Adults have meaningful work, family–sustaining incomes and healthy lifestyles

As we review protective and risk factors for health, it is important to note that for adults, a sense of “control” at work can be protective, and a sense of “lack of control” at work can be an additional risk factor for mortality, as shown by the Whitehall Study.  This study tracked (for 25 years) death rates of 17,530 male British civil service workers who all had access to free health care.  The study found (both at 10 and 25 years) that the highest death rates were in the lowest civil service rankings, which had a death rate three times greater than the highest civil service classification.

According to Hawaii Health Survey, Hawaii County has a higher percent of the workforce who work more than one job: 14.5% as compared to 12.2% of the State. Simultaneously Hawaii County has a greater percentage of households with incomes below 185% of federal poverty level.  Kona has an even higher percentage of the workforce working more than two jobs. 

Simultaneously the cost of living and workforce shortages are higher in Kona and Hawaii County as compared to the State (The Self Sufficiency Standard for Hawaii, 2006).

While 14.5% of Hawaii County workforce is working more than one job to make ends meet, according to the employer survey to the right, employers are having a hard time finding “qualified applicants” for job openings.

Implication:

Workforce training and growth is an important strategy to improve both workers’ income and businesses’ access to a qualified workforce.  This also suggests stronger employer partnerships with public education system at all levels.

Though our hopes are for adults to have healthy lifestyles, the reality is that there is room for improvement in several categories.  Improvement will likely require interventions at multiple levels

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Note: The BRFSS data for Hawaii County showed slight improvement from 2005 - 2007 in reducing diabetes and fewer sedentary people.  On the other hand, obesity increased as did adult smoking.   

Adult Excercise

Since regular exercise is clearly linked with better health, tracking improvements in this indicator over time is essential.  BRFSS data showed that North Hawaii had slightly more adults (58.0%) that are getting moderate exercise, 30 minutes per day, five times a week. 

Implication:

Interventions to promote regular exercise for adults will need to address the barriers of multiple jobs, high cost of housing, long travel times to work, access to walking trails and employer policies regarding exercise at work.

North Hawaii, like Hawaii County and the nation, has had the same gradual increase in the percent of people defined as obese by a body mass index (BMI)>30.  Obesity is associated with many health risks including increased risk of diabetes, high blood pressure, heart attack and stroke, cancer and decreased quality of life.

Implication:

Policy changes in the community, the work place and at schools could set the stage for reducing the obesity epidemic by designing safe walking areas to encourage walking, and offering healthier food choices.  See the U.S. Prevention Services Task Force recommendations:  screening for obesity in adults at www.ahrq.gov/clinic/uspstf/uspsobes.htm

High blood pressure is a major risk factor for stroke, heart attack and cardiovascular disease.  The first line of treatment is lifestyle modification, including increasing exercise, weight loss and decreasing salt and alcohol consumption. When lifestyle management alone is not effective and when blood pressure is greater than 140/90, medication is recommended.  Lowering high blood pressure prevents strokes. See www.ahrq.gov/clinic/uspstf/uspshype.htm

Reducing high death rates from heart disease, stroke and cancer will require reducing smoking rates. This will require targeting ethnicities with high smoking prevalence rates.

According to the BRFSS survey, the North Hawaii prevalence of diabetes in 2007 was slightly higher than 2006, as well as Hawaii County from 9.6% in 2005 to 7.0% in 2007.  For the same time period, the State increased slightly from 7.3% to 7.7%

Since diabetes is a major risk factor for cardiovascular disease and stroke, further analysis and intervention is clearly needed.

Obesity and lack of regular exercise are major risk factors for adult onset of diabetes.

Another life-style risk factor for diabetes and cardiovascular disease is inadequate consumption of fruits and vegetable.  In 2007, nearly 70% of both Hawaii County and the State consumed less than the recommended “five a day” servings of fruits and vegetables.

Though more recent data is clearly needed, between 1995 and 2002, there was a steady increase in hospitalizations for the complications of diabetes in North Hawaii, Hawaii County and Hawaii State.  More recnet data is clearly needed.

Decreasing hospital utilization for diabetes will require improving management through patient support and education, and reducing risk factors including inactivity, obesity, high blood pressure and smoking

Though obesity rates and diabetes hospitalizations have been increasing, it is important to note that according to the How’s Your Health, North Hawaii, more than 50% of adults surveyed (N=806) ARE concerned about their exercise and nutrition needs.  Though this may be a biased sample, it suggests that a large percentage of people ARE “ready” for support in lifestyle change.  These survey results also challenge the myth that “people don’t really want to change.”  According to the survey (March 7, 2008) North Hawaii adults top three concerns were: 53% - Excerise and nutrition needs, 31%-Preventing cancer or heart disease and 24% - Better health care (www.howsyourhealth.com, 2008).

The age-adjusted coronary heart disease (heart attack) death rates for both the State and County have declined over the past six years. However, the Hawaii County death rate is consistently higher than the State rate. This may be due to higher rates of modifiable risks including smoking, sedentary lifestyle and obesity, as well as Hawaii County’s challenges with access to healthcare.

Implication: Reducing Hawaii County coronary artery disease death rates will require addressing both life-style and access to care.

Congestive heart failure hospitalization rates reflect both the burden of heart disease and the effectiveness of management.  Variations in the North Hawaii rates may be due in part to a relatively small population.  General increases in the State rates may reflect in part the aging of the population.  Higher rates in Hawaii County compared to the State may reflect higher life-style risks for coronary heart disease, an older population, and problems with access. More recent data is needed.

Hawaii County has had a consistently higher age-adjusted stroke death rate compared to the State over the past decade until 2004 and 2005. Causes for this higher rate are likely multiple. The higher rate may in part be due to higher risk factors including: high blood pressure, smoking, diabetes, obesity, and high alcohol consumption which are all higher in Hawaii County. In addition, lower access to primary care is known to be associated with higher stroke death rates and access to medical care is lower in Hawaii County.

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Note:

This data again show the high stroke death rate in Hawaii County, which in this graph is compared to the other counties and to the Healthy People 2010 goal.  A leadership “think tank” meeting was held in Hawaii County in 2003 to begin to answer the questions “Why?” and “What can be done to improve?”  Conference proceedings click here

The overall age-adjusted death rate for cancer in Hawaii County is consistently twice the death rate for the State and three times the death rate for Healthy People 2010.  The authors are not aware of any previous analysis of this disparity.  The reasons for the large difference are likely complex and most likely include inadequate access to care, which would provide timely screening, diagnosis and appropriate treatment, as well as life-style risk factors such as smoking, obesity and alcohol consumption.  The possibility of other environmental factors should be considered and investigated.