Sullivan health study links common risk factors with worst ailments

J. H. Osborne • Apr 26, 2008 at 12:00 AM

BLOUNTVILLE — It sounds simple enough: better choices could equal better health.

Local health officials say that’s a very basic way of looking at a summary of Sullivan County’s overall health status, released last week.

It identifies the top 12 health threats in the county, along with five risk factors that play a role in the growth of each.

The summary is the result of more than a year’s work by the Sullivan County Health Council.

The council is made up of volunteers and includes medical professionals as well as representatives of social service organizations.

A similar group last produced such a study in 2002.

This effort is seen as an update, but is said to cast a wider net due to increased resources since the last time around.

The assessment shows the worst health problems in the county often share some common risk factors — and cultural behavior dominates most of those risk factors, according to some of those involved in the process.

Dr. Stephen May, medical director for the Sullivan County Regional Health Department (SCRHD) said health council members realize achieving the shift from “unhealthy” to “healthy” will take time — possibly generations.

“You look at how different things affect how many different diseases and it starts to become clear — you’ve got to change lifestyles,” May said. “For me, as a health officer, that’s the toughest question to answer: How do you change a culture’s behavior and a culture’s lifestyle. It’s a daily challenge of every physician with every patient they see.

“And it’s an age-old challenge. Along with freedom to choose how we live has to come the responsibility that goes with it. A lot of the answer is encouraging and motivating people to accept responsibility for their lifestyle choices,” May said.

How would you rate your own health?

Nearly 80 percent of Sullivan County residents rated their own health quite favorably in a 2005 survey used, in part, to develop the summary.

But about 22 percent of Sullivan County residents answered “fair” or “poor” when asked to rate their health.

That’s compared to about 19.5 percent statewide, and only 15.1 percent nationally.

“A key measure of general health status and quality of life is ‘perceived’ health,” a section of the summary states. “Even though perceived health is subjective, it has been shown to be a predictor of illness, mortality and functional disability.”

About two-thirds of respondents said they had no physical activity, or not enough physical activity to meet recommended levels. And two-thirds of respondents met guidelines to be classified as overweight or obese.

And that fits in with many of the top health threats in the county, including rising rates of diabetes and heart disease, said May.

The council looked both at factors that contribute to disease, and the secondary consequences of disease — an often circular progression.

“It all feeds upon itself,” May said.

For example, he said, a lack of a high school education can increase rates of smoking, which increase lung disease and cancer.

As a consequence or secondary consequence, disease caused by another factor can lead to depression and, in turn, increased drug or alcohol abuse — which can create more disease.

“It led us to look at the inter-relations of disease — how they interact with each other — and what are the common risk factors that tie them together,” May said.

The 111-page summary was issued last week by the Sullivan County Health Council.

Robin Elolia, environmental epidemiologist with the SCRHD, said the health council is now reaching out to other organizations for partnerships in addressing each health issue.

“We’re putting groups together now to begin to mold plans for Sullivan County,” Elolia said.

For the first such effort — reducing motor vehicle accidents — likely partners could be local school systems and law enforcement agencies.

The health council will look at how other communities have successfully addressed the same issues and use that information to develop local initiatives, May said.

Within the next few month, the council hopes to put several partnerships and action plans together to launch campaigns about some of the individual health problems identified as having the greatest potential impact on county residents’ lives.

Motor vehicle accidents are not the highest-ranked health problem for Sullivan County, according to preliminary results of the health council’s assessment.

They were number two.

But in choosing which health problem to address first with some sort of initiative, health council members considered various factors, including how effective a public campaign might be and to what degree changes in behavior could alleviate the problem.

The health problem which ranked number one for the county, upper respiratory infections, was deemed difficult to address through a public campaign geared to behavioral change.

The top 12 health problems for Sullivan County, as ranked the health council, are:

•Upper respiratory infection;

•Motor vehicle accidents;

•Heart disease, stroke and hypertension;

•Lung cancer;

•Infant mortality;

•Lower respiratory problems; including asthma and pneumonia;

•Colon cancer;



•Drug and alcohol use;

•Sexually transmitted diseases (STDs); and

•Oral health.

There’s another caveat to the ranking order: all cancers, combined, would knock upper respiratory infections from the top slot.

A matrix was used to develop the ranking. Each health problem received a score, based on a weighted average point system for factors such as potential years of life lost, whether any up or down growth trend can be seen locally in the number of cases, and the community’s likely acceptance of public discussion of the particular problem.

The council’s work also identified risk factors that affect the community’s health.

Ranked by the number of diseases to which they contribute, those risk factors had a clear “top five:”

•An educational level less than a high-school diploma;

•Lack of resources/poverty;

•Barriers to access to healthcare opportunities, for example, no insurance or no transportation;

•Limited employment opportunities; and

•Health literacy/hygiene knowledge and practice.

Those risk factors produce consequences that contribute to 28 different diseases that affect the community, according to preliminary results of the council’s work.

For more information about SCRHD, visit www.sullivanhealth.org.

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