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In Alaska, the primary causes of death are chronic conditions such as heart disease and diabetes. But, ironically, these progressive diseases can be avoided with proper preventive measures that are simple and easy to implement. Moreover, preventative health care offers tremendous benefits to employees and employers by saving money and lives.
In 2003, there were 3,178 deaths in Alaska, 65 percent of which were identified within the top five causes of death, reports the Alaska Department of Health and Social Services "2002-03 Behavioral Risk Factor Survey: Preventative Practices."
According to the survey, the leading causes of death in Alaska in 2003 were malignant neoplasms (cancer), disease of the heart, unintentional injuries, cerebrovascular diseases (stroke), chronic lower respiratory diseases, intentional self-harm (suicide), diabetes mellitus (Type 2), Alzheimer's disease, chronic liver disease and cirrhosis, and influenza and pneumonia.
Most of the deaths--which were of a chronic nature--could have been circumvented, according to Ruth Townsend, Alaska Regional Hospital's director of cardiac rehab, diabetes and nutrition center. "If you think about most of the diseases that are causing problems, basically they're the chronic conditions," she says. "Chronic diseases don't happen overnight. It's 40 years of a behavior that's making a difference."
However, people have a great deal of capability when it comes to controlling behavior-related diseases, Townsend says. The key is to manage the behavioral risk factors that can increase your chance of having chronic diseases. In Alaska, the most prevalent behavioral risk factors include being overweight/ obese, high cholesterol, high blood pressure, smoking cigarettes and smokeless tobacco, and binge/heavy drinking.
So how healthy are Alaskans? According to Healthy Alaskans 2010 Volume 1: Targets for Improved Health:
* Alaska's population is slightly more overweight--having a body mass index greater than 25 and less than 30-than other states.
* In Alaska, more than 50 percent of the population exercises on an irregular basis or not at all.
* Alaska has one of the highest smoking rates in the country, with more than one out of four Alaskans addicted to tobacco. Nearly one-half of these people will die prematurely as a result of their addiction.
* Fourteen percent of Alaskans abuse or are dependent on alcohol, compared to just 7 percent of the U.S. population.
* Alaska has the highest injury rates in the nation, driven by low rates of protective behavior and the intrinsic hazards of the Alaska environment.
Diet and nutrition play an important role in the development or prevention of four of the top leading causes of death in Alaska and United States: cancer, coronary heart disease, stroke and Type 2 diabetes, according to Healthy Alaskans 2010 Volume 1. Healthy Alaskans 2010 is a state-focused adaptation of the national planning process known as Healthy People 2010, sponsored by the U.S. Department of Health and Human Services.
The prevention of chronic diseases boils down to diet, exercise and not smoking, Townsend says. And these factors are somewhat interconnected. "If you're exercising regularly, you can lower your blood pressure, cholesterol and body fat," she explains. "Healthy nutrition will help reduce cholesterol, blood pressure and help you not gain weight. There's so much that we can be doing, but it's not that easy for all people because it's behavioral."
People want a quick fix or pill to address their health issues, but preventive health requires effort and commitment, Townsend says. "It's a matter of education and a matter of getting people to understand it's a lifelong process," she adds.
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But it's well worth the effort. Disease prevention can help people avoid having to take expensive medication, not to mention settle for a lower quality of life.
BENEFITS OF PREVENTIVE HEALTH TO EMPLOYEES AND EMPLOYERS
Preventive health care is gaining more focus among employers, as they strive for more ways to reduce health care costs, says Tammy Green, director of health risk-management services for Providence Alaska Medical Center in Anchorage.
"There is an increased trend toward preventive health care," Green says. "We've seen it heading that way over the past five years, and we've seen it pick up momentum as employers have grappled with rising health care costs."
Preventive health provides major benefits for employees and their employers, Green says. Employees are healthier, which can transfer to their families and that has a ripple effect on health care costs. "If an employer can reduce their costs, that impacts employees because they pay lower premiums," she explains.
