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C-minus health

alaska report card

Alaska leads the nation in the rates of violent crime and the sexually transmitted disease chlamydia, according to the latest edition of “America’s Health Rankings” from the United Health Foundation, but there is otherwise good news in the report and some of it is surprising.

Overall, the state’s 29th place ranking puts it at the top of the loser’s group on a United Health’s health-care graphic, but the details of the rankings paint a somewhat better picture.

Diabetes, which had once been considered an epidemic in the 49th state, is falling.

“In the past year, the percentage of adults (nationally) who reported being told by a health professional that they have diabetes increased 6 percent from 9.9 percent to 10.5 percent of adults,” the study reported. “This is a new high. Since 2012, the
prevalence of diabetes increased 11 percent from 9.5 to 10.5 percent of adults.”

While the national rate has been going up, the Alaska rate has been going down. It is now at about 7 percent and still dropping.

Some of the improvement might be tied to Alaskans getting up and moving if the numbers in the study are to be believed. The report claims more than 80 percent of Alaskans are now engaging in “some sort of physical activity or exercise other than their regular job….”

Only 19.1 percent report they are physically inactive. That’s seventh best in the nation, and makes the cold, dark north look way better than the hot, bright and muggy Deep South. The study reports that more than 30 percent of those living in Mississippi and Arkansas are inactive, and the Deep South in general is the nation’s regional leader in inactivity.

Maybe it’s that heat. Whatever it is, the report notes that it is not good:

“Physical inactivity is a risk factor for cardiovascular disease, type 2 diabetes, some cancers, depression and premature death….Physical inactivity costs $117 billion annually and accounts for more than 11 percent of total U.S. health care expenditures.”

Healthy Alaskans

Physical activity isn’t the only place where Alaska is scoring well.

The state’s health care system is a lot more robust than a lot of people like to think and so, too, the results it produces, especially for lower-income Alaskans.

In general, the state follows the national trend showing that people with college educations and higher incomes are healthier than college drop-outs with low incomes, but the differences between these two groups are smaller in Alaska than anywhere else in the nation.

When it comes to “health equity,” the report says, “North Carolina has the widest gap between adults aged 25 and older with a college degree, 70.0 percent, and those without a high school degree, 18.8 percent. Alaska has the narrowest gap, 71.4 percent versus 42.6 percent.”

Nationally, the average for “high health status among U.S. adults aged 25 and older without a high-school degree is 22.6 percent.” In Alaska, the members of that group fair twice as well.

Alaskans lacking a high-school diploma are actually reported to be in slightly better health than high-school graduates, although the difference doesn’t appear big enough to be statistically significant.

The downside of this successful showing is that it costs. Alaska is second only to West Virginia in per capita public health funding at $285 per person. That’s almost twice as much as fifth-ranked New York and more than three times the national average of $86.

United argues the spending is an investment.

“Research shows investing $10 per person per year in community-based programs
proven to increase physical activity, improve nutrition, and prevent smoking or other tobacco use could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1 invested,” the report says.

The argument might have merit in Alaska if the high score for physical activity and the drop in tobacco use are indeed linked to 49th state spending. Nineteen percent of Alaskans remain smokers, according to the study, but that’s down from 35 percent in 1990.

The decline has been slow,  but it is steady.

Efficient medicine

The state is also in the top-10 – number seven to be exact – in preventable hospitalizations.

“Preventable hospitalizations reflect the efficiency of a population’s use of primary care and the quality of the primary health care received,” the study said. “Accessible and effective primary care can reduce hospitalizations for many preventable infectious diseases, asthma attacks, diabetes and hypertension….Preventable hospitalizations are more common among the uninsured and often occur because of failure to treat conditions early in an outpatient setting.”

Alaska, however, runs counter to that  last observation. Despite ranking high in preventable hospitalizations, the state is a leader among the uninsured, coming in second only to Texas. Almost 15 percent of Alaskans lack health insurance, according to the study. The national average is 9 percent. Massachusetts reports only 2.7 percent of its residents uninsured.

Alaska also appears to a be a bit short on primary care physicians. The 133.7 per 100,000 population lags behind the national average of 149.7, but Alaska is loaded with dentists and mental-health providers.

The state ranks sixth highest in the number of dentists per 100,000 population and eighth highest in the number of number of mental-health providers per 100,000. The 364.2 per 100,000 mental health providers is way above the national average of 218 per 100,000 and dwarfs the number of doctors in the 49th state.

Whether all those mental-health providers deserve credit for helping Alaskans hold it together is unclear, but Alaska ranks tenth in freedom from “frequent mental distress.” Only 10 percent of Alaskans reporting struggling from day-to-day.

“Frequent mental distress is a measure of perceived poor mental health and represents the percentage of the population experiencing persistent and
likely severe mental health issues,” the study says.

West Virginia is the most troubled state with 16.5 in distress. The national average is 11.8.

