The 11 Most Obese Metro Areas in America

Gallup-Healthways has issued their report on the 11 Most Obese Metro Areas today, and my comment is regarding the location that tops the list: The population of McAllen/Edinburg/Mission, Texas is almost 40% obese, and another Texas city makes the list that's only 6.5 hour away (measuring distance in the typical Texan way, by hours rather than miles). Where do the other top 8 rank?  

1. McAllen-Edinburg-Mission, Texas (where 38.5% of residents are obese);
2. Huntington-Ashland, W.V., Ky., and Ohio (37.7%);
3. Little Rock-North Little Rock-Conway, Ark. (34.7%);
4. Mobile, Ala. (33.7%);
5. Hagerstown-Martinsburg, Md. and W.V. (33.4%);
6. Myrtle Beach-North Myrtle Beach-Conway, S.C. (33.1%);
7. Toledo, Ohio (33.0%);
8. Charleston, W.V. (32.9%);
9. Reading, Pa. (32.8%); and
9. Erie, Pa. (32.5%); and
9. Beaumont-Port Arthur, Texas (32.5%).
On the flip side of things, the lease obese metro areas is led by cities in Colorado:

1. Boulder, Colo. (where only 12.5% of residents are obese);
2. Charlottesville, Va. (14.3%);
3. Bellingham, Wash. (15.9%);
4. Fort Collins-Loveland, Colo. (16.5%);
5. Naples-Marco Island, Fla. (16.6%);
6. Denver-Aurora, Colo. (17.8%);
7. San Francisco-Oakland-Fremont, Calif. (18.0%);
8. San Luis Obispo-Paso Robles, Calif. (18.1%);
9. Madison, Wis. (18.2%); and
10. Colorado Springs, Colo. (18.3%).

As someone initially from the South, this doesn't surprise me. I can only hope that funding sources and industry-sponsored funders will see there is a significant need for research in these metros and choose to fund studies or trials in these areas.

On a separate "MHA" note, I wonder if anyone has considered cross-examining the hospital structure in these metro areas, and seeing what might be correlated: payor mix {percentage of Medicaid/Medicare payments , income of patients, community collaborations, etc. 

If you live in these communities, what are your local health care leaders doing to create a healthier population?

Medicaid Expansion: Too Many Questions

In the midst of the multitudes of updates, sometimes daily, on Governors' decisions on whether their state will participate in the Medicaid expansion provision of the Affordable Care Act {ACA}, it can be difficult to keep up with the latest in strong opinions and scoffs.  To this Everyday Jane, I need all the help I can get on understanding this complicated section of the endless ACA.  Many questions come to mind when considering the Governors: Are their constituents truly aware of what's at stake?  Are Governors communicating their plans to accept or refuse in a way that their constituents can rally behind them? What about the newly elected Governors, and what's the appropriate expectation of them?

For the poorest states, cost is a 'nail in the coffin' in so many minds.  No one can deny there will be significant costs associated with a Medicaid expansion, but are the expansion opponents considering the 'rubber meets the road' aspects of closing the door on the provision?  How many state-supplied dollars are states already spending on this particular population, and how much could they receive from the government if they participate?  Where would these potential Medicaid recipients go for care with or without the expansion?

When reading through my daily smattering of health care news, I pulled out the following detail from The Advisory Board Company, which 'keeps score' on where each Governor stands {without any of the usual flair from the national media outlets} to share and discuss.

{Actual link.}

I find it interesting that both states I've resided in {Texas and Pennsylvania} have chosen against Medicaid expansion, of course citing costs. What is your governors decision {If they've made one at this point}?  How do you personally feel? How will this affect your local hospital?

Article: "Big Med"

As an introductory assignment in my Health and Medical Organizations course, we were asked to seek out and discuss a news article concerning a public health or health management issue/topic.  I've not had the chance to present my article to the class yet, but I couldn't help but share here.

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The health care or policy matter of this article, titled Big Med, centers around the reality that health care in our country is rapidly changing, and Gawande considers the industry testing the theory of chain-like delivery producing better and more efficient results. This shift in health care delivery is due to several factors, namely rising health care costs, the need for efficiency, and the desire to regulate consistency of the quality of care.  To achieve this goal of better health care, Gawande suggests the current changes to standardize practices should be widely circulated and increased. These changes are thus far fragmented, like our current system.

