State improves three spots from last year’s rankings

New data released today in the United Health Foundation’s (UHF) 20th annual America’s Health Rankings™ report show Utah is the 2nd healthiest state in the nation. The report credited Utah with the lowest rates in the nation for smoking, cancer deaths, infant mortality and binge drinking.

The annual report provides a measurement of the overall health of the nation on a state-by-state basis, with the purpose of educating individuals, elected officials, healthcare professionals, employers and communities to take action to improve health. In 2008, Utah ranked as the 5th healthiest state in the nation.

“The UHF report is the most respected of its kind in the public health world, so to be recognized as the 2nd healthiest state is truly something to be proud of,” said Utah Department of Health (UDOH) Executive Director Dr. David Sundwall. “However, it doesn’t mean we can rest on our laurels. My goal is to be the healthiest state in the nation, and we still have some challenges to address before we can achieve that goal.”

The UHF cited Utah’s limited availability of primary care physicians, high geographic disparity within the state, and low public health funding as significant challenges.

“To become the healthiest state in the nation Utah must focus on closing the gap in health disparities, particularly among the state’s rapidly growing minority populations,” said UDOH Deputy Director Teresa Garrett. “Utah should be a place where all people can enjoy the best health possible.”

And despite being ranked 5th in the nation for prevalence of obesity, Utah’s rate continues to climb, with 23 percent of Utahns falling into that category.

“I take no comfort in being ranked 5th in the nation for obesity, as it simply means Utahns are not yet getting fat as fast as the rest of the nation is. However, we are on a quick track of getting there,” Sundwall said. “Obesity is a significant public health threat to our entire community; my goal is to see a time where our obesity rate actually falls from one year to the next.”

The UHF report praises Utah for its efforts in preventing infant mortality; the state’s rate dropped by 45 percent over the 20 years the health rankings report has been published. The state also received credit for decreasing its rate of uninsured residents.

Utah ranks in the top 10 in 12 of the 22 determinants, including;

Prevalence of smoking	1st (no change from 2008)
Infant mortality	1st (up from 4th)
Cancer deaths	1st (no change)
Prevalence of binge drinking	1st (up from 3rd)
Children in poverty	2nd (up from 9th)
Preventable hospitalizations	2nd (no change)
Cardiovascular deaths	3rd (no change)
Prevalence of obesity	5th (up from 7th)
Poor physical health days	5th (down from 4th)
Violent crime	6th (up from 7th)
Infectious diseases	6th (down from 5th)
Premature death	7th (up from 6th)

There are many factors at work in Utah’s consistent top 10 ranking over the 20 years of the UHF report. “The rankings document much of the valuable work done in public health,” said Sundwall. “But we fully acknowledge the benefit of other significant factors that contribute to good health. These include a culture that promotes healthy behaviors, and our nationally-recognized, high quality private health care systems.”

The report ranked Vermont as the healthiest state in the nation. Massachusetts, Hawaii and New Hampshire round out the top five.

For a full copy of the United Health Foundation—America’s Health Rankings™ Report, visit www.americashealthrankings.org or www.unitedhealthfoundation.org

From the Utah Health Policy Project Newsletter

Rochelle is insured.  This year after getting very sick with pancreatitis and resulting severe complications, she was in the hospital for a couple months.  By April, she had hit her annual insurance benefit cap of $250,000.  Since then, she has been paying her monthly premium of $850 but is essentially uninsured.  Rochelle now has $35,000 in medical debt and is postponing surgery she needs until next year when her annual cap resets.  But in the meantime, she worries about getting sick and ending up in the hospital again.  How would she pay that bill?

We can all agree that health reform is needed.  A recent poll by the Salt Lake Tribune found that a majority of Utah voters – 55% — said health reform is a “necessity.”  Utahns recognize the need for health reform and are critical of the existing system.  We see everyday examples of our fellow Utahns, like Rochelle, who are falling through the cracks.  We also see how the cost of health care escalates every year.

At the same time, health care is responsible for 17% of our gross domestic product (GDP) and 13.7 million jobs nationally. One in 10 Americans work in the health care sector. The health care industry impacts every one of us personally, our businesses and employers.  The enormity of this issue explains why our country has gone decades without meaningful health reform.  And why the current debate has devolved into a bitterly partisan political battle.

The Tribune poll also found that Utah voters’ disapproval of the national health reform is tied to dissatisfaction with the President. Fifty seven percent of registered and active Utah voters oppose President Obama’s proposal to reform health care. HOWEVER, when the President’s name is removed from the equation, most of the opposition dissipates. A solid majority, 57%, say it’s necessary for the federal government to reform health care.  This reflects the results of our small business survey from this summer, which found that 68% of Utah small business owners agree that the state and federal governments must be partners in reforming health care.

