West Virginia’s Other Public Health Crisis

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Now that President Trump has declared that the opioid epidemic in this country is a national disaster, we may soon see more attention being paid to that health crisis in West Virginia. But there’s another health crisis in West Virginia that’s been festering under the radar: the epidemic of chronic disease and general poor health. According to the most recent report by the West Virginia Health Statistics Center, West Virginians have the second highest obesity rate in the country, the fifth highest rate of inactivity or lack of exercise, and the fifth highest rate of cancer. The state ranks first in the country for heart attacks, second for the prevalence of mental health problems and fourth for diabetes. Panhandle counties, particularly Jefferson, generally fare better than the rest of the state on these measures. Yet from any viewpoint, these statistics are troubling.

But unlike with opioids, recent science has shown there’s a quick, inexpensive, and certain cure for this crisis of poor health: it is our feet. When it comes to the epidemic of chronic illnesses that West Virginians are facing– cardiovascular, cancer, diabetes, orthopedic and even Alzheimer’s and depression– the remedy is to get moving.

Our current medical delivery system is a complicated mess, with most of the focus being on acute care fixes, and little on prevention. Primary care doctors can’t spend much time with individual patients. Insurers and the government reimburse for “procedures,” fixing what’s wrong after you’re sick, not preventing it in the first place. So the classic rule of economics applies. We get more of what we subsidize, and the US healthcare system rewards fixes—pills, coded treatment routines, but not prevention.

So the latest medical news is something that everyone in West Virginia and the rest of the nation should read and heed: simple, inexpensive and relatively easy forms of exercise can both extend lives and improve the quality of our years.

For 15 years, the nationally regarded Cooper Institute in Dallas compiled data from over 55,000 men and women on whether running – slog or speedy – showed health differences. In 2014, the published study showed a remarkable difference, regardless of how fast you moved, or how far. The overall risk of dying for movers went down 30 percent, and heart-related deaths declined 45 percent.

This year the news got even better. In a follow-up to the 2014 study, a new published study reexamined the Cooper data, added results from other recent related studies and reported even more striking benefits. If you regularly move some, regardless of pace or distance, you can add three years to your life. The study found as little as five minutes of daily running led to better life spans. Notably, the overall longevity benefits of 25 to 40 percent were found even after the scientists, in their syntax, controlled for such “confounding factors” as smoking, drinking, hypertension or obesity.

But wait, as the late-night infomercials say, there’s more. The health benefits weren’t just for better cardiovascular health, which showed a risk reduction of 45 to 70 percent when compared to non-runners. A similar powerful result was achieved from just walking. In addition, the report noted a 30 to 50 percent cancer death risk reduction, as well as an unquantified protection from death due to neurological conditions, such as Alzheimer’s and Parkinson’s. Just regular walking at a moderate pace lowered memory loss risk by up to 50%, slowed age-related declines in brain function, and improved cognitive task performance.

With all this compelling evidence, the question becomes what could government and employers do to help people get moving? To its credit, West Virginia has begun steps to formulate a plan to do just that. Two health-related initiatives at West Virginia University, along with a non-profit, have set up “ActiveWV 2015.” These groups took the generalized outline from the National Physical Activity Plan (NPAP) and began adapting it to fit the state’s unique challenges. Its most recent report says:

Examples of implementation activities include multiyear programs to provide resources and support to pre-K through 12th grade schools seeking to establish comprehensive school physical activity programs and a public awareness and social marketing campaign to promote physical activity using the people, programs, and places of West Virginia. Other examples include providing resources for primary care physicians interested in writing physical activity prescriptions based on use of local and state parks.

These are good ideas, and hopefully will produce long-term results. But are there other more concrete policy steps that might move things along faster? I think so. One is tempted to think how smoking was substantially reduced by treating it as a public health problem. Strong government efforts were implemented, such as warning notices on tobacco products, and graphic public ads on the adverse results of smoking. Then laws were passed prohibiting smoking in most public places, and slowly the tide turned against smoking. But could this approach be applied to increase physical activity? The problem is different. There is not one single behavior that needs to change. There is no single harmful product on which to affix warnings. More fundamentally, it probably is much easier to persuade people not to do something than to take positive action. Nevertheless, the public health campaign approach should not be ignored.

