Golden state of health

California jumps in U.S. rankings, though North State lags behind

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As Butte County’s public health officer, Dr. Andy Miller sees a lot of statistics. He pores over charts and graphs to gauge how our area compares with the rest of the state and the nation—even ourselves over time.

So, when he got wind of the latest America’s Health Rankings report, touting big improvements in California, Miller gave the results close scrutiny.

The report placed the Golden State at 12th best in the nation, a jump of five spots in a year (2017 to 2018). That’s the second-largest leap; Maine went up seven places, to 16. Hawaii supplanted Massachusetts at the top, while Louisiana ranked last.

“I’m always a little skeptical that in one year California can change five spots and another state can move seven spots when, from year to year, you can’t imagine there’s that much difference in some of these numbers,” Miller said by phone. “But better to be 12th rather than 48th, and better to be moving up than moving down.”

Propelling California were comparatively low rates for premature death (5.7 percent, second-best nationally), smoking (11.3 percent, second), physical inactivity (20 percent, third) and obesity (25.1 percent, third), among others. Along with obesity prevalence, the report cited as strengths the state’s low rates of infant mortality and occupational fatalities; as challenges, high levels of air pollution and low immunization coverage.

The state’s good news is not the North State’s. Locally, Miller said, we continue to struggle in categories where California fares favorably—obesity and smoking, notably—plus have disproportionately high numbers of certain cancers and in deaths from opioid overdoses. Meanwhile, as the state and nation make gains in two professions with provider shortages, primary care and mental health, our rural region lags behind in both.

The Butte County Public Health Department is partnering with hospitals and other health groups to address pressing concerns. Miller will make a presentation to the Chico City Council next month about tobacco—the first step in what a local coalition hopes will lead to regulating flavored tobacco and vaping. He’ll also participate in two summits for health care professionals at Enloe Medical Center in March: one on gastrointestinal cancers, one on opioids.

“I always try to look at the individual things and think, How important is that? How can we move the needle up or down?—rather than the collective [statistics or rankings],” Miller said. “Sometimes you have to be careful about the conclusions you draw.”

First released 29 years ago, the annual America’s Health Rankings report represents what its sponsoring organization, the United Health Foundation, calls “the longest-running annual assessment of the nation’s health on a state-by-state basis.” Researchers evaluate 35 points encompassing care, outcomes, behaviors, environment, policies and communities. The data come from state agencies such as the California Department of Public Health.

Contacted by the CN&R to elaborate on the measures, the state health department released a statement saying it “considers this improvement in America’s Health Rankings to be an acknowledgment of the strong collaborations undertaken to improve the health of the people in California.” To keep improving, the statement continued, “we must all work to address the conditions that can improve health equity so all Californians are able to reach their highest quality of life.”

Miller, whose department shares data and works with the state on public health programs, also sees a connection to economics. California ranks 16th in public health funding ($108 per capita)—21st for uninsured residents (7.3 percent) and 28th for children in poverty (18 percent). In the latter, Butte County will continually trail the state average: “The more rural you get, the higher that number becomes,” he said.

“We know that poverty brings with it poor health outcomes,” Miller added. “To the extent that the boat can all float up together, when we have times of economic prosperity—and the last few years have been, relative to 2008 [during the Great Recession]—we’d expect those [overarching] numbers to come up.

“My concern is how we do in difficult times, whether we can all have less poverty and address income disparities, which help perpetuate health inequity and poorer outcomes among those that are at higher risk.”

Among various local initiatives, Miller cited three the report evoked. Butte County has particularly high rates of digestive-system cancers; Enloe will hold a day-long symposium for providers on March 15. The preceding Friday, March 8, Enloe will host a symposium on opioids, following up on a summit last spring at Chico State (see “Heart of the matter,” Healthlines, May 31, 2018).

Tobacco—which encompasses smoking, vaping and chewing—concerns a cross-section of the health community. Miller’s agency is one of a dozen in the Nicotine Action Alliance, a Butte County coalition advocating for local regulations, and stronger enforcement of state regulations, related to retail.

The group has two major aims. First, it seeks stricter restrictions on flavored products whose packaging and taste appeal to minors. Second, it wants cities to establish tobacco business licenses and earmark the revenue to policing merchants.

Butte County’s smoking rate is 16 percent—a third higher than the state stat. Tobacco use, in all forms, among youths is at 22 percent; that’s nearly double the state rate (13.6 percent). While California ranks among the top five states in regulation, prevention and use-reduction, according to the American Lung Association’s newly released State of Tobacco report, Butte County communities fall short of the mark (see Sifter, page 9).

Miller will make a presentation to the Chico City Council at its Feb. 19 meeting, at which time the group hopes council members will be inspired to act.

“The focus is on flavored tobacco,” said Ellen Michels, Public Health’s project manager for the Tobacco Education Program. “But we’d like to see the broader policy [including licenses] passed; that’s what the coalition wants and would recommend.”

Michels and a contingent from Chico Unified School district, including students, met with Chico Mayor Randall Stone last year when he was a councilman. He told the CN&R he’s open to considering such regulations; none are on the table at this point.