West Virginia’s Other Public Health Crisis

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.