Through a series of vignette-like case studies, Gawande explores the notion of health care as an industry becoming more like a chain restaurant (Cheesecake Factory, to be exact); in that converging hospitals groups will aim to serve a greater amount of people, at a reasonable cost and at a consistent level of quality.

“Medicine has long resisted the productivity revolutions that transformed other industries. But the new chains aim to change this.”

Cheesecake Factory vs. Today's Medicine

Gawande begins the article by showing us his perspective on a recent visit to Cheesecake Factory, where he learns about the large chain’s methods in standards, productivity and quality. He likens this ‘mastery’ of the system to a new health care chain in the Boston area, Steward Health Care System. Steward is comprised of 6 hospitals which were previously failing, and when purchased by a successful investment firm, were turned into a production line-style health care system.  Gawande praises their use of an Intensive Care Unit "Command Center," which strategically utilizes a tele-ICU to complete rounds and do quality checks.

Gawande proceeds to discuss other shifts in health care delivery: his mother's knee replacement; "super regional" health systems; a Alzheimer victim's experience with a hospital located far away from her home.  All of these situations were compared to Cheesecake Factory's thoughts on standardizing a job, illustrating his theory of mimicking food chains in producing better outcomes.

What about the issues that may arise?  Gawande recognizes this may be a perfect storm for more consolidation, but insists on organizational governance and relying on law to counteract the potential monopolies.

He also suggests that new systems will help give patients the power.  “Patients won’t just look for the best specialist anymore; they’ll look for the best system," Gawande writes. One could argue that putting a different emphasis on who handles the decisions will help keep health care leaders in line.

He finishes the article in an open-ended fashion, with the question of "when can this happen?" Changes in health care are not far away, but how will we determine what's best for the country?

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I chose this particular article because I am interested in both the author and the subject. I learned of the article via Dr. Gawande’s Twitter, @Atul_Gawande, as I’m a follower of his writing, both article-wise and book-wise. As for the subject matter, I’m interested in this study of large health care systems because I'm in a city where health care providers and insurance payers are 'at war,' due to potential consolidations. This is becoming more common around the U.S., which makes this article incredibly poignant. The article has received mixed reviews, as expected.

About the Author
Atul Gawande is a general and endocrine surgeon and associate director of their Center for Surgery and Public Health at Brigham and Women's Hospital in Boston, Massachusetts, a staff writer for The New Yorker, and an assistant professor at Harvard Medical School and Harvard School of Public Health. Gawande is the author of The Checklist Manifesto (how checklists could bring about striking improvements in a variety of fields, from medicine and disaster recovery to professions and businesses of all kinds), Better (how success is achieved in this complex and risk-filled profession), and Complications (exploration of the power and the limits of medicine).

MPH Vs. MHA: Making Decisions

Once again, it's time to reveal a turning point in my decisions for furthering my education within public health.  It's funny: though it's taken me more than 4 years to decide this path, my vision for my future is still somewhat fluid in that my end goal is continually changing.  This makes me human, I guess.

Here's the result: My plans have shifted slightly from pursuing a Master in Public Health degree (MPH), to a desire to earn a Master in Health Administration degree (MHA).  The majority of the reasons behind this change stem from two things: my past and my future.

There's no shame in the fact that I'm bossy.  When my classmates were asked to describe each other with words from the dictionary in 4th grade, my tag became 'belligerent'.  How was the 4th grade me supposed to react to this? Own it. And, I have come to do so over the years.  I've turned this negative, very personal message into a positive, aiming to be a leader by retaining the drive with in me to give my best in all situations to serve the greater good.

Some would call it tenacity.

I'd call it 'me.'

If you know me, or as you come to know me, you know my future is pointed towards making health more accessible, clearly understood, and important.  These are a few of the factors that drive me to pursue this advanced education - I feel as though without it, I won't be able to do the most good, for the most people.  It's both thrilling and the cause for a weighty conscience; the power to improve lives is compelling, but comes with many nights of studying, lost sleep, hard decisions and spending less time with loved ones.