Alaska does slightly worse on frequent physical distress than on mental distress, but remains in the top-20 for positive outcomes. Poor physical health affects 11.2 percent of the Alaska population, ranking the state number 18 among the suffering. The national average score is 11.7. More than 18 percent of the people in West Virginia report they are struggling with poor health and pain.

Overall, West Virginia makes Alaska look good on most fronts. It rates 46th in the over health ranking followed by Alabama, Arkansas, Louisiana and Mississippi in that order. The problems the states of the Deep South face in some ways make it appear Alaska is doing very nicely.

Upside down

Ironically, those states report the least “excessive drinking,” a known health problem. West Virginia leads the list of teetotalers with Mississippi and Alabama fourth and fifth respectively. Arkansas is ninth.

The state with the biggest drinking problem is Wisconsin where more than 26 percent of the population is reported to be drinking too much. Wisconsin is a hard-drinking red state adjacent to liberal Minnesota.

Minnesota, as it turns out, is a hard-drinking blue state. Almost 23 percent of the residents of  The Land of Ten Thousand Lakes are reported to be drinking excessively.

The hardest drinking states are, in order from worst to least worst: Wisconsin, North Dakota, Minnesota, Iowa and Nebraska. Alaska does not begin to have the drinking problems the Midwest does despite popular perceptions.

Alaska ties with Ohio as the 30th hardest drinking state in the nation. Less than 20 percent of the Alaska population, 19.1 percent, drink too much, putting Alaska within the range of a grouping that includes the other West Coast states.

The roll of alcohol and health is obviously complicated. Despite the drinking and a nation-leading rate for premature deaths, Minnesota was rated the sixth healthiest state in the country. Iowa and Nebraska are in the top-15.  North Dakota is at 18 with Wisconsin coming in at 21.

They are healthy despite being among the cluster of Midwest states plagued by binge drinking, the worst kind of drinking. South Dakota, Michigan and Illinois, along with Pennsylvania and Colorado, join the aforementioned states in a grouping of those with serious binge-drinking problems.

All have higher numbers of binge drinkers per capita than Alaska, according to the study, which notes the downside.

“Binge drinking is the most common, costly and deadly form of excessive alcohol use in the U.S., ” the study said. “It is associated with unintentional injuries and deaths, violence, risky sexual behavior and many chronic diseases. One in six adults binge drinks four times a month on average. Binge drinking is most prevalent among men and adults aged 18 to 34. Most binge drinkers are not considered alcohol dependent.
In 2010 excessive drinking cost the United States $249 billion due to missed work, additional health care expenses and increased crime.”

Colorado has a drinking problem despite being one of the fittest states in the country. It has the lowest prevalence of obesity in the country, and the second most active population. Only the residents of Utah are more into physical fitness, and the activity scores for the two states are so close they are essentially tied.

Drugs

Both Utah and Colorado are also dealing with drug problems which Alaska seems to have avoided despite popular feelings and some anecdotal indications drug use is up significantly in the 49th state.

The United report, however, says Alaska drug deaths have declined slightly since 2012, and the death rate of 15.6 per 100,000 is better than Colorado at 16 per 100,000 and significantly better than Utah at 22.9 per 100,000.

While Alaska’s drug death rate has gone down 0.3 per 100,000 over the past five years, Utah’s is up 4.5 per 100,000, and Colorado’s is up 1.7. But even with that, those states are far from ground zero int the drug crisis.

“In the past five years, drug deaths increased 69 percent in Massachusetts (No. 1), from 11.7 to 19.8 deaths per 100,000 population,” the study reported. “Over the same period, drug deaths increased 118 percent in New Hampshire (No. 8) from 11.2 to 24.4 deaths per 100,000 and 56 percent in Rhode Island (No. 11) from 16.0 to 24.9 deaths per 100,000 population.”

Massachusetts, it is worth noting, was rated the healthiest state in the country in the study despite the drug problem.

The ranking is tied to the state’s high scores on health-care “policy” and “clinical care.” It rated ninth in actual “health outcomes.” Minnesota was number one in the latter category with Utah second.

“Utah ranks high overall at number four but only ranks number 35 in policy measures,” the study observed. Utah’s residents led the poll in healthful behaviors, but scored low in policy for lagging vaccination rates and a large number of uninsured residents. Almost 10 percent of Utah residents lack health insurance.

And what could have been a four-star, clinical-care score for Utah was dragged down by a lack of primary care physicians. There were only 99.8 per 100,000 residents, putting Utah significantly behind Alaska in the availability of physicians.

But Utah residents live healthy. Less than 1 in 10  smoke; less than 1 in 7 drink excessively; only 1 in 4 are overweight; and almost 9 out of 10 engage in regular physical activity.

And in the big picture, health care outcomes depend as much on what people do to care for themselves as what they expect the health-care system to do to care for them.

 

 

 

 

 

 

 

 

 

 

 

 

 

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