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Healthy signs: Professionals see improving and declining health trends

In some respects, the health and well-being of residents in this region is improving, but there are health challenges that still need continued attention and focused effort, say health care and public health officials.

A community health assessment, conducted in 2016 by the Grand Forks Public Health Department and Altru Health System in conjunction with other partners, revealed several areas of concern to those who are dedicated to improving the health of people in this region.

Topping the list are access to mental health services, prescription and illegal drug abuse, the rate of obesity, and binge-drinking and alcohol abuse, said Debbie Swanson, director of the Grand Forks Public Health Department.

Following closely behind are concerns about fragmentation of care and access to addiction treatment and counseling.

Analyzing data compiled in the County Health Rankings—a project of the University of Wisconsin Population Health Institute—as part of developing the community health assessment has provided some positive findings, Swanson said.

"If you look at our mental health providers, we look pretty good, but there might be system challenges that might be preventing (people from) getting the care they need," she said.

That might include barriers to care due to insurance that "may not cover mental health services, because parity (with coverage other health services) has not been completely achieved."

And although Grand Forks may have an adequate number of mental health providers, "their capacity (to treat patients) is not as great as it could be," Swanson said.

Signs of progress

Dr. Jennifer Raum, Sanford internal medicine service chair, said she and her colleagues often see patients with chronic diseases such as hypertension, high cholesterol and heart disease.

"We see a lot of depression and anxiety that often coexists with other chronic diseases and complicates the treatment," she said.

"Chronic disease puts you at increased risk for developing depression. In turn, people who have mental health issues have worsening (health) outcomes."

In her practice, "we measure outcomes in various chronic diseases such as hypertension, diabetes, vascular diseases," she said. "We have seen improvements in these metrics."

In recent years, Raum and her colleagues have taken a team approach—which differs markedly from the past—involving psychiatrists, social workers and other professionals to treat patients diagnosed with chronic diseases coupled with certain mental health issues.

In Grand Forks, as part of the development of the most recent community health assessment, Swanson and others who analyzed the data on County Health Rankings, a synopsis of health behaviors, also found signs of progress.

"As a community, we do well in clinical care, in terms of taking care of people who already have chronic health conditions—with the exception of diabetes monitoring, we could improve on that a little bit. But we do well in all other categories."

In Grand Forks and Polk counties, progress is being made in the areas of reducing tobacco use, especially among youth, said Swanson.

"Tobacco use is way down," she said. "It has improved significantly—and we're going to be watching that closely because of changes at the state level and how the program is delivered."

Excessive drinking is an area where some progress is evident.

"In youth alcohol use, we're not where we need to be, but we are starting to see some improvement," Swanson said.

A reduction in the number of hospital readmissions for preventable conditions also represents a positive trend, and something that Altru has worked hard to impact, she said.

Another bright spot is the number of people who are uninsured.

"Our rate of uninsured has really dropped, due to the Affordable Care Act," Swanson said.

At Altru Health System, Mike Little, manager of primary care programs, focuses on initiatives that have improved the health status of people with diseases such as diabetes and hypertension.

According to Minnesota Community Measure, an independent organization that measures quality outcomes, Altru has made strides in helping patients who have those chronic conditions.

Looking at data that measures optimal diabetes care, "in 2013, 25 percent of our patients with diabetes met all of the optimal care measures," Little said.

"In 2017, 51 percent of our patients met those measures—so that's a 26 percent increase."

In the hypertension category "in 2013, 76 percent of our patients met the optimal care measures and now 86 percent of our patients meet (them)," he said.

More work to do

Raum said an increase in the rates of childhood obesity is worrisome.

"Ten to 15 percent of adults have diabetes. What's that going to be like in the next 10 to 30 years as our children age and become adults," she said.

In analyzing Grand Forks data in the County Health Rankings, Swanson said the county's ranking has dropped over time.

"In 2011, we were ranked No. 4 among all of the counties in the state—the highest rank Grand Forks County ever had. Now we're at 16," she said. Traill County, however, has jumped from 16 in 2011 to first place today.

In the most recent community health assessment, the issue of access to mental health services ranks far above the second highest health care concern. But it's not simply a matter of numbers of providers.

"If you look at our mental health providers, we look pretty good but there might be system challenges that might be preventing (patients) from getting the care they need," Swanson said.

Other areas that demand continuing effort include binge-drinking and sexually transmitted diseases, she said.

Little sees potential threat of diabetes in aging baby boomers as a looming health concern, especially given the high percentage of people "who don't know they have prediabetes," he said.

"Type 2 diabetes is highly preventable, and it's going to have such a major impact. Prevention is the key. Prevention is really everything," Little said.

Grand Forks County

Adult smoking: 17 percent (adults who are current smokers)

Adult obesity: 30 percent (adults who report a body mass index of 30 or more)

Excessive drinking: 25 percent (adults reporting binge or heavy drinking)

Sexually-transmitted infections: 458.2 (number of newly diagnosed chlamydia cases per 1,000)

Poor mental health days: 2.9 (average number of mentally unhealthy days reported in past 30 days)

Physical inactivity: 21 percent (adults age 20 and over reporting no leisure-time physical activity)

Alcohol-impaired driving deaths: 29 percent (driving deaths with alcohol involvement)

Source: County Rankings and Roadmaps (a program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute)