State Climbs Three Notches from 2010
After years spent in the bottom 10 when it comes to health rankings in the United States, Tennessee pulled up to number 39 in the nation. True, the state is still in the bottom third of the country when it comes to health status, but the latest statistics show upward movement of three slots since 2010 and five slots since 2009, continuing a trend of gradual improvement.
Health Rankings at the Top and Bottom
2. New Hampshire
“We have to be pleased as a state with our steady, upward progress. It’s truly impressive and represents the collective work of thousands,” said Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, FACEOM. “It also represents a collective understanding in decisions … both great and small … of hundreds of thousands of Tennesseans.”
He continued, “This is a point where all Tennesseans, as we climb this health mountain, should take a breath and enjoy the view for a moment and then work hard to climb further up … but this is not a time to stop.”
America’s Health Rankings 2011, released in December by United Health Foundation, showed the state has a number of strengths and challenges. Perhaps one of the most positive notes is Tennessee’s rank of 37 for health determinants since those measures tend to lead outcomes. In fact, the state had an outcome ranking of 42 and overall ranking of 39 this year. In 2010, the state had a determinant ranking of 39, an outcome ranking of 44, and an overall ranking of 42.
“Outcomes measure the type of health we have now, and the determinants are indicators of the types of health we may have in the future,” explained Dreyzehner. Having determinants lead outcomes suggests the interventions being put in place are working.
|For Detailed Information, See America’s Health Rankings 2011 at HYPERLINK "http://www.americashealthrankings.org" www.americashealthrankings.org
Also on the positive side, Tennessee has a low prevalence of binge drinking, a high immunization rate and a readily available supply of primary care physicians. On the flip side, the state has a high prevalence of obesity, diabetes and violent crime. Still, there was a decrease in violence from last year and a slight drop in obesity rates.
“For the first time our rate of obesity has not gone up,” stated Dreyzehner. “We went from a rate of 32.8 last year to 31.7 this year in prevalence of obesity in terms of a percentage. This is the first time since 1995 where that movement has been in a downward direction. One year does not make a trend, but it’s certainly the first bit of good news we’ve had in regards to obesity and overweight in many years.”
Dreyzehner was quick to add, however, that the state is still looking at roughly one-third of the population being obese and another third being overweight. Of a total population of 6.346 million, approximately 4.3 million Tennesseans are clinically defined as overweight or obese. Tennessee’s highest ranking public health official also said there is a proven, effective way to begin to lower those statistics … and that is for health professionals to speak with patients about their weight. Providers have seen success by educating and motivating patients to make better choices when it comes to seatbelt use, bike and motorcycle helmet use, and tobacco cessation.
“Gentle but firm words from a healthcare provider are strong, evidence-based interventions that can begin the process of motivating people to eat less and exercise more, but it still remains for many of us uncomfortable,” he said of bringing up the subject. “It might be particularly uncomfortable when we need to talk to ourselves, as well.”
Tobacco cessation is another area of steady progress. In 2003, 26.5 percent of the Tennessee population smoked. In 2011, that had dropped to 20.1 percent. The national rate, dropped from 22.1 percent in 2003 to 17.3 percent in 2011. “What’s very positive about that is our rate of decrease is accelerated vs. the rate of decrease in the United States for smoking,” Dreyzehner explained.
Nationally, the decline was 4.8 percent over the eight-year period. In Tennessee, the rate of decline was 6.4 percent during the same period. “The absolute number of smokers has decreased substantially. Having said that,” Dreyzehner continued, “we still have more than 1.3 million smokers to encourage to quit.”
Another stat that saw slight improvement but continues to worry Dreyzehner is the infant mortality rate. The rate, measured in deaths per thousand live births, was 8.2 in 2011, which is down slightly from the 2010 rate of 8.5. However, Dreyzehner pointed out, “In 2009, we had 129 preventable, sleep-related deaths among infants. These are infants that died as a result of suffocation, strangulation, and other preventable events. If we were able to eliminate all 129 of those infant deaths, our infant mortality rate in Tennessee would be at or below the national average of 6.4.”
He added that eliminating the tragic deaths that occur when infants co-sleep with an adult or are placed on their stomachs on a soft surface is a realistic goal. Dreyzehner said the Tennessee Department of Health is actively working with providers to get out safe sleep messages outlining the ABC’s of sleep — Alone, on the Back and in a Crib.
“We, as Tennesseans, need to mourn every one of those deaths, and we need to work actively to stop them. They can be stopped,” he asserted.
Another area of needless deaths Dreyzehner wants to spotlight is the number of people who die from a drug overdose. Although those rates don’t appear in the health rankings, Dreyzehner said 887 Tennesseans died in that manner according to the most recent data. “That is certainly an area where we are losing too many Tennesseans. They are preventable deaths. We need to apply some of the same systemic interventions in terms of prevention, treatment and control that we applied successfully to tobacco abuse and are beginning to apply to obesity and overweight.”
The sliver lining is that most of the issues that plague the state stem from lifestyle choices, which can be changed. “I really want us to focus —certainly as a Health Department and as much as possible as a population — on those health behaviors, those determinants, that are in our control,” he said. Dreyzehner added, we control how much we eat, and whether or not we exercise, smoke or use mind-altering drugs abusively. Those are things that can be changed with a collective willpower.
The good news is that such a will seems to be taking root in Tennessee. “We’re beginning to pull together on these critical issues,” he said.