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RELATED Harvard School of Public Health Lienhard School Of Nursing at Pace University MedWeb: Public Health Mortality, Morbidity Weekly Report
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By
Mary Ann Hellinghausen
Californians, teased about nibbling on bean sprouts and tofu, are considered "health nuts." East Coast residents are thought to be chain smokers scurrying to their stressful jobs. Texans are branded as whiskey-drinking meat eaters. Midwesterners—consumers of beer, cheese, and sausage—are presumed to be fat, while Southerners are defined by their diets packed with butter, grits, fried chicken, and gravy. Neither group is known for being exercise lovers. Do Americans’ health profiles fit these stereotypes? Are our health habits, and thus our general health, affected by where we live? The answer is yes—there are areas of the country that are defined by their percentages of healthy and unhealthy residents. In some cases, the regional stereotype fits the real profile. But researchers also believe that our nation’s unhealthy habits—namely eating more fat and calories than we burn—are blurring the regional health boundaries and making our health problems more homogeneous. Geography matters Utah shines as the healthiest state in the nation, with low rates of cardiovascular disease, cancer, smoking, and obesity. A significant Mormon population that tends to refrain from tobacco, alcohol, and caffeine is considered a factor, as is Utah’s attractive environment, which encourages hiking, skiing, and other physical activities.
A strip of Southern states stretching from Louisiana to the East Coast—known as the "stroke belt"—has the unhealthiest residents, ranking high in rates of cardiovascular disease, tobacco use, and obesity. Wisconsin, with a large Scandinavian-rooted population with a taste for beer and cheese, scores high in its percentage of overweight males. But why a region is healthy or not is not always clear. "It’s a real conundrum," said Martha Hill, PhD, RN, president of the American Heart Association and director of the Center for Nursing Research at Johns Hopkins School of Nursing in Baltimore. Genetics, race, tobacco use, exercise, diet, and access to and use of health care all play a role, Hill said. Christopher Murray, MD, PhD, associate professor of international health economics at the Harvard School of Public Health in Cambridge, Massachusetts, researched life expectancies and death rates across the country. He found the highest death rates in the rural Southern Mississippi Valley states and in isolated regions such as American Indian reservations and inner-city black areas such as the Bronx, New York, and Washington, D.C. He attributed much of that to tobacco use and poor quality or hard-to-access health care.
Murray found higher life expectancy in Midwestern and Mountain states, where tobacco use is lower and physical activity is higher. Interestingly, he said, higher incomes did not appear to have a substantial impact on health. "On the East Coast, in the richest parts of the U.S. as far as income per capita, surprisingly, their health was not that much better," he said. "The question is why isn’t their health better given the amount of money and education status of that population? In Utah, Iowa, Minnesota they are low-to-moderate income, yet they are quite healthy folks. We can’t explain these patterns entirely." One
pocket of well-to-do Asian women on the
East Coast had a high life expectancy rate,
adding further to the mystery. Unhealthy history "What’s more striking is what we have in common, rather than our differences," said Michael Thun, MD, director of the epidemiology and surveillance research program at the American Cancer Society in Atlanta.
Heavy marketing telling us that more food is better is a big part of why we’re getting fatter as a nation. Restaurants serve extra-large portions (the average restaurant plate has increased from 9 to 12 inches) and emphasize bargains by offering all-you-can-eat specials. "It’s easy to see it as an American cultural phenomenon, especially when you go outside the United States," said Ellen Rich, PhD, FNP, chairperson of the Family Nurse Practitioner Program at the Lienhard School of Nursing at Pace University in Pleasantville, New York. "We Americans want immediate ratification, a magic bullet, a quick fix." Rich, who lived in Europe, said when she noticed a group of overweight people overseas, they almost always were Americans.
The times in which we live, new technologies, and trends also affect our health as a nation. Stomach cancer was the most common cause of cancer fatalities in the 1930s because of the consumption of preserved and salted foods before the use of refrigerators, which allowed us to have fresh meat, fruit, and vegetables year round, Thun said. Lung cancer later became the No. 1 cancer killer as cigarette smoking became widespread, starting with the distribution of free cigarettes in soldiers’ C-rations during World War I and II. "The military took the habit home with them, and then it spread to women," Thun said. Smoking today is more prevalent among less affluent, less educated blue-collar workers, particularly in tobacco-growing states, which rank low on our nation’s health scale.
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