News From Terre Haute, Indiana

December 13, 2012

Hoosier health rankings declining

2012 statistics put Indiana four spots worse than 2011

Brian Boyce
The Tribune-Star

TERRE HAUTE — Smoking and obesity continue to weigh down Hoosier health scores into the bottom of American rankings.

Statistics released this week by the United Health Foundation, American Public Health Association and Partnership for Prevention place Indiana at No. 41 on the list, four spots worse than 2011.

 In compiling an annual report, America’s Health Rankings, researchers attribute the state’s low placement to one of the highest smoking rates in the country, growing levels of obesity and underfunded public health initiatives.

According to the data, Indiana’s 1.25 million adult smokers earned it a No. 44 in that category, while its 1.5 million obese adults helped score 42nd in both obesity and sedentary lifestyles. The report also notes more than 500,000 Hoosiers are diabetic.

Local officials didn’t seem shocked by the data, but agreed there’s no one simple reason for Hoosiers’ unhealthy state.

Joni Wise, administrator of the Vigo County Health Department, pointed out that Indiana spends significantly less on its public health programs than other states, which in turn causes a number of seemingly unrelated problems. Whether involving unclean water or air pollution, public health funding matters.

“Public health takes in so many things, and if you don’t invest the dollars in it, then your citizens are less likely to have healthy lives,” she said.

According to the report, Indiana has one of the lowest levels of public health funding per capita in the country, increasing to just $44 from $33 in the last five years. Meanwhile, Vermont, which came in No. 1 in the country’s health rankings, boasted $149 per capita health spending.

Wise said those population-based health programs span air-quality initiatives to seat-belt education. Tallied together, they add up to a healthier environment, and ultimately healthier citizens, she said.

“We were slow as a state to address clean, indoor air policies,” she said, explaining her preference for that term as opposed to an “anti-smoking” label. But when coupled with what the report termed “high levels of air pollution” in Indiana, second-hand tobacco smoke indoors adds to the high numbers of chronic illnesses faced by Hoosiers. Counties such as Vigo used to operate Air Pollution Boards, she added, until funding for those has been cut in recent years.

And obesity continues to be a problem for Hoosiers. Even in a nation where every state is struggling with the issue, Hoosiers seem to be more complacent about their status, even accepting of it, she said. Like other health issues, obesity is complicated and involves socio-economic factors, access to healthy food and recreation areas, and at some point, personal choices, she explained. Other states with better rankings have citizens making different choices.

“They have the knowledge to make healthier choices,” she said, pointing out money does seem to matter. States, and even counties within states, that have higher household incomes and education levels tend to fare better in overall health. Whether it’s more disposable income for food and exercise or the knowledge to better utilize what they have available, the topic is ripe for discussion, she said.

Nationally, No. 1 Vermont was followed in the rankings by Hawaii, New Hampshire, Massachusetts and Minnesota. At the other end, Mississippi and Louisiana tied for 49th, followed by Arkansas, West Virginia and South Carolina.

Leamor Kahanov, chair of Indiana State University’s department of applied medicine and rehabilitation, agreed the issue stems from a complicated set of problems.

“There are so many variables, I think it’s really hard to hit on one,” she said.

Kahanov was instrumental in establishing the university’s new Center for Health, Wellness and Life Enrichment, and said addressing the topic of overall health from a “team approach” is helpful, particularly when utilizing a “patient-centered perspective.” Instead of sending one patient to see multiple specialists — such as those addressing nutrition, smoking, and diabetes — it often works best to have those individuals on the same team to address the total patient, she said.

But most patients already know what they need to do, whether it’s quit smoking or lose weight, she said. Getting them to follow through seems to be the tough part.

Lifestyle and culture play a role, and the types of food Hoosiers will be eating this holiday season, for whatever reason, isn’t as healthy as other regions. The population found in rural areas tends to display low levels of health literacy, and if they live great distances from health care providers, they seem less likely to keep up with visits, she said. Unemployment and lack of health insurance are also at play.

“If there was one thing we could address, I think we would have done that a long time ago. It’s the accumulation of those things put together,” she said.

Likewise, Jenna Hasenour, diabetes educator at Union Hospital, said the swirling factors are as varied as an advertisement-driven media culture and family dynamics.

“Education does have a lot to do with it, and how people have eaten historically is how they feed their kids, and that’s how it passes down from one generation to another,” she said, estimating her heaviest patients are in excess of 400 pounds. “And it’s starting younger and younger too.”

But why Hoosiers tend to reach for different foods than their counterparts in Vermont remains a puzzle, she admitted. Why a rural state with farms full of vegetables has residents opting for fast food is a complicated issue.

“That’s a good question, and sometimes it has to do with a lack of knowledge about healthy foods,” Hasenour said. “It’s about choices. And I’m not sure why this area tends to have more high-fat, high-carb choices than other places in the country that have lower numbers.”

Indiana also scored poorly in terms of activity level, ranking among the most sedentary states. Again, why a state full of parks and trails has residents rated sedentary compared with those on the East Coast isn’t completely clear.

“That plays a major role, and people don’t realize the impact that exercise can have on modifying their risk factors, not just for diabetes, but for heart disease,” Hasenour said. Also, the link between obesity, diabetes and heart disease tends to spiral, one interacting with the others. “So it’s kind of a progression.”

With her patients, Hasenour encourages setting small goals which can be accomplished and measured. Substituting soda with water can be the first step in helping a patient lose 50 pounds, with other goals added along the way.

“Just a simple change like that can make a difference in weight loss,” she said.

Wise said the United Way of the Wabash Valley is tackling the topic through its Community Health Initiative Committee, which she chairs. Among the group’s goals is to create a program to increase community access to fresh produce.

But ultimately the decision to participate in those and other programs comes down to individuals’ choices.

Brian Boyce can be reached at 812-231-4253 or