Why Utah Is One Of The Healthiest States
In 2015, I returned home from the gym one night and noticed several missed calls from my mother and brother in California. Instinctively, I knew something was wrong and called my mom back. That’s when I learned that my father, who was divorced and living alone, had died suddenly at the age of 62.
When I heard my father had hit his head the day he died, I asked for an autopsy to determine his cause of death. It was not a traumatic brain injury as I suspected―it was obesity. My father’s heart was so enlarged that it had doubled in size.
Obesity isn’t just cutting people’s lives short, it’s expensive. According to the latest report on the rising costs of obesity by the US National Library of Medicine National Institute of Health (NCBI), obesity raised the medical care cost of each obese adult to an average of $3,429 annually for a total of $315.8 billion.
Obesity in the United States has reached 39.8 percent, affecting about 93 million US adults, according to the Center for Disease Control and Prevention (CDC). Obesity is linked to heart disease, Type 2 diabetes, stroke, and certain cancers―all leading causes of premature, preventable death. Obesity has impacted most American’s lives just as it has impacted my own.
The Booming Fitness Industry
The fight against obesity has been rocket fuel for a booming fitness industry. The International Health, Racquet & Sportsclub Association (IHRSA) reported that in 2017, the global health club industry was $87.2 billion and the US alone generated over 30 billion in revenue. Not only is the US the single, biggest market in the world for revenue in the health and fitness sectors, it ranks number one in the total number of health and fitness clubs worldwide.
Adopting a healthy lifestyle is critical to preventing a host of diseases, but not all states are equally “healthy.” In 2018, Hawaii, Massachusetts, Connecticut, Vermont, and Utah were the five healthiest states in the nation, with Utah ranking fifth, according to America’s Health Rankings report.
The report considers 35 health factors and examines them in each state, such as the lifestyle behaviors people are choosing, the community and environment people are living in, the public policy established by the states, and the quality of healthcare people receive from primary care physicians and hospitals.
Dr. Rhonda Randall, chief medical officer at UnitedHealthcare National Markets and senior advisor to the America’s Health Rankings report, told CNN that for the first time in the history of the report, obesity rose by five percent in just one year, hitting 31.3 percent in 2018. Lifestyle choices are key obesity factors, which led me to ask, “What are Utahans doing right to rank fifth on the list of healthiest states? Here’s where my research led me.
Factors That Determine Health
“NCHHSTP Social Determinants of Health,” by the CDC, recognizes specific social determinants of health and describes them as a “complex, integrated, and overlapping social structure and economic systems that are responsible for most health inequities.
Scientists, reports the CDC, have recognized the five determinants of health in a population to be: 1) biology and genetics, 2) individual behavior, such as drug and alcohol use, 3) social environment, 4) physical environment, and 5) access to quality healthcare. These economic systems and social structures are all tied to the social and physical environments, societal factors, and the health services in a given area.
Access to quality education is closely linked to a population’s health. The relationship between poverty and unhealthy behaviors such as illicit drug use, tobacco use, a sedentary lifestyle, and poor nutrition have been well demonstrated and go much deeper than having the financial ability to purchase organic foods, pay for gym memberships, and access quality healthcare. After all, smoking, drugs, and alcohol are often more expensive hobbies than hiking or walking or other activities in the fitness industry.
The tendency for low socioeconomic groups to engage in chronic, unhealthy behaviors despite the health and life expectancy costs was a puzzle until recently. According to “Socioeconomic Disparities in Health Behaviors,” published by the US National Library of Medicine National Institutes of Health, stress and disadvantaged social position are sources of adversity that can drain a person’s capacity to cope.
Under chronic stress, unhealthy activities such as smoking, drinking, overeating, and inactivity create feelings of pleasure and relaxation that help disadvantaged individuals regulate their mood. Those who live in disadvantaged neighborhoods encounter a variety of chronic stressors, so they’ll engage in unhealthy behaviors that are highly addictive and limit their ability to adopt healthier behaviors, which can be extremely challenging.
When people continuously struggle to make ends meet, have fewer opportunities to establish and attain positive life goals, have difficulty accessing higher education, are lifelong victims of abuse, and experience one negative life event after another, they can develop compulsive behaviors, such as overeating, drinking, and smoking.
All of these factors contribute to declining health in the unhealthiest states in 2018, such as Arkansas, Oklahoma, Alabama, Mississippi, and Louisiana. Utah’s robust economy, access to quality education, and social environment are key reasons why it’s the fifth healthiest state in the nation.
According to the 2018 American Community Survey, Utah’s high school graduation rate is 92 percent, ranking third for all states in the area. The number of adults aged 25 and older with a bachelor’s degree in the state was 33 percent, ranking second after Colorado at 39 percent. With just an eight percent high school dropout rate, Utah had the smallest high school dropout rate for all the states in the area according to the survey.