This federal-state partnership is how health care is regulated and delivered today, and both partners will need to act in order to remove the barriers Utahns face in getting or keeping quality, affordable coverage and care.  The national reforms focus on access and affordability of coverage, while containing costs through new efficiencies in Medicare.  Using uniquely American solutions, national reforms will strengthen the private insurance market by creating new exchanges where small businesses and individuals can shop and compare plans, while pooling their risk together.  Low and moderate income Americans will have access to subsidies to help them afford coverage. Small businesses will be largely exempt from coverage obligations but given new tax credits to help them purchase coverage.  In addition, insurers will no longer be able to deny coverage or charge more for pre-existing conditions or gender.

While national reforms will provide a much needed framework and parameters for reform, Utah still has a very important role to play.  Our state has already demonstrated a commitment to health reform, and we will need Utah to build on these efforts if we are ever going to sustain the commitment to quality, affordable coverage and care for every Utahn.  While the national reforms focus on reining in costs for public programs, our state can take an active role in bending the cost curve in the private market.  We already have pilot programs underway to study changing the payment structure so that providers are rewarded for keeping us healthy rather than being paid for every test and procedure.  We need to increase our investment in these pilot projects and work on implementing them on a broader scale. Our state’s innovative approach to value-based purchasing and care delivery could easily propel us to the front of the pack on issues that matter most.

While national and state health reforms are far from perfect, we have to recognize two things.

1. The status quo is unsustainable: it’s time to get started on health reform. Like us, you may be surprised—and much relieved—to learn that even countries with lower costs and universal coverage go through a process of fine tuning their reforms every 10 years or so (read all about it in Healing of America by T.R. Reid).
2. This is a process.  The bill that is passed won’t be implemented until 2013 and 2014.  There will be plenty of time to improve upon these reforms—at both the state and national level.

In the Tribune poll, when respondents were asked which of 6 reasons is most responsible for rising health care costs (health care providers charging too much and performing unnecessary procedures; insurance companies charging high premiums and refusing to cover bills; lawyers who file too many malpractice suits; people living unhealthy lifestyles; people who don’t buy insurance and then use emergency rooms for care; or, government over-regulating), the most common answer, without any prompting from poll-takers, was “all of the above.”  This finding confirms an abiding belief of the coalition Utahns for Sustainable Health Reform (U-SHARE) that all stakeholders—insurers, providers, hospitals, employers, and individual Utahns—must share in the responsibility for reforming health care.  Each group stands to gain something and lose something from reforms. But the question is: are we courageous enough to take the leap, to imagine a more sustainable approach to financing and delivering health care?

This January, 10-year-old Benjamin Mitchell of Sandy was skiing with his grandmother when he lost control and crashed headfirst onto the slope. He wasn’t wearing a helmet and suffered a devastating frontal lobe brain injury.

“I still remember that terrible phone call from my mother-in-law,” said Benjamin’s mother, Kari. “I also remember the guilt I felt for not making him wear his ski helmet like he always did while riding his bike.”

Nearly 10 months later, Mitchell still deals with memory problems caused by the traumatic brain injury. He is just one of thousands of Utahns who suffer a TBI every year. As a young male, he is in the highest risk category.

“Most males under age 30 sustain a TBI in car crashes and sports activities,” said Trisha Keller, manager of the UDOH Violence and Injury Prevention Program “And the real tragedy is that most of the injuries are easily preventable.”

When asked if he would wear a helmet when skiing again and what he would tell his friends, Mitchell said, “Definitely I would wear my helmet. It may not be cool but it’s your life.”

The Brain Injury Association of Utah is the only non-profit organization dedicated solely to education and support for the issues of prevention and recovery of brain injury in Utah. Each year an estimated 44,000 Utahns receive services through BIAU.

Like Mitchell, 19-year-old Andrew Allred of Salt Lake City deals daily with the life-changing effects of several sports-related TBIs. Allred sustained multiple concussions in football, lacrosse, longboarding, and snowboarding. His first was during his first football game as a freshman at Olympus High. Allred was cleared to go back in and play, but after struggling to catch the football and remember the plays, he knew his injury was more serious than previously thought. Allred has suffered from depression, memory loss, dizziness, and even had to re-learn how to read as a result of his brain injuries.

“Going back in the game after the first concussion only increased the severity of it,” said Allred. “Coaches and athletes need to understand how serious a concussion is. I’m going to be dealing with these issues for a long time,” he added. “Sitting out and letting your body heal is a small sacrifice when you’re talking about the rest of your life.”