My future is also driven by my skill set.  My personality.  My genetic makeup.  My outlook on health issues.  All of these things combined tell me that I'm not science- or clinically-driven, but driven by the desire to make decisions that impact the most people for good.

No one can ignore the problem of dysfunctional health care systems or putting the right foods on your dinner plate.  Each issue associated with public health is a piece to our health puzzle; And, I'm ready to start on this road as a student of public health.

Please read on, as I continue my journey and start my formal educational journey in public health.

Be Ready: Learning Your Family Medical History

For me, public health goes hand-in-hand with prevention, which is primarily what my background is in.  It’s a fact that so many of the common diseases in America are preventable – we know this.  From here, it’s to our benefit to know our family history, so we’ll have a better picture of what we’re up against.

I reached out to the closest expert on family history I could quickly find: my Mom.  She emailed me a detailed list of what ailments and causes of death spotted my family history, and from this initial outpour one thing was clear – there are a significant number of incidents of heart disease in my family.  Of the known causes of death/ailments,

·         My maternal great-grandfather died from a heart attack;

·         Both my maternal grandparents have high blood pressure;

·         My paternal great-grandfather died of a heart attack at 65;

·         My paternal grandfather died of a heart attack at 43;

·         My own Dad has high blood pressure;

·         And I have prehypertension, a precursor to high blood pressure.

According to the University of Iowa,“high blood pressure is considered a silent killer, because many people with this disease have no symptoms.  Over time, this increase in blood pressure can damage the blood vessels or vital organs.  This can lead to strokes, heart disease, or kidney disease.  High blood pressure is one of the most common risk factors for heart disease.”

In an article by Martha Irvine of the Associated Press (AP) released on Monday, she outlines the fact that heart disease is the #1 killer of folks in the county, a fact that’s been drilled into my mind over and over throughout my training.  Good to know, considering my family history is peppered with it.

It’s also worth noting that many of my family members who suffered from heart disease were men, a trend more common than I knew.  Irvine quotes Russell Luepker, Mayo professor of public health at the University of Minnesota and a spokesman for the American Heart Association, in stating that men are more vulnerable because they may have high blood pressure, smoke, and most often, don’t go to the doctor.

“Men are not seekers of care,” Luepker said. “We did a study a couple of years ago, and we autopsied people who were under 60 who died a premature, sudden death — 95% of them were men. Practically all of them had heart disease. They all had physicians and medical insurance but rarely went to the doctor. They may have gone to the doctor because they cut their finger with a hedge trimmer, but they weren't going in and being evaluated for heart disease."

From here, what can I do? I’m a female, but I’m already classified as having prehypertension. I’d better mind my P’s and Q’s, right? The American Heart Association outlines that I, along with anyone else in my shoes, should consider doing the following:

Get active. Get at least 30 minutes of moderate physical activity each day like brisk walking, five times a week.“Make a commitment that you are going to be more active today than you were yesterday ,” says cardiologist Gordon Tomaselli, president of the heart association.

Eat better. Avoid excess salt which leads to hypertension, and saturated fats which leads to high cholesterol, Tomaselli says. Also, limit sugar intake. Instead eat fruits, vegetables, whole grains, fish, poultry, low-fat or non-fat dairy and other healthy fare.

Manage your blood pressure. Normal blood pressure is less than 120/80. If it’s within healthy ranges, you reduce the strain on your heart, arteries, and kidneys, the heart association says.

Control cholesterol. “Your total cholesterol and LDL (bad) cholesterol should be low, and your HDL (good) cholesterol should be as high as possible,” Tomaselli says. If your total cholesterol is 200 or higher, you need to take action. High cholesterol can cause blocked arteries, and like a multi-car pile-up, one problem often creates another.

Don’t smoke. “Tobacco at any level of intake is bad for your health and should be avoided,” Tomaselli says.

Lose weight. Being obese — roughly 30 or more pounds over a healthy weight — increases the risk of heart disease.

Without doing this small amount of research, I wouldn’t have known to be wary of any symptoms of heart disease.  I’d encourage you, readers, to look into your own family medical history, and gather what knowledge you can.  I’ve been told history repeats itself.

What are your thoughts on heart disease? Have you pieced together a history of your family’s medical past?