Below is a briefing of the health issues facing cities in Boys State of Kansas. City councils may use this information as needed to define and understand challenges or to prioritize initiatives for the progress of the city. Each issue does not be addressed, and city councils may decide that a challenge included in the briefing is either not a problem or not one that needs to be prioritized.


Access to healthcare Boys State, like most other states, faces a growing healthcare cost dilemma. Over the last ten years, the cost of medical care has increased an average of 14% every year. The rising costs are making health care for the poor more expensive. Rising costs are also threatening the viability of county hospitals. The threat to county hospitals exacerbates the shortage of physicians in Boys State. The cost of health care directly affects county and city budgets. Boys State operates a health care program for unemployed citizens. Under the program, the state pays 60% and your county pays 40% of the cost of the plan. Today the cost is $20.00 per day and rising. Depending on the economy, as many as 15 citizens per county (or 5 per city) may be eligible for the plan. In addition to the high cost of health care for eligible citizens, another problem exists. Many citizens are employed but too poor to afford health insurance. Citizens who work in the service sector or who are paid less than the cost of living in their city are unable to afford private health insurance. Because these citizens are employed, they are ineligible for the state health care program. This group of “not-poor-enough” citizens does receive medical treatment at county hospitals, but at very high expense. The poor, employed citizens have no insurance and cannot afford primary and preventive medical care. Because most hospitals are not-for-profit businesses and will not turn away any patient at emergency rooms regardless of their ability to pay, poor and employed citizens wait until their condition requires them to use the emergency room. Emergency rooms treat the citizens but the costs are estimated to be at least five times as expensive as other forms of care. Legislators were concerned about the coordination of programs and services and whether adequate access was in place for soldiers and families and how the responsibilities for meeting veterans’ needs could shift from the federal to state level as defense spending is cut. Legislators said they wanted to make sure that state agencies were assisting the National Guard and other reserve forces in reaching members of the military who live in rural areas of Kansas. The concern is that those individuals will not readily have access to services in their communities, or broadband connections to get help online.


Family Planning Some have proposed school-based health centers that could distribute contraceptives to high school students. The program would use doctors from the health department, who prescribe contraceptives, and school nurses. Parents would be allowed to select any or all of four types of reproductive services that they did not want their child, if they are under 18, to receive, including emergency contraception, birth control pills, pregnancy testing, or condoms. However, this suggestion has encountered many critics. They argue that the school is overstepping their responsibilities, saying the responsibility of sex education lies with parents and that schools have no business providing contraceptives. Abortion continues to be a contentious topic among Boys State residents – clashes between those who consider it a women’s health issue clash with those who believe it is a human life issue, which includes but is not limited to religious groups. A preliminary report by the state for the year 2016 showed that 6,810 abortions were performed in the state (6,798 of them being performed by certified physicians). Of that total, 30.6 percent were ages 20-24, another 27.8 percent were ages 25-29, and 2.8 percent were under the age of 18. In 64.3 percent of cases, the fetus had gestated for less than 9 weeks, while less than 5 percent were performed after 17 weeks of gestation. Just over 80 percent of the women who received abortions were unmarried, and just 0.4 percent filed complaints of neglect or abuse after receiving the abortion.


Illicit Drugs and Drug Paraphernalia Public health advocates are requesting the removal of legal barriers to syringe access. Similar actions in other states have proven to be an important part of a comprehensive approach to reducing HIV transmission among injecting drug users (IDUs). Needle distribution comes with similar actions to treat injection drug use as a public health issue rather than a criminal matter. The National Institute for Public and Community (NIPC) states providing free needles and syringes is a cost-effective use of the Department of Health’s money. NIPC advices local clinics that harm reduction services for addicts should run throughout Boys State, suggesting combining non-judgmental needle exchange schemes with treatment to help users come off drugs. Research shows that needle distribution and treating the addiction is a more successful strategy for preventing the spread of HIV than incarcerating addicts. Legal barriers include both law on the books and law on the streets, i.e., the actual practices of law enforcement officers. Changes in syringe and drug control policy can be ineffective in reducing such barriers if police continue to treat syringe possession as a crime or evidence of criminal activity. This removal will also include training and education of police officers on avoiding accidental needle sticks and how to handle used syringes. The lack of proper training causes serious anxiety for officers and has resulted in the enforcement of laws relating to distribution and possession of syringes, despite their redaction. The move has drawn criticism from groups who say the program is at odds with their efforts to end injecting drug use, and some have threatened legal action. Religious leaders expressed similar views, urging the government to spend the money and manpower allocated for the project on drug rehabilitation instead. Still others contend that criminalization is the best route to preventing drug use and abuse.


Public Health A group of anti-spending advocates are pushing for ceasing free HIV testing in most Boys State regions. These advocates argue that money should continue going to areas with higher population, as these areas have the most cases of HIV, but in lower populated regions the money is not necessary and the funds would be better used elsewhere. Some health officials are concerned that a decision to stop providing free HIV testing in most regions will cause a drop in services for people with the virus. The add that for HIV+ individuals in low populated areas already have few health resources and any cut will drastically impact their lives and the spread of the virus. Some citizens have urged their elected officials to ban adding fluoride to drinking water; 75% of the citizens drink water with added fluoride. Fluoride is a controlled additive to public drinking water to reduce tooth decay, such as cavities and has been added to public drinking water for several decades. Dental health remains a serious and lingering public health issue. Eighty percent of school aged children suffer from dental-related health problems. More than half of these children do not make regular dentists visits as their family does not have dental insurance. Since adding fluoride, Boys State municipalities have seen an 18%-40% drop in cavities. The Center for Disease Control bills fluoridation of the drinking water as one of the top ten achievements in public health.


Your Task: Determine those issues that appear significant to your city and develop actionable experiments to address those challenges. Monitor the progress of these experiments to decide if further action needs to be taken. Experiments may take the form of city ordinances, collaboration between counties and cities on joint measures, or any other measure developed by the city council.