Utah Department of Health data show just how serious the problem of TBI is:

• In 2007, 2,329 Utahns suffered traumatic brain injuries (TBIs) severe enough to require hospitalization
• 205 (9 percent) of the injuries in 2007 occurred during sports-related activities like biking, skiing/snowboarding, skateboarding, water sports, and baseball.
• 500 (23%) died of their injuries.

For more information visit the BIAU website at www.biau.org To learn more about TBI-related data in Utah, visit www.health.utah.gov/vipp/

Source: Utah Health Policy Project

Three years ago, 62-year-old Merce Butler, left her job of 11 years to care for her dying mother overseas. She sold her car and drained her savings to make the move. Sadly, her mother passed away after a few months. Upon returning to Utah, Merce tried to re-enter the workforce, but with the economic downturn, nobody was hiring, particularly women in their sixties. She now makes due with her social security income, coping day by day.

In June disaster struck. Merce became extremely ill and ended up in the emergency room.  She was diagnosed with a serious case of the swine flu and had to remain in the hospital for three days. Since Merce lost her health insurance when she left her job, the $16,000 hospital bill fell in her lap. She pleaded with the hospital to take her situation into account and reduce the bill, but she still owes over$11,000. “I have no idea how I’ll pay this off – I don’t even have $100 dollars right now, and I’m living month to month. I don’t know how this happened – I’m such a healthy person.  The swine flu?  I still can’t believe it. What was I supposed to do in the emergency room?  Go home because I had no insurance, and infect everyone around me?”

Merce will not qualify for Medicare for another three years. In the meantime she feels trapped. Although, she has recovered from the swine flu, she has not recovered from the medical debt. She also knows that at any moment, disaster could strike again.

Pass National Health Reforms This Year

Utahns like Merce are playing Russian-roulette with their health and their finances when they go uninsured. People like Merce are less likely to get vaccinated, raising the risk of contracting swine flu and infecting all of us!  The status-quo is not sustainable. Without federal and state action this year, our health care costs will double over the next decade, millions more of Americans will become uninsured, and bankrupt our state and federal governments. Congress and Utah must enact health reforms this year to bring peace of mind and security to Utah families.  Reforms should ensure Utahns can get the care they need, when they need it, and from the doctor they choose.

Some look like candy and mints, others like toothpicks. Then there are the dissolvable strips you’d swear are breath fresheners. But inside, they’re still just cancer-causing tobacco, wolves in sheep’s clothing that will entice and hook new, young smokers and keep current smokers addicted.

At a news conference today, the Utah Department of Health (UDOH) helped the public understand just how insidious the new products are. Faced with a growing number of quitters, big tobacco is now offering nicotine that doesn’t need to be smoked or chewed: some of the new products melt quickly in your mouth and deliver nicotine straight to the bloodstream. Others are shaped like breath mints and come in eye-catching tins that hide easily in a pocket.

“As comprehensive tobacco control efforts help to lower use, the industry quickly responded by developing new ‘tobacco candy’ products to maintain their profits at the expense of public health,” said Amy Sands, program manager for the UDOH Tobacco Prevention and Control Program (TPCP). “These products are designed to make tobacco addiction more accessible as well as to promote the dual use of cigarettes and smokeless products, creating an even stronger addiction.”

“Because these products were brought to market very quickly, there’s limited research about their long-term effects,” said University of Utah Health Care pediatrician Ellie Brownstein, M.D. “What we do know is that they have a high nicotine content and could be very deadly to a child who thinks he’s picking up a piece of candy.”

Kathy Baebler, Salt Lake Valley Health Department health educator, pleaded with parents today to be aware of the products and their harmful effects. “The slick packaging makes the products appealing to children,” said Baebler. “Teachers, too, need to be aware that they are very likely to be making their way to the classroom. So it’s critical to remind students that there is no safe tobacco product.”

Tobacco prevention and control efforts in Utah are working, but much more needs to be done. Tobacco use in Utah costs taxpayers $369 million in smoking-related medical expenses and $294 million in lost productivity each year. Cost-effective anti-tobacco programs and quit services pay for themselves through the resulting health and economic benefits for the state. In addition to saving lives, each percentage point reduction in the smoking rate equals savings of $315 million in future health care costs.

