Five years ago, Rhode Island leaders set out to make a big improvement in key aspects of state residents’ health: reduce obesity and get more people to exercise and eat well; cut back on smoking and exposure to secondhand smoke; discourage teen sex, or at least make it safe.
The campaign, “A Healthier Rhode Island By 2010,” was the state’s take on a national effort, “Healthy People 2010.” It looked at 27 health measures, all geared to helping every Rhode Islander – regardless of race, income or disability – to lead a longer, higher-quality life.
Those priorities have shaped the R.I. Department of Health’s agenda, guided policy-makers, and informed Gov. Donald L. Carcieri’s wellness initiatives.
Now, to gauge how well it’s all working, officials have issued a mid-term report on “Healthier Rhode Island,” goal by goal. What it shows is a mixed bag:
*Despite efforts to reduce obesity, Rhode Islanders are actually getting heavier – 19 percent of adults are obese, and 35 percent of children and teens are obese or overweight, up from 17 and 34 percent, respectively. And the problem is worse among adults with disabilities.
*Smoking bans and tobacco education have paid off: 22 percent of adults now smoke, down from 23 percent, and 19 percent of adolescents smoke, down from 35 percent. The share of nonsmokers exposed to secondhand smoke has also declined, from 44 percent to 38 percent.
*More adults are binge-drinking: 18 percent reported doing so in the past 30 days, up from 16 percent. But 50 percent of adolescents now report not having used drugs or alcohol within 30 days, up from 45 percent, and 56 percent now say they haven’t drunk, up from 48 percent.
*More teens are having sex, and more aren’t using condoms – 15 percent, up from 11 percent. Adults, on the other hand, have increased their condom use – 34 percent of women now use them, up from 30 percent, and 49 percent of men, up from 47 percent.
*Looking at measures of environmental quality, some are improving – such as the rate of infections from food-borne pathogens – but the share of Rhode Islanders served by a water system that meets the Safe Drinking Water Act’s standards dropped from 81 to 76 percent.
Why does this all matter?
For policy-makers, it’s obvious: This is how they can tell if Rhode Island’s laws and public health initiatives are working – though, as project coordinator JoAnna Williams noted at a presentation of the new data last Monday, with obesity, for example, the national trend in the wrong direction is so strong that it might be a success just to hold things steady.
But Dr. David R. Gifford, the state health director, Williams and others at the event, at the Radisson Airport Hotel in Warwick, made it clear that they don’t want these measures to be looked at just by policy-makers. They want municipal leaders to ask themselves, “What can I do about this?” They want schools and YMCAs and community groups to get involved.
And they want employers and the general population to understand that these figures have a direct impact on their health care costs: Obesity, smoking, excessive drinking, poor environmental quality – all these things have a price tag, and they’re paying it.
To drive that message home, the Department of Health invited Michael Samuelson, executive director of The Health & Wellness Institute at Blue Cross & Blue Shield of Rhode Island and a nationally respected authority on the issue, to explain the “So What?” of the report.
Samuelson, a 30-year industry veteran, has long been an advocate of personal responsibility when it comes to health, on the notion that if individuals choose to eat healthily, exercise, and generally take care of themselves, they can dramatically reduce their need for health services.
The figures show there’s a real need for change, Samuelson said, but change “is an extremely complex process.”
It’s not enough to have the intellectual knowledge of the problem (the data), he said. You have make an emotional connection. And to really get mobilized to do something, you need a visceral reaction: You need to be “mad as hell” and unwilling to take it anymore.
Many people are already “mad as hell” about health care, Samuelson said. Skyrocketing costs and access problems have built up a lot of anger and emotion, among consumers and among those involved in the system. Blame is spread all over, but insurers are particularly despised, whereas individuals are usually treated as victims of a bad system.
Now that’s changing, Samuelson said. The industry is moving toward a new approach in which people who willingly neglect their own health may be asked to pay extra. Individuals are going to have to take more responsibility for their own well-being.
“The paternalistic system of health care is over,” Samuelson said. “We can’t afford it anymore.”
