The Impact of Behavior on Health Status in the Southeast
By CINDY SANDERS
UnitedHealthcare Annual Rankings Highlight Good & Bad
As Americans begin a new year filled with good intentions to kick bad habits, eat healthier and increase physical activity, United Health Foundation's annual America's Health Rankings® might serve as extra motivation to stick to those resolutions.
Once again, the Southeast falls to the bottom of overall health status linked to challenges with weight, inactivity, smoking and drug abuse. The 2017 report that was released last month ranks eight southeastern states in the bottom 10 with Tennessee, West Virginia, Alabama, Arkansas, Louisiana and Mississippi ranking 45-50, respectively. Tennessee moved down one spot from the 2016 report.
Despite the obvious health concerns faced by the region, Karen Cassidy, MD, chief medical officer for UnitedHealthcare Commercial and Medicare for the Mid-South and Gulf States, said it was important to recognize that all states have both challenges and areas of leadership. Rather than feeling discouraged by a specific ranking, she said the goal is for healthcare providers, policymakers, public health officials and community partners to take a deep dive to look at trends and search for solutions.
Even among the healthiest states, there are significant issues threatening health and well-being. "From a national standpoint, we're seeing a rise in premature deaths," Cassidy said of the increase in the years of potential life lost before the age of 75. The premature death rate rose for the third straight year and marks a 3 percent increase from 6,976 to 7,214 years lost before age 75 per 100,000 population since 2015.
While the data doesn't pinpoint specific causes for the increase, a number of health trends are likely contributors including an upward tick in the rate of drug-related deaths, a second consecutive year of increased cardiovascular deaths, and continued high rates of obesity and of unhealthy behaviors. "As we've seen, obesity and diabetes rates are going up every year. I think that directly speaks to premature deaths ... you can't pull those apart," said Cassidy.
Drug-related deaths are a growing concern in Tennessee. In the 2017 report, the state ranked 39th in the nation, and Cassidy pointed to a troubling statistic. "In Tennessee, we saw an increasing trend (in drug-related deaths) ... it's up 27 percent over a five-year period," she noted of the rise from 15.7 to 19.9 deaths per 100,000 population.
Excessive drinking is another issue to monitor. While Tennessee's low prevalence of excessive drinking has consistently been a strength - and Tennessee still ranks number 6th in 2017 - the concern was a 29 percent jump in the number of adults who reported binge drinking or chronic drinking over the past year. In a 12-month period, the numbers increased from 11.2 percent of adults to 14.4 percent of adults, which is still considerably lower than the national average of 18.5 percent of adults.
There was also good news for Tennessee. Cassidy pointed to a relatively small disparity in health status vs. education and low incidence of pertussis among Tennessee's strengths. She said it's also important to keep perspective even in areas where Tennessee lags. Despite still having higher smoking rates than other areas of the country, she pointed out, "Our rates are lower than they were 20 years ago so it is falling. It's just not falling as quickly as everywhere else."
Other highlights include a 16 percent decrease in infant mortality over the past seven years, and a 29 percent drop over the last five years in preventable hospitalizations among Medicare enrollees. Unfortunately, 34.8 percent of Tennessee adults are now categorized as obese, which is a 19 percent increase over the last five years.
Looking at the data in aggregate, Cassidy said behaviors seem to be a signficant driver behind so many poor outcomes. "I think it should be a call to action for physicians across the country to be working on those preventable lifestyle choices very seriously," she noted. With New Year's resolutions freshly made, she said it was a great time to initiate difficult conversations. Even when met with resistance, Cassidy added, it's important not to let a 'no' be the final answer when it comes to quitting smoking or losing weight. "I still think we have to reopen that conversation intermittently and let patients know you're ready to be there for them."
She was quick to add many providers are already routinely talking to patients about the direct link between behaviors and health. Cassidy noted one way to take those conversations to the next level is to become familiar with available resources within the community and through a patient's health coverage. "Make sure you're really aware of the benefits your patients have," she advised. Cassidy added many plans have unique programs to help build healthy habits at no charge and have established partnerships locally to provide access to other resources like gym memberships at reduced rates for health plan enrollees.
The takeaway from the annual America's Health Rankings report, Cassidy said, is to focus attention where it's most needed and to foster conversations and innovations to address issues within a state. "I don't want people to feel negative about a 'bad grade' and not be able to get past that and be able to use this information in a positive way," she noted.
"The more meaningful piece of this is focusing on where are the strengths and what are the challenges rather than getting hung up on the number," Cassidy concluded. "Let's use this data to make positive changes."