curricular changes quickly to continue to provide the highest quality educational opportunities for students despite the challenges of class cancellations and system-wide uncertainty.

“The programs have been able to provide opportunities for students to complete their curriculum and graduate on schedule to join the workforce at a critical time,” she said, singling out UND’s Master of Public Health program in particular for its efforts. From April 2020 to June 2022, MPH faculty, students and staff used funding provided by the North Dakota Department of Health and Human Services to send more than 180 case investigators to work 80,113 hours in an effort to combat with the spread of COVID.

“The MPH program’s contribution to the state’s contact tracing efforts has been a very important asset that serves the entire state,” Peterson said. “An additional highlight was the collaborative response at the regional level by public health, health systems and organizations to coordinate large-scale vaccination efforts to ensure that vaccines are available to the public in a highly organized and efficient manner.”

Ultimately, both Winn and Peterson suggest that the health picture, while not perfect, is improving in North Dakota.

“Several years ago, Governor Doug Burgum asked me to lead a task force tasked with developing a strategic health plan for the state of North Dakota with the goal of making North Dakotans the healthiest people in the country,” Winn concluded. “We have since taken this plan to the North Dakota Department of Health and Human Services and State Health Officer Dr. Nizar Webby. And as this new data from this report shows, while we have a long way to go to achieve this bold goal, North Dakota is moving in the right direction.”

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