Why is Louisiana, by some accounts, the most unhealthy state in the Union?
This month's Louisiana Public Square looks at Louisiana lifestyles, and how they affect our health. "Is the Good Life Killing Us?" addresses the question of why Louisiana is, by some accounts, the most unhealthy state in the Union. We are at the top of the list for morbidity and mortality for a number of dread diseases. Is it a question of genes? The environment? Our cultural heritage? A panel of experts in the field of public health will try to provide answers to these and other questions about the good life in Louisiana. Our panelists are Elizabeth T.H. Fontham, Dr.P.H. , Dean, LSU School of Public Health;
Steven Smith, M.D. , Endocrinology Laboratory, Pennington; and B. Jay Brooks, M.D., Chairman, Department of Hematology/Oncology, Ochsner Clinic Foundation Baton Rouge .
LPB President Beth Courtney and former CNN anchor and reporter Charles Zewe are the hosts for the program.
Louisiana promotes itself as a destination for fun. Good times are often defined in terms of cuisine and the idea of “partying”. Whether it’s attending public celebrations, like festivals and parades; visiting bars and restaurants, or enjoying the company of friends and family at private get-togethers, many of these activities involve the consumption of alcohol and lots of great-tasting food. Therein lies part of the problem.
The social, economic and health costs of living in a paradise of earthly pleasures are many, and they are reflected in Louisiana’s very poor ranking nationally in a number of health-related indices. The following data is from the non-profit United Health Foundation’s most recent report:
Cancer Deaths (Deaths per 100,000 population)
Infant Mortality (Deaths per 1,000 live births)
Premature Death (Years lost per 100,000 population)
Prevalence of Smoking (Percent of population)
Lack of Health Insurance (Percent without health insurance)
Risk for Heart Disease (Percent above or below national average)
Overall Ranking [Many factors determine Overall Rating. Go to http://www.unitedhealthfoundation.org/
shr2003/Methodology.html for Methodology and additional Louisiana statistics.]
Louisiana has the dubious distinction of coming in 50th in 14 of the last 15 editions of this state-by-state report. Although there have been improvements in some risk factors – notably, in the adequacy of prenatal care and prevalence of obesity – Louisiana still ranks in the bottom 10 states for high incidence of infectious diseases, low support for public health and a high total mortality rate.
The Northwestern National Life State Health ranking also places Louisiana as the unhealthiest state in the nation.
Many public health professionals believe that, more than medical access, environmental factors or biology, the most influential determinants of health are personal behaviors. Let’s look at three areas where [in varying degrees] individual choices can affect our lives.
The problem of over-eating and/or not exercising is a national one. Nearly two-thirds of U.S. adults are either overweight or obese. Although the prevalence of obesity in Louisiana declined slightly [0.7 percent] between 2003 and 2004, the rate of obesity in our state has more than doubled since 1990. Nearly one adult in four living in Louisiana is obese.
Obesity tends to be higher in women, minorities, and people with lower income and education levels. Louisiana has a very high proportion of African-Americans, one of the at-risk groups for obesity and overweight. Unfortunately, we are frequently ranked among the worst states in nation in quality of education and income. These factors all contribute to our low standing in overall healthiness.
The Louisiana Office of Public Health says that 80% of obese Louisiana residents have diabetes, and 50% have high blood pressure. Obesity contributes to a number of other serious medical conditions, including stroke, osteoarthritis and several types of cancer. Annually, Louisiana spends about $1.4 billion on obesity-attributable medical expenses.
Louisianans seem to be waging a losing battle against weight gain. Many of our cultural and social traditions elevate eating to the level of communal ritual. Louisiana Folklife Director Maida Owens believes that Catholicism - the religion of many in the southern section of the state - affects attitudes toward food and drink, “Catholicism is going to encourage you to live boldly - not only in relationship to God - but to life”, according to Owens. “Food is very important in both North and South Louisiana. The difference is the relish with which the South Louisiana culture embraces a celebration of life; where to indulge is to live, and to fully experience life, to celebrate life. Protestantism is much more likely to promote moderation.”
No matter what your religious preference may be, we all live in what Dr. Claude Bouchard, Executive Director of the Pennington Biomedical Research Center, describes as an “obesogenic” environment. This is an environment which promotes obesity by down-playing physical activity [taking the elevator instead of the stairs, playing computer games, watching TV, driving instead of walking] and bombarding people with incentives to eat more [heavy media advertising, increased food and beverage serving size].
What can be done?
At the individual level:
Many Louisianans spend hundreds – sometimes thousands of dollars – attempting to lose weight through dieting, drugs, even procedures such as gastric surgery, which can cost $25,000. Many variables can affect the success of individual weight-loss programs, but one thing always remains constant: to maintain weight, calories burned must equal calories consumed. To lose weight, calories burned must exceed calories consumed.
At the state level:
A few states have set nutritional standards for foods sold in schools that are not part of the federally sponsored school lunch program. These are called “competitive foods” and include items sold in vending machines and school snack shops. Louisiana has not chosen to set nutritional standards for these foods, but it is one of 18 states which limit the availability of competitive foods beyond current federal requirements.
Seventeen states have enacted some form of “snack tax” to try to discourage consumption of low-nutrient foods and beverages. The effectiveness of such taxes is unknown, and theoretically could have negative unintended consequences. Louisiana does not have a snack tax.
Louisiana has joined ten other states in enacting legislation designed to limit obesity-related lawsuits.
