Southern states fare worst in well-being survey
■ Hawaii residents score the highest in the nation, while West Virginians have the lowest overall health.
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In Tupelo, Miss., where James A. Rish, MD, is a pulmonologist, patients frequently must choose which prescriptions to fill because they can’t afford them all. Many of the people he treats are overweight, and they often have low levels of education.
These are common problems in Mississippi, where residents have the nation’s poorest access to basic necessities, including affordable food, clean water and medicine, according to the latest Gallup-Healthways Well-Being Index data released Feb. 27.
“National health survey results for Mississippi rarely are good news,” said Dr. Rish, chair of the Board of Trustees for the Mississippi State Medical Assn.
The Gallup-Healthways Well-Being survey is no exception. The annual poll found that Mississippi residents have the third-lowest sense of well-being in the nation, with a score of 63.4 out of 100. The state follows West Virginia (62.3) and Kentucky (63.3).
“It is frustrating” that physician efforts haven’t had a greater impact on residents’ health, he said. “We’re hardly scratching the surface.”
But health professionals involved with the survey encourage primary care physicians to use the findings as motivation to continue working to improve all aspects of patients’ health, including their emotional well-being and lifestyle habits.
Doctors also should consider becoming more active in their communities by educating policymakers about health issues that affect the public and advocating for changes that could improve residents’ health, such as walking trails, said Andy Perez, MD, director of science and medical integrity quality, quality and accreditation at Healthways. Healthways, based in Nashville, Tenn., is a leading disease management organization that serves that serves more than 1.6 million people.
“Primary care doctors play a key role in the population’s well-being,” Dr. Perez said. “They help influence the environment that promotes a positive sense of well-being. There are favorable consequences that extend beyond the patient to the person’s family, employer and community.”
Acknowledging primary care physicians’ time constraints, Dr. Perez said doctors do not need to try to make changes in their community on their own. But he encourages them to start initiating discussions about possible changes.
The well-being index was based on phone surveys of a random sample of 353,492 adults 18 and older between Jan. 2 and Dec. 29, 2011.
Researchers asked participants about their emotional and physical health, work environment, lifestyle habits and basic access to necessities. Respondents also were asked to evaluate their present life situation as well as their anticipated situation in five years.
Researchers assigned scores of 0 to 100, with 100 being the ideal well-being, to all of the states and the nation overall.
Ranking states’ well-being
In 2011, the nation’s overall score was 66.2, down slightly from 66.8 in 2010. Similarly, states scores changed little from the previous year.
Hawaii residents had the highest well-being for the third consecutive year, according to a report based on the survey findings. The Aloha State’s score of 70.2 was due in part to its high scores on the survey’s emotional health and healthy behavior questions, researchers said.
For example, Hawaiians were the most likely to say they smiled or laughed a lot “yesterday.” They were least likely to report daily worry or stress and ever to have been diagnosed with depression.
Hawaiians’ good eating and exercise habits and low smoking rates earned them the distinction of having the best healthy behaviors in the nation.
The survey found that Alaskans were the most likely to rate their lives highly enough to be “thriving,” giving them the nation’s highest life evaluation score (60.2). West Virginians had the lowest score (41.1). West Virginia had the highest percentage of obese residents, contributing to its last-place ranking on the physical health index with the score of 69.9. The top physical health score (79.9) went to Minnesota.
Huntington, W.Va., family physician Stephen Sebert, MD, considers obesity his state’s most significant health issue. But he said remedying the problem is challenging, in part, because eating rich, calorie-dense food is part of the culture in West Virginia, as it is in many Southern states. Additionally, Dr. Sebert said many patients cannot afford healthy food.
“It all goes together — people’s socioeconomic status, education and health. Our economy has suffered for years. We’ve had a lower education rate, and the health has suffered,” Dr. Sebert said.
But it’s not all bad news in West Virginia. Dr. Sebert has noticed an improvement in his patients’ overall health in the past few years, due in part to their ability to fill their prescriptions regularly. He attributes the improvement to the availability of cheaper medications.
He compares a primary care physician’s role in improving a patient’s well-being to that of a coach.
“We try to interpret their health status and advise them how to play the game, but it’s really up to the patient,” Dr. Sebert said.
How to improve health
In Mississippi, which had the nation’s third-lowest score for physical health (74.1), Dr. Rish said he and his colleagues focus on talking to patients about decreasing their portion sizes during meals, eating more fresh fruits and vegetables, and avoiding items that are fried and processed.
Beyond educating patients during office visits about leading a healthier lifestyle, doctors in Mississippi are working with local communities to improve the public’s well-being, Dr. Rish said. For example, the Mississippi State Medical Assn. has sponsored initiatives to stock school vending machines with healthier foods and get more playground equipment for children to ensure they’re physically active.
Similar action is taking place in West Virginia, where a Huntington physician spearheaded the creation of more than 60 miles of biking and walking paths in honor of a local doctor, Paul W. Ambrose, MD, MPH, who was killed in the Sept. 11 attacks when his plane crashed into the Pentagon.
“Improving the public’s health will be a process,” Dr. Sebert said. “But I really think we’re headed in the right direction.”