Here is my modest proposal for three concrete policy changes that would have significant public impact. First, motivate both primary care physicians and their patients to have a dialogue about the benefits of exercise, and to recognize when good exercise habits are being formed. The best way to do this is not some “command and control” regulation, but rather to find the right motivator. Most doctors already do a good job on the dialogue and tracking of blood pressure, cholesterol and insulin resistance. Perhaps some way to compensate doctors for positive changes in patient physical activity can be found, emphasizing prevention rather than cure. And while we are at it, why not find some creative way to reward patients financially for doing what they should do for themselves? Doing so would be far less expensive than the current healthcare approach.

Second, let’s build more public gyms and exercise facilities. Governments already find it a useful expenditure of public money to build and staff facilities for the preschool population as well as senior centers for the aging population. Today only a small proportion of people in the middle age groupings have sufficient resources to afford private health facility memberships. Indoor exercise facilities could be incorporated into, or become, community centers. The dollars spent on these type of facilities will substantially reduce the state’s soaring Medicaid expenditures and other public health costs.

Third, some employers acting in enlightened self-interest get their employees to engage in healthy activities and give them a small reward for doing so, often in the form of a modest reduction in their health insurance premium. Most of the time that reward is too small, so employers might create a scaled-up version of subsidies and rewards for exercise and related good health outcomes, sharing more of the employer’s healthcare expenses that are avoided.

West Virginia now has the medical and scientific evidence on how simple it can be to extend the quality and length of its citizens’ lives, and to reduce the soaring incidence and cost of chronic disease. This state could be an excellent laboratory for dramatic reductions in poor health indicators and set an example for the rest of the country. After all, there is nowhere to go but up.

 

Charlottesville

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I have spent a lot of time in Charlottesville, first for college and then numerous visits later.  It is a lovely city, home to a fine university that pursues reason in the Enlightenment tradition of its founder. So it was that yesterday, as I saw the still photographs of the violent demonstrations by white supremacists and alt-right thugs in Charlottesville, I let out a convulsive sob. How could this kind of thing be happening in our country, much less in Charlottesville? On the pretext of protesting the removal of a statue of Robert E. Lee from a city park dedicated to the emancipation of African-American slaves, these hate-mongers slithered out from under their rocks and paraded around as if they were respectable. Something has  emboldened this ugliness. That something is Donald Trump.

It is painful to see the thugs in public dressed up in uniforms reminiscent of the fascist past, complete with Nazi emblems. But because of the First Amendment, the polestar of our democracy, this kind of thing is lawful as a form of protected speech. That has been the law of the land since at least 1977 when the American Nazi Party was granted a parade permit in Skokie Illinois, home to a large number of Holocaust survivors. We have decided as a nation that freedom of expression, particularly of political matters, carries a higher value than the pain that speech may cause to listeners. In this we are unique among nations. But we do not have to be silent in the face of hateful speech, thereby letting the haters mistake our silence for our assent. Yet that is precisely what our President did yesterday in his tepid response to the Charlottesville events.

Donald Trump has never made outright statements of support for the alt-right movement, but that movement clearly feels he supports their views. During his campaign he urged supporters to rough-up protesters at his speeches, which promptly happened. He doesn’t need to give the thugs overt support. He gives them a wink and a nod — which they recognize. Former KKK leader David Duke, who was in Charlottesville said at a rally that the events there were to “fulfill the promises of Donald Trump” to take back America. Take it back from whom? You guessed it — African-Americans, Jews, Muslims and immigrants.

On the day it occurred, Trump made a brief live statement condemning the violence but not calling out the white supremacists and alt-right fascists who caused it: “We condemn in the strongest possible terms this egregious display of hatred, bigotry and violence on many sides. Many sides.” Trump can be very specific when he wants to criticize someone or something. In this statement he pulled his punches. Where was the specific condemnation of the movement whose fundamental mission is the spread of hatred and bigotry? The alt-right surely must see this as a public relations success. One alt-right demonstrator interviewed by an Atlantic magazine reporter called the Charlottesville events “a tremendous victory.”

Two days after the horrific events in Charlottesville, under tremendous pressure, Trump finally specifically mentioned white supremacists and neo-Nazis. But many consider this too little too late. Writing in the Washington Post on August 14, Alexandra Petri remarked:

Here we are in the year of our lord 2017 and the president of the United States lacks the moral courage to condemn Nazis and white supremacists. And they are not even making it difficult. They are saluting like Nazis and waving Nazi flags and chanting like Nazis and spewing hatred like Nazis.