Some proposals for state involvement in reducing obesity:
* Improve access to low-cost, nutritious food in low-income areas
* Tax incentives for employer-provided wellness programs
* Tax incentives for real estate developers to convert brownfields into activity-oriented facilities
* Tax incentives for real estate developers to include green space and sidewalks in residential development plans
In 2002, about two-thirds of American adults consumed least some alcohol. Although many medical experts believe alcohol may have beneficial effects when consumed in moderation, even less-than-heavy consumption can be risky. Drinking more than one drink per day for women, and more than two drinks per day for men increases the risk for [among other things] car accidents, high blood pressure, stroke, and some types of cancer. Some people, in certain situations, shouldn’t drink at all - for example, pregnant and lactating women.
Drinking is a fact of life in Louisiana. But while most Louisianans drink responsibly, the costs of alcohol abuse is staggering.
The National Institute of Alcoholism and Alcohol Abuse (NIAAA) in their 10th Report to Congress on Alcohol and Health [June 2000] estimated the economic cost of alcohol abuse in Louisiana at $2.989 billion in 1998. The report broke costs down into direct economic costs related to services received and indirect economic costs related loss of productivity and future earnings:
Direct Costs - $814 million:
* $120 million for health care costs for treatment, prevention, and support services
* $305 million for the medical consequences of alcohol consumption
* $254 million for ancillary services at motor vehicle crashes
* $102 million for alcohol-related crime
* $25 million related to fire destruction
* $7.8 million for social administration
Indirect Costs - $2.166 billion:
* $1.414 billion related to loss of productivity due to alcohol-related illness
* $589 million related to loss of future earnings due to premature death
* $163 million related to loss of productivity due to alcohol related crime
The excise taxes paid to the state by the alcohol industry defrays about $50 million of the $800+ million in direct economic costs of alcohol abuse. That leaves Louisiana taxpayers footing the bill for the remaining $750 million in medical and social services related to alcohol abuse.
To re-coup these costs, LSU Health Sciences researcher Richard Scribner, MD, MPH, has estimated that the alcohol tax would have to be raised from its current rate of about 3 cents a drink to about 40 cents a drink.
The last time the excise tax rate was raised for beer was 1948. The rate for wine was increased in 1956; liquor went up in 1970. To put the alcohol “sin tax” in perspective, you would have to buy over 100 bottles of wine to pay the same amount of excise tax charged for one carton of cigarettes.
Alcohol is a factor in 32% of Louisiana’s auto crash costs. According to national Highway Traffic Safety Administration [NHTSA] estimates, alcohol-related crashes In Louisiana cost the public about $2.9 billions in 2000.
Underage drinking is widespread in Louisiana. In 2001, underage drinkers consumed almost 18% of all alcohol sold in Louisiana. About a quarter of a million underage youths in Louisiana drink each year. Underage drinking is a causal factor in homicide, suicide, traumatic injury, violence, property crimes, high-risk sex and alcohol abuse and dependence.
Due, in part, to powerful lobbying efforts by the alcohol industry, Louisiana was one of the last states to raise its drinking age to 21, and among the last to set tougher blood-alcohol limits for drunk drivers. It has now adopted a number of important impaired driving measures that are saving money and lives, based on NHTSA estimates. These measures include Graduated Licensing, Administrative License Revocation and the Intensive Sobriety Checkpoint Program.
Louisiana ranks in the bottom five states on six of the 18 measures used by the United Health Foundation to rate the healthiness of states. One of the six measurements that Louisiana scored so poorly on is “Prevalence of Smoking [Percent of population]” Since tobacco use is the single most preventable cause of death and disability in the US., and since we have a high prevalence of smoking - at 26.5 percent of the population – Louisiana’s lamentable showing in this category helped secure the state’s position as the most unhealthy place to live in the nation. And while the rest of the country cut back on use of tobacco, Louisiana actually increased its prevalence of smoking by 2%, which helped slide the state down from 32nd in this category in 2003, to 47th in 2004.
The Louisiana Department of Health and Hospitals has assembled a number of significant facts about smoking in Louisiana:
Louisiana Smoking Facts
* Tobacco use is the single most preventable cause of death and disability in our society causing more deaths every year that AIDS, alcohol, car crashes, murders, suicides, and illegal drugs combined.
* Cigarette smoking was the leading risk factor for disease, responsible for an estimated 6,427 deaths and 96,085 years of potential years of life lost in 1999.
* Cigarette smoking is responsible for one in four deaths due to cardiovascular disease and contributes to illness and death due to cancers, respiratory diseases, premature and low birth weight infants, sudden infant death syndrome, and burns.
* More than 750,000 adults (24.6%), 79,000 high school, and 28,000 (17.1%) middle school aged children in Louisiana currently smoke cigarettes.
* Nine out of ten current smokers started before they were 18 years of age.
* 15.7% of the adult population in Louisiana has used smokeless tobacco products such as chewing tobacco, dip, or snuff at some point in their lives.
* Individuals in the 18-44 year age group, individuals with an annual household income less than $25,000, individuals with less than a high school education, and African Americans were more likely to report that they are being exposed to second-hand smoke at their place of work.
* The total cost during 1999 for Louisiana that was attributable to cigarette smoking was estimated at $2.81 billion.
* Smokers not only put their own lives at risk, but also affect the lives of people around them.
For more information on tobacco risks, go to:
To learn more about health and health initiatives in Louisiana, visit the Louisiana Department of Health and Hospitals Web site at: http://www.oph.dhh.state.la.us/
“We have met the enemy, and they are us.”