For free information or to get help quitting, call the Utah Tobacco Quit Line at 1-888-567-TRUTH or visit www.utahquitnet.com

A new report shows Utah is not meeting national goals for consumption of fruits and vegetables. The Centers for Disease Control and Prevention (CDC) reports just 32% of Utah adults meet the goal of eating at least 2 fruits daily and just 25% eat at least 3 vegetables a day. Adolescents in grades 9-12 fare even more poorly, with 30% meeting the 2 fruits goal and 11% eating 3 vegetables daily.

“Most of us already know how important it is to eat fruits and vegetables to preserve our health and prevent disease,” said Utah Department of Health (UDOH) dietitian Patrice Isabella. “But just getting fresh produce can be difficult for many families for a variety of reasons,” she added.

The report card points out that schools may not provide enough produce in foods offered outside of regular school meals, such as a la carte and vending. And some communities don’t have full-service grocery stores within walking distance for residents who don’t have transportation.

Other key report highlights include:

• Utah does not have a state-level policy for improving the availability of stores that offer healthy foods.
• Only 25% of middle and high schools in Utah offer fruits and non-fried vegetables in school stores or vending machines.
• Utah is one of 29 states that do not have a state policy for ‘Farm to School’ programs. These programs link schools with local farms and can help increase fruit and vegetable access, as well as students’ knowledge of nutrition and agriculture.

The good news is Utah is one of just 20 states with an active Food Policy Council. The group’s mission is to educate and inform the public and policy makers about relevant food system issues, and advocate for policies that support and strengthen a sustainable community food system.

The report card lists in detail produce consumption rates across the state and will help UDOH target the communities and schools that need the most help. The information will also help advocates shape policies that will help promote healthy eating in all neighborhoods.

“We’re very glad to have this new information,” said Isabella. “Now we’ll pull together government, health professionals, businesses, schools, farmers and community members to talk about how to make healthier food more available and affordable,” she added. “As has been shown in other states, this can be a key difference in helping people eat better and stay healthier.”

The State Indicator Report on Fruits and Vegetables, 2009 is available from the CDC’s Division of Nutrition, Physical Activity and Obesity at www.fruitsandveggiesmatter.gov/indicatorreport

When David and Tammy Atkinson of Kaysville adopted their son Schylar at age 16 months, they knew his birth mother had used drugs and alcohol. They knew he would have learning disabilities. But they didn’t know all the other profound effects the alcohol use would have on their family and especially on Schylar.

“We were worried about the meth and heroin,” says Tammy. “But it was years before we finally learned that the severe brain damage he has is a result of Fetal Alcohol Syndrome.”

Now six years old, Schylar has pica, an uncontrollable urge to eat non-food items, like his own diapers, glass, and rocks. He has ADHD, Asperger’s Syndrome and OCD, which is so severe he chews his fingers and toenails until they bleed. His parents are sharing their story to warn pregnant women and girls of the dangers of drinking.

“Schylar suffers every day of his life, angry and confused about why he does what he does,” says Atkinson. “So please tell everyone you know who drinks and is pregnant or thinking about having a baby to get help for their addiction,” she pleads.

Also known as FAS, Fetal Alcohol Syndrome is just one of a set of conditions called Fetal Alcohol Spectrum Disorders (FASDs), which are the number one known cause of birth defects and intellectual disabilities. Forty-thousand babies are born with FASD in the U.S. every year – and the majority of them are adopted by unprepared families.

“No one knows how many drinks it takes to cause FASDs,” says John C. Carey, Medical Director of the Utah Department of Health and University of Utah’s Pregnancy Risk Line. “These children have heartbreaking, lifelong problems that are 100 percent preventable,” said Carey. “If you don’t drink when you’re pregnant, your baby will not have FASD,” Carey adds.

While some children have facial or other physical deformities that alert doctors to FAS, many don’t, which means parents lose precious time struggling to get them diagnosed. That’s why babies born to mothers who drink are called ‘visible children with invisible disabilities.’

September 9 is Utah Fetal Alcohol Spectrum Disorders Awareness Day. A primary goal of the observance is to let women know they can get help to quit their addiction.

“Utah’s substance abuse treatment programs provide services designed especially for women,” said Becky Barnett, Program Manager for the Utah Division of Substance Abuse and Mental Health. “And pregnant women get priority admission, where they will find a continuum of services ranging from pre-treatment to residential services.”

According to The Lewin Group, considered the gold standard for determining health care costs, the average lifetime cost of caring for a child with FASD may be higher than $2 million. The group also estimates the lifetime cost to the state Utah for medical treatment, special education, and home and residential care for children with FASD could be as high as $27 million.

“The emotional cost to families is high, too,” says Schylar’s mother. “Still, even if we had known about FAS, we would have adopted Schylar, and we live for those moments when he is happy,” she adds. Atkinson gives much of the credit for those times to his three older sisters. “The love and support of siblings for families like ours can’t be underestimated.”

