don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

The much anticipated 15th edition of America's Health: State Health Rankings by the U.S. Centers for Disease Control and Prevention (CDC) is now available to the public in bookstores and online at the -- United Health Foundation website. 

While an attempt is made to look on the bright side, expressions of concern and calls for remedial action permeate the CDC findings. Loaded with data on a state-by-state basis, the Rankings report makes clear two principal findings already evident to all wellness promoters and enthusiasts:

1. Individuals should make responsible choices, particularly by avoiding tobacco and other substances abuses, while eating properly and exercising regularly; and
   
   
2. Communities should implement health policies and programs that render environments conducive to health promotion and disease prevention.

The Rankings report offers information on many topics, including emerging biomedical and infectious disease threats, child health promotion and obesity prevention and control. It also has a "Guide to Community Preventive Services." However, the highlight is the state-by-state rankings and assessments of how things are and what needs to be addressed. 

Want to guess which state came out #1, that is, healthiest of all states in the US? How about #50? I won't keep you in suspense -- Minnesota is ranked America's healthiest state. Let's hear it for the gopher state, which has as it's official bird the Common Loon (gavia immer), a creature with a 600 million year history making it one of this good earth's oldest living bird species. According to the official website of this most healthy of all American states, there are about 12,000 loons (as opposed to loonies, an entirely different species) in Minnesota. Loons are large black-and-white birds with long black bills.Clumsy on land, they are excellent divers, underwater swimmers, and high-speed flyers. Have a look at one.

Of course, I digress; let's get back to the rankings.

Minnesota's position at the top will come as no surprise to followers of the Rankings report, since it has been either number one or two since 1990. New Hampshire, which has occasionally traded places with Minnesota as number one in the rankings since 1990, is second this year. Vermont is third, followed by Hawaii, Utah and Massachusetts.

At the other end of the ranks is Louisiana, this nation's least healthy state. Mississippi, Tennessee, South Carolina and Arkansas round out the five least healthy states. My own Florida is 42nd, nothing to brag about. 

Minnesota's strengths include low death rates for cardiovascular disease and premature deaths, as well as a low rate of citizens without health insurance. It also scored high for its support of public health and low rates of children in poverty, infant mortality, occupational fatalities and high rates of high school graduation. On the other hand, even the healthiest state has problems, namely, a high prevalence of obesity (23.0 percent) and low access to adequate prenatal care (only 76.0 percent of pregnant women in Minnesota received adequate prenatal care).

Louisiana is 50th this year, a position it has held for all but one of the fifteen years of the CDC reports. It is among the bottom five states on six of 18 key health measures, namely premature death rate, infant mortality rate, rate of cancer deaths, percentage of children in poverty, rate of uninsured population and prevalence of smoking. It also ranks in the bottom ten states for five other measures. Pitiful. 

The Ranking report concludes with five categories of action recommendations:

• Learn about your own health -- blood pressure, cholesterol, body mass index, etc.-- and identify your own risk factors -- smoking, exercise, genetic, occupational, etc. Learn about nutrition and food labeling, understand the role and value of regular exercise and preventive care and practice good personal hygiene.
  
  
• Access the resources available to you:public parks and trails for exercise; stores for fresh fruits and vegetables; your healthcare provider for preventive care; public health services for information, tools and statistics; schools for education and training; and community and church groups for social engagement and personal fulfillment.
  
  
• Participate in public health education and screening programs, join support programs to help you with your problems, and implement your regular fitness and wellness program.
  
  
• Change your own behaviors, take charge and understand yourself, identify inhibitors to personal change, identify resources that can help you change, set a plan and then do it. Specific behaviors to nurture include regular physical activity, healthier weight, good nutrition, no tobacco use or substance abuse, responsible sexual behavior, mental health well-being, safe and injury-free activities, regular immunizations and routine preventative health care.
  
  
• Teach and mentor others, especially your own and the community's children. Set an example of sound health behaviors; discuss healthy living and your personal plans and habits. Be active. Share through your example.

While the Rankings report is a fine resource, I question if the data used by the CDC really identify the healthiest states. The data compiled for the annual report are appropriate for identifying and ranking the unhealthiest states, but measures of dysfunction (for example, death rates from various diseases, premature deaths, health insurance levels, children in poverty, infant mortality, occupational fatalities and high school graduation rates) do not reflect the presence of advanced states of well-being as would a selection of indices for positive functioning. 

Perhaps the CDC will evolve and in time promote wellness awareness, as well as disease and dysfunction assessment. If that happens, we might look forward to reports of well-being, both physical and mental, regarding genuine achievements on a state by state basis. This requires the CDC to identify fitness and nutrition measures, as well as others of positive health and life quality.  

"What measures might these be?" The significant resources of the CDC will be needed to make that determination, after some period of study and public input; but I would imagine the selected indicators would reflect the extent that populations are happy, the degree adverse consequences of aging are inhibited with proactive lifestyle habits, as well as indicators reflecting satisfying relationships, ample enjoyment of humor and play levels, the capacity of people for critical thinking and the extent to which residents experience meaning and purpose in their lives. That would be a good starter set, and the kind of data that would enable a more accurate picture of genuine health than the current collection of morbidity, mortality and perturbation levels. 

Naturally, none of this kind of analysis would be easy, but who better to lead the way than the CDC? (See my earlier essay on "Gross National Happiness" at http://www.seekwellness.com/wellness/reports/2003-01-09.htm) Without such positive information, we won't really know if Minnesota, New Hampshire, Vermont, Hawaii, Utah and Massachusetts are in fact any "weller" in the positive sense of health than the seemingly backwater states of the south. In fact, there is nothing to keep civic boosters in Louisiana and other bottom-of-the-health-barrel states from deluding themselves with spurious claims for being truly healthier than they really are, based on seriously bogus criteria  (for example, "We're # 1 in college football and tattooed fans of NASCAR")! 

However, please do not let all this detail distract you from what should be the two main messages of this essay, neither of which I have made, until now. The first is to congratulate the CDC for its role in producing the Rankings report for fifteen years--it is an excellent work as far as it goes, and will pave the way for wellness rankings at some point in the future. The second is that no matter what ranking your state obtained, you can be number one in terms of living the healthiest, most satisfying possible quality of life within your power. You can live a wellness lifestyle in Louisiana as well as Minnesota, or anywhere else. It may be a little more challenging in some states than others, but it will always be your choice, wherever you are.

Be well. Always look on the bright side of life.

(Note: This essay will be filed in the archives in the MENTAL DOMAIN under the skill area of factual knowledge. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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