The link between education and health are huge. The US Department of Health & Human Services (HHS) says education is critical to social and economic development and “has a profound impact on population health.” The health benefits of education, such as skill development, access to resources, social policies, and healthy cultures are all factors that directly impact health outcomes.
Those who are well-educated are more likely to eat better and live in neighborhoods with access to parks, or walking and bicycling paths that enable residents to play outside, walk, or cycle to work. In contrast, lower-income neighborhoods are less likely to have health clubs or access to green spaces.
Learning From The Healthiest States
I was intrigued that Hawaii ranked first in the US for the record seventh time. So, I reached out to Dan Witters, the research director for the Gallup National Health and Well-Being Index, which he’s spearheaded since 2008.
I wanted to know how Gallup defined wellbeing, and what Hawaii was doing to come out on top. Mr. Witters explained that looking at our physical health alone was too narrow of a view. To look at “wellbeing,” you have to take a holistic approach. He explained how someone can be in great shape physically, but if they’re not doing well in the other elements; for example, community, social, or career, they can still be miserable.
I asked Mr. Witters why Hawaii consistently ranks first in wellbeing nationwide, and he said it has a lot of things going for it, and contrary to popular belief, it’s not the weather. When you examine the relationships between warmer states and colder states, and you look at the historic high health wellbeing states, the northern plains and mountain west regions, along with pockets in the northeast fair better nationally.
There can be some advantages that give you a little leg up in a place like Hawaii due to the outdoor weather. Residents are more likely to be moving, exercising, eating more fresh fruits and vegetables―that’s all a part of physical wellbeing and that’s going to give you a boost, but it’s not as big of a factor as you might guess. “In the case of Hawaii, there’s a huge culture of wellbeing. It’s a hard thing to quantify in survey research, but it’s very real,” Mr. Witters says.
“I consider career to be the most important of the five elements. It has the longest tentacles. Career is the highest correlate to each of the other four elements, so it carries the greatest influence on overall wellbeing. If career is strong then it really lends a buoyancy to the other four. If it is weak then it tosses a lot of sand into the gears of the other four. So, it’s very important,” he says.
In addition, low ranking states such as Arkansas, Louisiana, Mississippi, Alabama, and Tennessee have a lot in common. Compared to residents of high wellbeing states, residents of low wellbeing states are much more likely to be obese and to carry a heavy disease burden. They are even heavier smokers, they don’t exhibit good eating habits, and they exercise less.
Residents of low wellbeing states are much less likely to have someone in their lives who inspires them to be healthy, they are less likely to be actively involved in improving their community, they are less likely to live within their means and to manage the wealth effectively, they lead less intellectually active lives, they use their strengths less, and they are less likely to exhibit good oral health habits, he says.
Practical Solutions To Keep Utah Healthy
After speaking with Michael Friedrichs, lead epidemiologist at the Utah Department of Health, Bureau of Health Promotion, and author of the Utah Health Status Update: The Hidden Epidemic of Obesity: A Closer Look at Unhealthy Weight, I realized it might be hard to stay at the top.
According to the Utah Health Status Update, the percentage of obese adults in Utah rose from 32.8 percent in 1999 to a striking 41.7 percent in 2017, representing nearly a 30 percent increase in adults who moved up to an unhealthy weight category. Clearly, we’ve got work to do, and fast.
When I asked Mr. Friedrichs about the surge of obesity in Utah, he cited poor diet and lack of physical activity. No surprise there. We’ve engineered physical activity out of our lives, explained Mr. Friedrichs. “The whole cell phone phenomena and the way it’s shaped our country is overwhelming to me. Who would have thought we’d become a bunch of phone zombies?” he says.
And there’s little money in public health. “Big soda and big tobacco outspend our budgets within a few hours. We have the tiniest little money for obesity―only three people who work at the state work on obesity,” he says.
Rebecca Fronberg, the program manager at Healthy Living Through Environment, Policy & Improved Clinical Care (EPICC), an arm of the Utah Department of Health, says we have to look at the obesity epidemic as a nation: Corn and soy are overproduced, so the food industry tries to find ways to use all the extra, she explained. “Then, they produce high fructose corn syrup―they engineer foods for addiction, and it’s really frustrating because people are in a fast-paced society.”
Keeping Utah healthy means battling against the obesity epidemic. Heart disease and cancer are the two leading causes of death, and both are directly related to obesity, says Mr. Friedrichs. “We used to think that cancer is more genetic. Now we know that way more than half of cancers are environmental behaviors. They’ve both bottomed-out, he says. “But we’re going to see an upturn as we’ve exhausted the medical interventions that keep people alive after they get sick. [From now on,] it’s going to be about reducing the demand for healthcare.”