Donald Trump did not at first specifically condemn the white supremacists and alt-right haters because he sees them as political allies. It is as simple as that. This man — our President — has no commitment to what is morally right rather than politically expedient. It is hard to imagine a less presidential statement when the country needed our leader to stand up to bigotry and hatred. He allowed a false moral equivalency to be created between the two sides of the conflict. But, as Chris Cillizza, CNN Editor at Large, pointed out this morning:

both sides don’t scream racists and anti-Semitic things at people with whom they disagree. They don’t base a belief system on the superiority of one race over others.  They don’t get into fistfights with people who don’t see things their way.

This is a sad moment in our country. Not only do we have the death of one innocent person and injuries to others in Charlottesville to mourn. We have the revival of the alt-right knuckle-draggers to fear. We have a further debasement of civility and our social fabric, which we cannot afford. And, if we needed further proof, we have a President who is morally bankrupt.

 

The Old Bait And Switch

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West Virginia voters have just been made the victims of a fraud — we were sold one thing by Jim Justice and he has now delivered another. It did not take him long to reveal the fraud, suggesting that it was intended from the beginning.  In Huntington with Donald Trump on August 3, 2017, Justice announced that he was switching parties from Democrat to Republican. Recall that this is a man who switched party affiliations from Republican to Democrat in February 2015 so he could run for Governor on the Democrat ticket. He was elected in November 2016, a mere nine months before switching back to Republican again. In front of a cheering crowd who had booed him just moments before, Justice explained that “I just can’t help you anymore being a Democrat governor.” This bait and switch had far less to do with Justice’s desire to be an effective governor than with his lack of character.

It’s easy to dispose of Justice’s claim that being a Democrat governor limited his effectiveness during the recent budget fiasco. When his proposed budgets were first introduced to the Legislature they involved generating new revenues and preserving the spending necessary to retain the state’s social fabric. He got wide support for this from the Democrats but little support from the Republicans. As the debate wore on, however, Justice abandoned the progressive aspects of his budget and began caucusing with the far-right Senate Republicans in their effort to cut income taxes.

These income tax cuts were not only opposed by Democrats, but also by House Republicans. Since Republicans control the House of Delegates, it was Justice’s inability to deal with them that ultimately frustrated him. But actually being a registered Republican would not have improved his effectiveness.  He had already taken up with the right fringe in the Senate and begun to act like a Republican. Instead it was his poor policy choices, frequent course reversals and shallowness that caused his ineffectiveness. He has poor political instincts and is simply not a leader.

There is no question, however, that Justice’s switch of party affiliation has damaged the already lame Democrat party. That party has been able to elect only one Democrat out of five Congressional representatives and now all in the state’s elected leadership are Republican. Sen. Joe Manchin, who is reputed to have recruited Justice to switch parties to Democrat and run for governor, looks like a fool. So does current State Democrat Party Chair Belinda Biafore, who claims that Justice duped her, not to mention former Democrat Party Chair Nick Casey, who is Justice’s Chief of Staff. Calls for a shake-up of Democrat party leadership have already begun. Former West Virginia Senate President Jeff Kessler, a respected Democrat who lost to Justice in the 2016 primary, said “It’s time for a change at the top . . . They need some new leadership at the Democrat chair.”

Nobody looks good in this. The Republicans have their own problems welcoming back to their party a governor they were happy to lampoon just days ago. The Republican Governor’s Association said in November 2015 that Justice was “a selfish businessman who consistently put his interests before anyone else’s, especially taxpayers.” The West Virginia Republican Party said in July 2017 that “Jim Justice embarrasses our state every single day.” These statements were catalogued by the Democratic Governor’s Association, who are now firing their own invective at Justice when formerly they embraced him. The hypocrisy on both sides of this sad event makes you want to take a shower.

Not all politicians lack character.  One thinks immediately of Sen. John McCain on the Republican side and former President Obama on the Democrat side. But if character is the trait of steadfastness to principle when the going gets tough, Jim Justice has failed us miserably. It is hard even to see what he hopes to gain from this switch of party affiliations. Perhaps he expects larger campaign contributions from Republicans than he raked in from the Democrats whom he deceived in 2016. Maybe he wants to bask in the Mar-A-Lago sun. One thing is certain, though. The question of what he has to gain is the right question to ask.