More than a quarter of adult Kansans say they don’t have any of five major behavioral risk factors for chronic disease, but the picture isn’t so rosy for minorities, men or people with lower incomes.
A recent report from the United Health Foundation examined the percentage of adults with five unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity.
In Kansas, 29.1 percent of adults had none of the risk factors, but 11.6 percent reported having three or more — placing them at elevated risk for heart disease, cancer and other chronic illnesses.
Those numbers were roughly in line with the nation as a whole, with 28.1 percent of Americans reporting no unhealthy behaviors and 12 percent reporting three or more.
In Missouri, 26.9 percent of adults reported no unhealthy behaviors, while 11.8 percent reported three or more. As in Kansas, rates were higher among some demographic groups.
Melissa Robinson, president of the Kansas City, Mo.-based Black Health Care Coalition, says people living in poverty have many sources of stress, particularly if they are minorities, so health behaviors aren’t a top concern.
“Folks are really focused on survival rather than whether they’re reducing their risk for cardiovascular disease,” she says. In the black community, she says, “you feel abnormal if you don’t have stress in your life.”
People who have to focus on work and family obligations may not go to a doctor regularly, Robinson says, and some view the doctor’s office as a place to go only if they are too sick to work. That means they may not get the support they need to make lifestyle changes like quitting smoking, she said.
The report noted that adults with higher levels of education and income were less likely to have multiple unhealthy behaviors.
Kansans who are younger, male or black, or who have lower incomes or a high school education or less, are more likely to have three or more unhealthy behaviors.
It isn’t that those Kansans don’t care about their health or haven’t heard that smoking and obesity are bad for them, says Jeff Willett, vice president for programs and policy at the Kansas Health Foundation.
Low-income people are less likely to be able to afford resources like nicotine gum that could help them quit smoking, and tobacco companies market more heavily in low-income areas, he said.
“I think some of it’s also related to social stress,” he says.
Willett said Kansas health advocates are working to spread awareness that smoking cessation assistance is covered by private insurance and KanCare, the state’s privatized Medicaid program. About 75 percent of smokers — wealthy and poor — want to quit, he said, and half of both groups have tried to in the past year.
“It’s the success rates where we see the big difference,” he says.
Craig Barnes, co-chair of the Heartland Healthy Neighborhoods healthy eating and active living workgroup in Shawnee County, says the group didn’t start with the idea that population disparities would be an area of focus, but public interest in them has grown.
For example, Barnes says, the group found that people living low-income areas and public housing neighborhoods in east Topeka had less access to fresh produce.
“East Topeka is almost an entire food desert,” he says. “We understand that socio-economic status, race, sex all address people’s ability to achieve good health.”
The group has worked to recruit vendors for a farmers market and encourage them to accept food stamps, he says.
It isn’t likely that a farmers market will lead to a quick reduction in the obesity rate, Barnes says, but the group hopes it will provide a foundation for residents to improve their health.
“Policy, systems, environmental changes are in there for the long haul,” he says.
Connection to chronic conditions
Health behavior varies widely across the country. In Utah, only 6.9 percent of residents have three or more unhealthy behaviors, while 17.8 percent of residents do in Mississippi.
The prevalence of most unhealthy behaviors declined nationwide from 2012 to 2015, although obesity increased. Getting less than seven hours of sleep per night was the most common risky behavior.
The report didn’t examine specific chronic conditions, but it did find that adults with three or more unhealthy behaviors were 6.1 times more likely than adults with no unhealthy behaviors to report that they were in fair or poor health.
The report estimated about 71 percent of all U.S. health care spending is on people with multiple chronic conditions. Among Medicare beneficiaries, 93 percent of spending goes toward people with multiple chronic conditions.
While having unhealthy behaviors doesn’t doom people to chronic conditions — and healthy living doesn’t guarantee they won’t develop one — behavioral factors are a driver of health care costs.
Diseases related to smoking and obesity account for about $2 billion in costs to KanCare annually, Willett says.
“There hasn’t been progress made for some populations, and it’s time for us to double down and try to address those stubbornly high rates,” he says.
Editor’s note: The Kansas Health Foundation is the primary funder of the Kansas Health Institute, which is the parent organization of the editorially independent KHI News Service.