HIGH ON HEALTH: N.D. ranks 12th on healthy lifestyles surveyMinnesota held steady from 2010 to 2011, ranking sixth in the nation. But the state has slipped slightly in recent years after holding the top rank from 2003 to 2006.
By: Pamela Knudson, Grand Forks Herald
Minnesota and North Dakota rank high in a new state-by-state survey measuring overall health and lifestyle statistics, but their rankings have slipped in the past decade while the rate of obesity and diabetes has risen among adults.
North Dakota ranked 12th among states in the 2011 America’s Health Rankings survey, up from 16th in 2010. The state ranked first in 1990, the first year of the survey analyzing the nation’s health, and remained in the top 10 states until 2008.
Minnesota held steady from 2010 to 2011, ranking sixth in the nation. But the state has slipped slightly in recent years after holding the top rank from 2003 to 2006.
Vermont topped the list this year, followed by New Hampshire and Connecticut. Mississippi ranked lowest behind Louisiana. South Dakota ranked 23 and Montana 25.
North Dakota has made progress in lowering the number of smokers in the past decade. But the state has lost some ground in the fight against obesity and diabetes, as has the nation overall.
About 39,000, or 7.4 percent, of the state’s adults now have diabetes, up from 5.2 percent in 2001.
In the same timeframe, the rate of obesity increased from 20.4 percent to 27.9 percent, amounting to about 146,000 residents.
While the percentage of smokers decreased from 23.2 percent to 17.4 percent in the past 10 years, 91,000 adults still smoke in the state.
North Dakota’s score was bolstered by high rates of immunizations and students graduating high school, a low crime rate and clean air.
But the state’s ranking was dragged down by a high percentage of adults (20.1 percent) who reported binge drinking, defined as having more than four or five drinks in one sitting in the previous 30 days. That was the nation’s second-highest binge drinking rate, behind only Wisconsin at 22.8 percent.
The health status of the state’s American Indian population also negatively affected the ranking. Nearly 15 percent have diabetes, more than twice that of white residents.
In the past year, the percentage of North Dakota children under 18 in poverty increased from 14.4 percent to 16.1 percent.
Obesity is also more prevalent among North Dakota’s American Indians (43.5 percent) than white residents (27.9 percent).
Deanna Askew, Healthy Communities coordinator at the North Dakota Department of Health, said there is a national push to prevent obesity by changing the environment. Some efforts include creating pleasant and safe walkways or bike paths, or offering healthy snacks in vending machines.
“Obesity is very complex; it requires a multi-pronged approach,” she said. “And every community is different.”
Askew and her staff work with communities to determine priorities in promoting health, whether it be in schools, workplaces, health care systems or parks.
“We’re looking at ways to make the healthy choice the easy choice,” she said.
While the Healthy Communities program focuses on policy and environmental changes to reach and affect large populations, Askew said it does come down to the individual’s behavior.
“It’s not going to be easy, but I do think we’re moving in the right direction,” she said.
Diabetes on the rise
Diabetes costs the state more than $40 million annually, according to Tera Miller, diabetes prevention and control program director for the North Dakota Department of Health. Medical care and medications make it an expensive disease, she said.
And she said the disease also has a heavy cost in quality of life. People with diabetes face risk of blindness, amputation, heart disease, stroke and kidney disease.
The state’s aging population contributes to the prevalence of diabetes.
“As you get older, you’re more at risk of getting diabetes,” Miller said.
Being overweight and lack of exercise are significant risk factors. But she said the state’s Healthy Communities initiatives that attempt to control weight and prevent obesity are helping to prevent diabetes.
“We hope these efforts will cause a plateau or decrease in the prevalence of diabetes here,” Miller said.
Hard-hitting, anti-smoking media campaigns and smoking cessation programs, such as Quitline and Quitnet, are effective in reducing the number of smokers, said Michelle Walker, director of the tobacco prevention and control program in the North Dakota Department of Health.
Increasing the price of tobacco is a proven strategy to encourage people to quit or not start smoking, she said, especially in youth.
“When the federal tobacco tax increased in April 2009, our calls to Quitline skyrocketed,” she said. “It was hard for us to keep up.”
Quitline offers free, individualized tobacco cessation counseling for North Dakotans. The program, directed by Grand Forks family physician Eric Johnson, is based at UND which employs the counselors.
Walker said about 35 percent of smokers who quit with the help of Quitline are not smoking six months later.
North Dakotans who are uninsured or underinsured can receive up to eight weeks of free cessation medication when they join Quitline. More than 6,200 people have enrolled in the program in the past two years.
A 2005 state law that prohibited smoking in most public places has also had an impact, she said. Communities that have passed stronger ordinances that outlaw smoking in bars are Grand Forks, Fargo, West Fargo, Bismarck, Devils Lake, Napoleon and Pembina.
Such rulings “change the social norm,” Walker said, by making smoking be seen as not normal.
Don Shields, director of the Grand Forks Public Health Department, said studies like America’s Health Rankings provide health officials with “good data” to help focus efforts and funding to best tackle the issues.
“We only have so much in resources to go around,” he said.
Shields cited North Dakota’s commitment to providing immunizations as a positive influence.
“We’ve done well in that, and we certainly don’t want to slip in that area,” he said.
The state ranks 11th in the percentage of people (nearly 12 percent) without insurance, “not where we want to be.”
But Shields said his department recently received a federal planning grant to look at starting a community health center in Grand Forks, a reason for optimism.
“Issues like lack of health insurance, and others, they’re going to take time to address,” he said, “but we are hoping to make inroads.”
Reach Knudson at (701) 780-1138; (800) 477-6572, ext. 138; or send email to firstname.lastname@example.org.