Improvements in nation's health stalled after years of progress

In light of a recent report showing that improvement in the nation's health has stalled, public health officials are encouraging physicians to go into their communities to educate the public on how to lead a healthier lifestyle.

Primary care physicians "play a strong role in improving the nation's health. They have to be part of the solution. And it's not just about the patient sitting in front of them; it's about community engagement," said Georges Benjamin, MD, executive director of the American Public Health Assn.

"That means [physicians] have to yell and scream when elected officials want to cut the budget for the [local] public health department and when they don't want to support clean air laws or secondhand smoke laws," he said.

Doctors also should reach out to local organizations, such as churches and school districts, for help disseminating wellness messages across the community, said Reed Tuckson, MD, executive vice president and chief of medical affairs at UnitedHealth Group. He also is a board member of the nonprofit United Health Foundation, which issued the report America's Health Ranking on Dec. 6.

The rankings, which are published annually, have assessed the nation's health since 1990 by evaluating 23 factors, including binge drinking, diabetes, obesity and smoking. The report is published jointly by the United Health Foundation, American Public Health Assn. and Partnership for Prevention, a D.C-based organization that aims to increase use of evidence-based disease prevention to improve health. The report uses data from various sources, including the American Medical Association, Centers for Disease Control and Prevention, and Census Bureau.

For the past three years, America's overall health has improved as smoking rates and cardiovascular deaths steadily have declined, the report shows. But that progress has stopped.

Dr. Benjamin attributed the plateau, in part, to the downturn in the economy. He said financial troubles often lead stressed individuals to smoke and eat more and exercise less frequently.

Also contributing to the halted progress were increases in the nation's prevalence of diabetes and obesity, the report said. For every person who quit smoking in 2011, another became obese.

Twenty-eight percent of the population is obese, compared with 27% in 2010, data show. When the report was first issued in 1990, 12% of the population was obese.

Similarly, diabetes climbed from 8% of the population in 2010 to 9% in 2011.

"This alarming rate of increase shows little evidence of slowing or abating," the report said.

Public health officials are concerned that the highest rates of diabetes and obesity largely are confined to one region -- the South. In fact, the South is home to the nation's five least healthy states: Mississippi, Louisiana, Oklahoma, Arkansas and Alabama.

New England, on the other hand, features four of the five healthiest states: Vermont, New Hampshire, Connecticut and Massachusetts.

Health challenges in the South

The South's high level of poverty, which often is coupled with a lack of education, is part of the reason the region has poorer overall health than the rest of the country, said Thomas Joiner, MD, president of the Mississippi State Medical Assn.

"A lot of people don't understand modern health care and don't understand" they're eligible for Medicaid or another third-party payer system, said Dr. Joiner, a family physician in Jackson, Miss. "We see patients who only come in for medical care in a crisis, such as chest pain. If we saw them 20 years earlier to get their blood pressure under control, they wouldn't have been there that day."

The region's culture of regularly eating calorie-rich food also contributes to poor health, according to Dr. Joiner.

To remedy the problem, physicians should go into their communities and educate people that they are what they eat, Dr. Joiner said.

"Doctors have to point out that we're obese because of our lifestyles and our own decisions. They have to point this out to parents who will [pass the information on] to their children," he said.

To help address this issue, Mississippi's medical association is creating a committee that will assess the best ways for physicians to educate the public about healthy eating habits, said Dr. Joiner, who is leading the group.

"Obesity is a lifetime illness," he said. "It will take a lifetime of education" to resolve the problem.