The state of preventive health in North Carolina

Two weeks ago I took the car in to get a burned-out headlight replaced. In the course of snooping around to see what else might be wrong, the mechanic looked at the odometer and asked, “You have the timing belt replaced yet?”

Of course I hadn’t, the timing belt being one of those crazy expensive procedures that involves taking apart the entire engine. “It goes, you need a new engine,” he was quick to note. Despite the fact the car was running perfectly, I had the timing belt replaced a few days later, giving little thought to the $650 price tag. A little preventive maintenance is worth not having the engine blow 50 miles from the nearest garage.

If only we viewed our personal health with the same practical concern. Worried by the recession, North Carolinians are putting off annual checkups, health screenings and other preventive medical procedures that can help flag a potential problem and nip it before it becomes a major health issue. That according to the 2009 State of Preventive Health report issued today by Blue Cross Blue Shield of North Carolina. The report was presented this morning as part of a summit on the topic at the Raleigh Convention Center.

How much are we putting our health off? According to 501 North Carolinians surveyed for the report in April and May:

  • 18 percent said they have put off visiting the dentist.
  • 17 percent have put off scheduled physical exams.
  • 36 percent are buying fewer prescription medications.
  • 31 percent are refilling medications less quickly.
  • 17 percent are postponing medical tests or operations.

“They’ll come in when they have no choice but to be cared for,” according to Dr. Karen Smith, a family pediatrician in rural Raeford, who was part of a panel at this morning’s summit. In short, more and more patients won’t seek medical help when they feel a pain in their side, but will when their appendix bursts.

According to the North Carolina State Center for Health Statistics, 17.2 percent of North Carolinians were uninsured in 2006-2007, a figure that no doubt has grown with statewide unemployment rate hitting 10.8 percent in August. No insurance, no visits to the doctor unless it’s absolutely necessary. Even people who are employed and have insurance may be reluctant to incur out-of-pocket medical expenses if they’re worried about their job status.

medical_clipart_thermometerThe recession is having another negative impact on our health, according to the summit. With money tight and more people pinching pennies, we’re keeping a tighter reign on our food budget. And since it’s cheaper to eat unhealthy than healthy …

“As long as I can get a Big Mac and a Coke cheaper than an apple and a thing of yogurt, we’ve got a problem,” said Dr. Don Bradley, BCBSNC’s chief medical officer and a member of the panel.

North Carolina’s State Health Director Jeff Engel said the availability of cheap, nutritionally deficient food is the next big issue that needs to be dealt with from a public policy standpoint.

“That’s the next industry we have to go after,” said Engel, who was also on the panel. “We need to change the availability to cheap, poor nutrition fast food. And, we need to look at a sugar beverage tax.”

Going after doesn’t necessarily mean banning or restricting fast food: A little truth in advertising can go a long way. On a recent trip to New York City, Engel said he ducked into a Starbucks and was about to order the spongecake when he saw that it had 430 calories. Restaurants are required to post nutritional information in New York City, a city Engel praised as a pioneer in health policy matters. (Because of the cigarette tax there, a pack sells for about $9.50, nearly three times what they cost here. “It’s the best way to discourage young people from starting smoking,” Engel said.)

Perhaps the most curious numbers to emerge from the 2009 State of Preventive Health survey pertained to how North Carolinians view themselves. Despite the fact that, according to the Centers for Disease Control and Prevention,  nearly 30 percent of North Carolinians are overweight or obese, that one in five North Carolinians smoke (Source: CDCP) and that the state ranks 46th in the number of physically active adults, 77 percent of survey respondents said they maintain a healthy diet, 70 percent said they are “actively learning about health conditions and diseases,” and nearly two-thirds said they get cardiovascular exercise three days a week. In short, the majority of North Carolinians don’t view themselves as part of the problem.

That gave BCBSNC CEO Bob Greczyn pause. After ticking off those statistics, he continued to stare at his notes, before finally adding, “I’m not sure I believe all that.”

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I’ll look at more findings from the 2009 State of Preventive Health report and thoughts from today’s summit in the next few days.

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