The Utah Fetal Alcohol Coalition will sponsor a free parent seminar from 7–9 p.m. Thursday, Nov. 5 at the Business Alliance Bldg. in Kaysville. Guest speaker is Dan Dubovsky of the FASD Center for Excellence. Dan’s adopted son had FASD; their experiences together help Dubovsky as he works with other parents of FASD children. For more seminar information call Kellie Butcher at 801-663-5562.

For a list of resources ranging from substance abuse prevention and treatment for women to services for people with FASD, visit http://www.dsamh.utah.gov/fasd.htm

In tight economic times, some bypass the produce section at the grocery store and head for cheaper foods. But because fruits and veggies can be a key to staying healthy and preventing disease, the Utah Department of Health (UDOH) is urging shoppers to take a look at some easy, cost-saving ideas for using produce every day.

“The ideas come from Produce for Better Health and are backed by the CDC,” said Tania Charette of the UDOH Physical Activity, Nutrition & Obesity Program. “They emphasize things like making large batches of soups and freezing portions for later, and creating weekly meal plans that use similar fruits and veggies that are prepared in different ways.”

September is national Fruits and Veggies—More Matters® Month and it’s a great time to change your buying and eating habits. You can shop at local farmers’ markets, buy in bulk and freeze the items for later. Other tips include:

• Use a free online calculator (www.extension.iastate.edu/foodsavings/fooddollar/) to figure out how much you should spend to feed your family healthy meals.
• Don’t shop hungry! Eat a banana or apple before going shopping.
• Use 100% frozen juice concentrate instead of bottled juices.
• Keep a supply of frozen fruits and veggies on hand – and buy the large bags to stretch your budget.
• Instead of throwing overripe fruits and veggies away, use them in smoothies.

Research has shown that adding produce to your diet may reduce your risk for heart disease, high blood pressure and some cancers. It also adds important nutrients and provides fiber to help make you feel full and eat less.

For more ideas, visit www.hearthighway.org/morematters.html

Release Date: July 23, 2009

Salt Lake City –Yesterday Senator Orrin Hatch decided to quit the delicate negotiation process underway in the Senate Finance Committee. His decision is based on fundamental disagreements with the areas of consensus achieved thus far in the negotiations, including:

• the need for an employer mandate and individual mandate to underpin the reforms;
• a modest Medicaid expansion for those who are not offered coverage in the workplace;
• and a tax increase to finance the significant upfront costs of reform.

“We appreciate the Senator’s honesty in recognizing his limits, and we want to thank him for sticking with the process to this point,” says Judi Hilman, Executive Director of Utah Health Policy Project. “But the truth is, Senator Hatch’s areas of discomfort are with the most basic building blocks of reform.”

“Yes, the financing question is tricky in today’s economy, and this is precisely why reforms must be paid for through shared responsibility. This Congress must figure it out this year, or Utah stands to add an estimated 56,000 to the ranks of the uninsured,” according to Hilman.  “Small businesses, too, must have immediate and lasting relief or they will not be able to lead the way to economic recovery” (see UHPP’s recent summary of Small Business Majority’s scientific survey of Utah small businesses and their readiness for true health reforms, including shared responsibility and other building blocks).

“Reforms must bring everyone into the system with decent, comprehensive, and affordable coverage—this is our starting point in achieving cost containment and a more efficient system” explains Elizabeth Garbe, Coverage Initiatives Director of the Utah Health Policy Project. “On the private insurance side, an individual mandate and a basic benefit package is needed to minimize the separation of healthier individuals into some plans and sicker individuals into other plans, which drives up costs. Coverage must be made affordable to bring in enough young people thereby reducing costs for the rest of us.”

“Reforms can emphasize the private insurance market, but there must be a role for public programs in closing the significant coverage gaps for working adults” added Garbe. “The Congressional Budget Office has found it is most cost effective to simply expand Medicaid for those without a reasonable offer of coverage in the workplace—typically those with income less than 100-133% of poverty. This is a modest expansion in the scheme of things, and much of the expense will balance out through other proposed changes, including payment reforms. These are the basic building blocks of any successful reform,” Hilman clarified. “While, Senator Hatch’s concerns around long-term cost containment are altogether valid, the status quo is no longer acceptable. With him out of the ring, we hope he will still contribute to practical problem solving in this area. Without him in the process, it is up to Congressman Matheson and Senator Bennett to argue the case for stronger cost containment while being part of a comprehensive bipartisan solution this year.”