In poor health
Why is state at bottom of rankings?
There is a saying among many in the medical sciences that rings true. The United States does not have a health-care system. It has a treatment system for ill health.
Annually the United States spends a fifth of its gross national product on treating illness, while spending a comparative pittance on promoting or maintaining health, and Americans and Arkansans are suffering consequently. While we spend more than any other nation on treating illnesses, Americans are sicker now than just 30 years ago: 37 million Americans have chronic lung disease, including chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis; 37 million adults have chronic kidney disease; 34 million have diabetes and 88 million are prediabetic; and 30 million people have heart disease. Almost a third of Americans—132 million—will be diagnosed with cancer at some point during their lifetimes, and 82 million will have a stroke.
Ill health has become not only a problem of old age. A recent study found that 59 percent of Americans between the ages of 17 and 24 would be ineligible to serve in the armed forces because of health problems or lack of physical fitness, mostly due to obesity, asthma, hearing and eyesight problems, and mental illness.
The population of Arkansas is less healthy than the American population overall. The state is ranked below the national average on 38 of 51 health scoring measures. Currently, Arkansas is the 48th healthiest state in the union. The reason for the lack of health is largely attributable to increased rates of chronic disease. The top three chronic diseases in the state are obesity, diabetes and heart disease. Other chronic diseases are not far behind, including chronic lung disease and cancer.
The No. 1 preventable cause of death in Arkansas is tobacco use. According to recent reports, about one in four Arkansans smoke cigarettes. Tobacco causes cancer of the oral cavity, lung, esophagus, kidney and the urinary bladder. In addition, tobacco use causes almost all cases of COPD and markedly increases the risk of heart disease and stroke.
Nearly half of Arkansas adults are obese, including about 70 percent of Type 2 diabetics, most of whom would not have diabetes if they were not obese. Diabetes is the most common cause of leg amputation. Diabetes, paired with high blood pressure, is the most common cause of kidney failure. Diabetes increases the risk of having heart disease, stroke and impaired vision that may lead to blindness. Poor mental health that can lead to drug abuse or overdose also is a major problem in Arkansas.
Taken together, these health issues are strongly associated with the stress of the social conditions in which many Arkansans live. Many Arkansans struggle to pay rent, buy food and pay utilities. They live in unsafe neighborhoods with high rates of crime. Often children in these neighborhoods may not play safely outside, and a pleasant walk through a neighborhood can be risky. If these population health problems are not effectively addressed, Arkansans will continue to shoulder the consequences for years to come.
The major advancements made in health during the 20th century were largely due to public health measures, not advancements in clinical medicine. Mass vaccination programs, systems to provide clean water and deal with human waste, programs to ensure food and drugs are not contaminated, and policies to improve the environment have increased the lifespan of Americans from an average of 45 years at the beginning of the 20th century to over 75 at its end.
To be sure, when one is ill, having world-class clinical care is imperative. However, having the clinical wherewithal to treat is not the same as preventing illness in the first place.
Arkansas needs expanded access to health care, as noted in recent opinion pieces in the Democrat-Gazette. Arkansas’ rural counties are woefully underserved. Moreover, expanded access will require innovative and reformed financing and staffing of the treatment system.
However, we cannot treat our way out of ill health. Doing more of the same will end in the same result. Instead of focusing solely on treating ill health, the nation and the state should concentrate greater effort and resources on preventing disease and promoting healthy lifestyles. Many public health measures are outside the realm of medicine, but easy enough to achieve if health becomes a priority.
To have a healthy population and an effective health-care system, we need both public health and clinical medicine. To concentrate funding on one to the detriment of the other, as the U.S. has done, has had and will have dire consequences for the health of Americans and Arkansans.
To be sure, Arkansas needs greater access to health care. But, equally important, Arkansas needs more and better public health. Otherwise, we are likely to remain at the bottom of states’ rankings of health.