Understanding and Improving Health : Lessons from Appalachia and America s Poorest State

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1 Understanding and Improving Health : Lessons from Appalachia and America s Poorest State Randy Wykoff, MD, MPH & TM Professor and Dean, ETSU College of Public Health

2 Life Expectancy Estimated Average Life Expectancy in 2014: Years CIA Factbook 2014

3 Life Expectancy Change in the 20 th Century years

4 Cause of Deaths United States

5 Cause of Deaths United States

6 Life Expectancy In 2014, for Life Expectancy the United States Ranks: 33 rd Behind--- Monaco, Japan, Singapore, San Marino, Andorra, Switzerland, Guernsey, Australia, Italy, Sweden, Liechtenstein, Canada, France, Jersey, Norway, Spain, Israel, Iceland, Netherlands, Isle of Man, New Zealand, Ireland, Germany, United Kingdom, Greece, Austria, Malta, {European Union} Luxembourg, Belgium, Taiwan, South Korea, and Finland CIA Factbook 2014

7 Premature Death Rates: United States Minnesota Massachusetts Connecticut California New York New Hampshire New Jersey Washington Vermont Colorado Hawaii Nebraska Utah Iowa Rhode Island Oregon Wisconsin Virginia Illinois Maine Idaho Maryland South Dakota 6913 UNITED STATES Florida Texas North Dakota Kansas Arizona Pennsylvania Wyoming Nevada Delaware North Carolina Michigan Montana Alaska Georgia Ohio Missouri Indiana New Mexico South Carolina Tennessee Kentucky Arkansas Oklahoma Louisiana Alabama West Virginia Mississippi America s Health Rankings 2015:

8 Premature Mortality (YPLL): All Counties in the United States All US st 10th 20th 30th 40th 50th 60th 70th 80th 90th 99th 2016 County Health Rankings:

9 Premature Mortality (YPLL): All 2989 Counties in US vs 238 Counties in Central Appalachia Central Appalachia All US % 29% st 10th 20th 30th 40th 50th 60th 70th 80th 90th 99th 2016 County Health Rankings:

10 Factors Contributing to Premature Death Environmental Exposures 5% Health Care Social Circumstances 10% 15% 30% Genetics 40% Behavioral Factors We Can Do Better: Improving the Health of the American People Schroeder SA. New England Journal of Medicine 357:

11 Actual Leading Causes of Death Tobacco 18.1% of all deaths Diet/activity patterns 15.2% of all deaths Alcohol 3.5% of all deaths Microbial agents 3.1% of all deaths Toxic agents 2.3% of all deaths Motor vehicles 1.8% of all deaths Firearms 1.1% of all deaths Sexual behavior 0.8% of all deaths Illicit Drug Use 0.7% of all deaths Actual Causes of Death in the United States, 2000 Mokdad et al JAMA 291: and erratum:

12 Prevalence of Smoking: Adults 1 Utah California Hawaii New York Texas Maryland Massachusetts New Jersey Washington Connecticut Colorado Idaho =Minnesota =Rhode Island Vermont =Arizona =Illinois =Nevada =Oregon Nebraska =Georgia =Wisconsin New Hampshire Florida 17.6 UNITED STATES Kansas Iowa South Dakota =New Mexico =North Carolina Maine =Virginia =Wyoming =Alaska =Delaware =Montana =North Dakota =Pennsylvania Missouri Ohio =Alabama =Oklahoma Michigan South Carolina Indiana Mississippi Louisiana Tennessee Arkansas Kentucky West Virginia 26.7 America s Health Rankings 2015:

13 Adult Smoking: All 3140 Counties in US vs 238 Counties in Central Appalachia Central Appalachia All US 94% 30% st 10th 20th 30th 40th 50th 60th 70th 80th 90th 99th 2016 County Health Rankings:

14 Prevalence of Obesity: Adults 1 Colorado Hawaii Massachusetts California Vermont Utah Florida Connecticut Montana New Jersey = New York = Rhode Island Washington New Hampshire Minnesota Nevada Oregon Maine New Mexico Virginia =Arizona =Idaho Illinois Wyoming 29.5 UNITED STATES Maryland =Alaska =North Carolina South Dakota =Missouri =Nebraska =Pennsylvania Georgia =Delaware =Michigan Iowa =Tennessee =Wisconsin Kansas Kentucky Texas South Carolina North Dakota Ohio Indiana Oklahoma Alabama Louisiana Mississippi West Virginia Arkansas 35.9 America s Health Rankings 2015:

15 Adult Obesity: All 3141 Counties in US vs 238 Counties in Central Appalachia Central Appalachia All US 66% 6.4% (33.2 vs 31.2) st 10th 20th 30th 40th 50th 60th 70th 80th 90th 99th 2016 County Health Rankings:

16

17 The Social Determinants of Health Race and Ethnicity Economy Early Life Experiences Behavior Access Genetics Income Education Community Robert Wood Johnson: Commission to Build a Healthier America Housing Work

18 Children Living in Poverty 1 Wyoming New Hampshire Virginia Vermont Minnesota =North Dakota =Utah Connecticut Maryland Missouri Iowa Idaho Alaska New Jersey Wisconsin =Delaware =Kansas =Montana =Washington Hawaii Colorado Massachusetts =Rhode Island =South Dakota Nebraska Oregon New York Pennsylvania Illinois =Maine =Michigan 20.8 UNITED STATES Ohio South Carolina California Indiana Texas Nevada Florida North Carolina Oklahoma Alabama Georgia =New Mexico =West Virginia Tennessee Arizona Mississippi Arkansas Kentucky Louisiana 33.7 America s Health Rankings 2015:

19 Children Living in Poverty: All 3139 Counties in US vs 238 Counties in Central Appalachia Central Appalachia All US % 27% st 10th 20th 30th 40th 50th 60th 70th 80th 90th 99th 2016 County Health Rankings:

20 Relative Risk of Dying Before the Age of 65 By Income: United States Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the United States

21 Selected Measures of Household Income Disparities: : Ratio = 10.6:1 2013: Ratio = 15.9: % Poorest Fifth 50% INCREASE 2nd Poorest Fifth Middle Fifth 2nd Richest Fifth 46.6% Richest Fifth Income, Poverty and Health Insurance Coverage in the United States, U.S. Census Bureau

22 Adults with Some College: All 3140 Counties in US vs 238 Counties in Central Appalachia Central Appalachia All US % -16% st 10th 20th 30th 40th 50th 60th 70th 80th 90th 99th 2016 County Health Rankings:

23 Life Expectancy at Age 25 by Educational Achievement Men Women Less than HS High School Some College College+ Education Matters for Health: Robert Wood Johnson Foundation. September, 2009

24 Percent of High School Sophomores Who Complete College in Ten Years Based on Parents Education Level Education Matters for Health: Robert Wood Johnson Foundation. September, 2009

25 What Can We Do To Improve Health in the United States? Jobs and Education Health Care Behavior Change

26 What Can We Do To Improve Health in the United States? We need to work together to assure access to health care, especially preventive services; We need to work together to encourage healthier behaviors; We need to work together to enhance economic opportunity and improve educational achievement;

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