Eat, sit and die



Prolonged sitting is a serious condition in America today.

During the Grand Rapids Area Chamber of Commerce’s 2015 Health Care Summit, keynote speaker Dr. Dean Sienko presented emerging trends and issues influencing health care from a public health perspective to an audience of more than 250 community leaders, business executives and human resource professionals.

Sienko, associate dean for prevention and public health at Michigan State University’s College of Human Medicine, discussed the underlying reasons driving the nation’s population to seek health care, as well as strategies the country as a whole and individual businesses use to improve health.

“I would like to talk about this from the public health perspective,” said Sienko. “I often think it is a perspective about health we sometimes don’t hear enough about.”

Sienko began his discussion with a reference to a Health Affairs article published in 2002, “The Case for More Active Policy Attention to Health Promotion.” The article indicated the country’s health policy and health spending until recently “had been dominated by a focus on payment for medical treatment,” and “many of the conditions driving the need for treatment are preventable.”

“This is somewhat of a landmark article that came out. People have tried to modify it over the years and said, ‘What are the things that determine health?’” said Sienko. “Certainly, genetics is a significant component of your overall health and the social circumstances in which you live.”

While the leading determinants impacting overall health may include genetics, social circumstances, environmental exposures and shortfalls in medical care, Sienko emphasized behavioral choices and patterns represent the largest influence on overall health in the U.S.

“I think, particularly in this country, so much of our end state of health is determined by behaviors,” said Sienko. “When we talk about mortality statistics or morbidity statistics, we look at these medical conditions, medical diagnoses. People in public health talk now about what are the actual causes of death?”

The top three behavior risk factors contributing to U.S. death in 2000 included tobacco at 18.1 percent, poor diet and physical inactivity at roughly 15.2 percent, and alcohol consumption at nearly 3.5 percent, according to the Journal of the American Medical Association’s “Actual causes of death in the United States” article.

“It pushes us back in our thinking to think about what is underlying a lot of the mortality and morbidity statistics we have in the United States,” said Sienko.

While the prevalence of cigarette smoking in Michigan since 2001 has gone from 26.1 percent to 18.9 percent, and in the U.S. from 22.8 percent to 17.3 percent, Sienko said roughly two-thirds of the U.S. population is overweight or obese, and weight issues are emerging at the preschool age.

“Studies are showing about 12 percent of U.S. children age 2 to 5 are considered obese, and if these kids are overweight or obese as preschoolers, they are five times more likely to become overweight or obese adults,” said Sienko.

“I call this the critical first decade of life. We have to get at this problem at the earliest of years, or these studies indicate the risk is really high for these kids.”

Results from an analysis of the National Health and Nutritional Examination Survey in 2003-4, 2005-06 and 2007-08, indicated the leading source of dietary energy for U.S. adults includes soft drinks, yeast breads, chicken, grain-based desserts and alcohol, which have low nutritional value and are high in solid fats and added sugars.

Combining the flow of empty calories with daily routines that no longer require high physical exertion, Sienko said the energy intake exceeds energy output and causes individuals to gain weight.

“I declare the United States has become an obesogenic society. We have all this excess energy intake for all these reasons; we don’t eat the right things and our daily routines no longer require us to burn off sufficient energy,” said Sienko. “Prolonged sitting is a serious condition in America today.”

In terms of alcohol consumption, the Michigan 2011 Critical Health Indicators report indicated in 2005 more than 1.6 million hospitalizations and more than 4 million emergency room visits in the nation were a result of alcohol-related conditions. Roughly 79,000 individuals die each year in the U.S. as a result of excessive alcohol use, which can also have long-term health consequences such as neurological and cardiovascular problems.

“The U.S. estimates binge drinking accounts for 75 percent of the $223 billion dollars in economic costs to our nation, and a lot of that is in lost productivity,” said Sienko.

The New England Journal of Medicine published an article in 1993 indicating roughly 70 percent of the burden of illness and associated costs is attributed to preventable illness, while the Centers for Disease Control and Prevention indicated roughly 96 percent of the overall $2.2 trillion in health care spending was allocated toward medical services in 2007, and only 4 percent of spending was used for prevention.

“Presently, about 18 percent of Gross Domestic Product goes into health care. (Centers for Medicare and Medicaid Services) estimates by 2022, we will be at 20 percent, and if historical trends would continue, by the year 2040, we would be over 30 percent of the GDP that goes into health care,” said Sienko.

To address some of the health trends and concerns at the population health level, Sienko said there are a number of methods that can be used, such as health care approaches, insurance mechanisms, market self-regulation and promoting healthy behaviors in the workplace.

Sienko said some strategies for businesses include incorporating health as a corporate strategic objective, implementing health promotion programs such as going tobacco-free, giving employees flextime for physical activity and providing healthier food choices.

“The literature for the most part would argue health promotion programs do have a positive return on investment,” said Sienko.

Examples of public health interventions for diet and activity include the Let’s Move program developed by First Lady Michelle Obama, public service announcements, and the Michigan Health and Wellness 4×4 Plan. Approaches to address alcohol consumption include public announcements and tougher drinking and driving laws, according to Sienko. 

“We look at tobacco — we are still not where we would like to be with 2020 objectives for the nation, but we started taxing tobacco products more, Joe Camel and his friends are all gone, used prohibitions, and we watched the sales,” said Sienko. “We did a lot of things with tobacco, and that is where we saw the biggest decline.”

Sienko also indicated health care approaches include an overall shift in the payment structure for treatment from volume-driven to patient-centered care; insurance mechanisms include universal and preventable services coverage through the Affordable Care Act; and one market self-regulation includes food manufacturers signing on with the Children’s Food and Beverage Advertising Initiative.

“I think there is an inherit conflict of interest here when you just leave this to the market, and there is a role for government to play,” said Sienko.

While the resulting trends from the prevalence of tobacco, poor diet, physical inactivity and alcohol consumption are mixed, Sienko said there could be a lot of prevention if resources and efforts were allocated more appropriately.

“In the end, success will require engagement from as many sectors of society as possible,” he said.

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