Also, healthier employees are absent less and result in less "presenteeism," which is when people are present at work but not really productive. "If you have healthier, happier employees, it will make it a better place to work and it will increase the longevity of employees," Green says.
Green adds that as employees become healthier, the cost of health care may not decrease. But it will be slow to rise, which ultimately impacts the bottom line. "Research shows a return on investment for employers who are investing in employee wellness programs," she says. "For every dollar employers invest, they get a return on investment of $2 to $5."
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Fostering better health among employees does result in lower absenteeism, higher productivity and other benefits, says Jeff Davis, president of Premera Blue Cross Blue Shield of Alaska, a nonprofit independent regional health plan. Health education is a wise investment for employers and insurance companies, especially since workers in Alaska tend to change employers less frequently.
Increasingly, Davis says, employers are using education to help workers prevent illnesses and improve existing conditions. For example, employers in Premera's small-group community pool are engaging in a health risk-management program. In Alaska, the Premera Blue Cross network includes about 1,000 health care professionals, 20 hospitals and more than 114,000 members. The program helps people assess their health, identify risk factors, and access tools they need to mitigate with those risk factors. "If you start to influence people's awareness of where they are, they will start making changes," Davis says. "We're hoping to see reduction in risk factors, healthier lives, consumption of less health care, lower health care costs and lower premiums. It's a win-win."
Providence Alaska Medical Center is also big on employee education. In fact, disease prevention and health promotion are Green's primary focus. "We know that healthy communities, employees and employers make for a solid economy," says Green, who has a master's degree in public health and formerly served as deputy director for the Division of Public Health for the state. "In July, we (Providence) launched our own program, Your Health Reward, to encourage our own employees to take charge and manage their health."
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The voluntary program, which is open to Providence employees at no cost, provides health care screenings, a health survey and risk-management coaching. Participants with chronic diseases can complete a customized disease-management program. "The goal is that we want to have healthier employees," Green says.
Having healthy employees is also important to Alaska Regional. A while back, the hospital joined with Providence and other health care facilities to sponsor an employee health promotion program. Although the program is no longer active, employees can still take advantage of counseling relating to nutrition, exercise and smoking cessation, Townsend says.
CONTROLLING BEHAVIORAL RISK FACTORS
The process of preventing chronic diseases depends largely on controlling risk factors. Family history is an important risk factor, but you shouldn't give into it, Townsend says. Having a family history of a chronic disease is just one factor, but it doesn't have to determine your level of health.
If you have a family history of heart disease, for example, it's important to avoid a high-fat diet and smoking, Townsend says. You should also eat a lot of fiber, exercise regularly and take an Aspirin a day if you're over 40 (to make your blood less apt to clot). There are no guarantees, but the more risk factors you control, the more you reduce your chance of developing a chronic illness.
Modifying a behavior may seem difficult at first, but changing even a few risk factors can really make a difference. "It's just a couple of pieces that really make a difference," Townsend says. "High blood pressure accounts for almost 370,000 preventable strokes, and 150,000 strokes can be prevented by managing cholesterol."
Controlling your blood pressure is important because high blood pressure, also known as hypertension, is a major risk factor for heart disease, kidney disease, and congestive heart failure. It's also the main risk factor for stroke. Normal blood pressure is a systolic of less than 120 millimeters of mercury (mm Hg) and a diastolic of less than 80 mm Hg, according to Harvard Medical School. High blood pressure is a systolic of 140 mm Hg or higher, or a diastolic of 90 mm Hg or higher.
You can prevent high blood pressure by adopting a healthy lifestyle. You should try maintaining a healthy weight; being physically active; following a healthy eating plan with plenty of fruits and vegetables, low-fat dairy foods and foods with less salt and sodium. And if you drink alcoholic beverages, drink in moderation.
Maintaining a proper level of cholesterol also is crucial because having too much of it in the blood can be dangerous. Cholesterol, which is a waxy, fat-like substance, found in all the cells of the body, is used to make hormones, Vitamin D, and substances that help you digest foods. When blood cholesterol reaches high levels, it can build up on artery walls, increasing the risk of blood clots, heart attack and stroke.
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