Written by Brad Karger
One book on my summer reading list I’m making way through is Factfulness: Ten Reasons We’re Wrong — And Why Things Are Better Than You Think, by Hans Rosling. It’s a hefty book, but here’s a key takeaway I’d like to share with you:
Developing a worldview based on facts is a thinking tool I need to better develop to replace my overly dramatic, fear- or bias-based instincts — which are often based on misconceptions and out-of-date information.
If I can better understand “the big picture” and the most current data and trends, it will help me — and my staff — avoid being stressed about the wrong things or about isolated events and help me to make better, more well-informed decisions as a public official.
(We share an interest in me getting this right, since I’m the person responsible for priority setting and resource allocation for the government unit operating in the county in which YOU reside!)
So, taking this book’s insights into consideration, I thought I’d first try to update my understanding of local, state, and national public health trends.
I met with Joan Theurer, Health Officer with the Marathon County Health Department, to compare my perceptions of public health to her hard data to see how I fared…
* * *
BK: Hi, Joan. Thanks for meeting with me. I’m gonna start with an easy True or False question to get us started… I read that life expectancy for Americans declined for the second straight year. That seems rather disconcerting. Is it true?
JT: That is true. An American born in 2016 can expect to live on average 78.6 years — down from 78.8 years in 2015 and 78.9 in 2014.
But… Life expectancy in the year 2000 was 76.8 years. So, if you look at a 16-year window — instead of a 3-year window — you would see a 2.8-year gain, instead of a .3-year reduction in life expectancy.
In fact, taking an even longer perspective, life expectancy increased from just 47.3 years in 1900 to a whopping 76.8 years in 2000 due to a focus over that century on such public health factors as control of infectious diseases, food safety, vaccinations, workplace safety, healthy mothers and babies, motor vehicle safety, family planning, fluoridation of drinking water, and recognition of tobacco as a public health hazard. So, it’s important to look at overall trends and not just year-to-year data.
BK: Good reminder. That changes my perception some. But let’s try another one… I also read that there are more gun-violence deaths than there are vehicle-accident deaths in 21 states and that the overall number of deaths from these is converging nationally. Is that true?
JT: Right again. That’s partly because automobiles and roads are being made safer. For example, cars are now equipped with air bags, which have prevented a lot of deaths from vehicle accidents.
Gun violence deaths are up from 33,563 in 2012 to 38,656 in 2016 according to FBI and CDC data.
It is new that gun violence is considered a public health issue. Like many other public health issues, there are those that want to put forward “easy answers” to a complex problem. There are strategies that will help, but the issue is further complicated by a polarized political debate.
The big picture story in that comparison is in the reduction of deaths from vehicle accidents: 37,461 in 2016 — down from 44,525 in 1975.
BK: How about the number of people who utilize the Emergency Room as their health care provider because they don’t have health insurance? I’ve heard a lot about that.
JT: This IS a real issue. But for perspective, we have 7% of adults in Marathon County who are uninsured and 4% of children who are uninsured, according to the county health rankings. That means that 93% and 96% respectively DO have health insurance coverage.
BK: What about lifestyle choices that cause preventable disease — like smoking? I heard that more young people are starting smoking.
JT: Actually, according to recent CDC data, cigarette smoking dropped by half for high school students (from 16% in 2011 to 8% in 2017) and for middle school students (from 4% in 2011 to 2% in 2017).
What’s more, the prevalence of smoking has also declined among men and women aged 25 and over — from 36.9% to 15.6% between 1974 and 2015.
However, the vaping industry is targeting young adults in their marketing, and that is concerning. According to the CDC, in 2016, more than 2 million U.S. middle and high school students reported using e-cigarettes in the past 30 days, including 4.3% of middle school students and 11.3% of high school students.
Even so, this doesn’t offset the more than 50% reduction in cigarette smoking over the past 41 years. Now, THAT’s something to celebrate!
BK: Agreed. Let’s try one more… I read that the American life expectancy rate ranks 30th among nations. Is that true and what explains that, given all the public health advantages we have in the United States?
JT: Yes, it’s true, according to America’s Health Ranking.
But, to understand this startling statistic, you have to realize that health is not a commodity we purchase in the doctor’s office; it’s something that starts in our families, our schools, in our playgrounds and parks, in our workplaces, and in the air we breathe and the water we drink. Some people have said to me:
“Tell me your zip code and I’ll tell you your life expectancy.”
That’s because communities and health infrastructures matter.
Our health care delivery systems are strong, but where we fall down is not investing in preventing illness by creating conditions where everyone has the same opportunities; such as having access to safe places to walk, and more real food and less processed food. Better managing stress and achieving higher family incomes would also go a long way in improving individual and community health too. However, these are changes that involve altered social norms and economic shifts for health behaviors — which will take time. But be patient, Brad… Public health has already demonstrated that it can facilitate big changes that make big differences — it will just take focused effort from a lot of people over a long period of time.
BK: Well, then… As County Administrator, what are some things I should be focused on related to public health?
JT: Well, there are a few areas that we in Marathon County score less well in than the population of Wisconsin does. Some factors that you might want to focus on for our citizens include:
- Getting regular physical activity
- Having a sufficient number of mental health providers
- Instilling that one’s mental health is as important as one’s physical health
- Having access to exercise opportunities throughout the county… like the bike and walking paths adjacent to County Road R in Rib Mountain. Remember, when that was first opened, many people said that you can run or walk anywhere and questioned the expenditure. But our experience has shown that the path gets a lot of use, and national studies conclude that communities that have health infrastructure — like walking paths — have higher participation in healthy activities and attract health-conscious people to move there. The saying from the movie Field of Dreams is true… “If you build it, they will come.”
- And then there’s the opioid crisis… I think that we as a community have come to recognize that we can’t incarcerate our way out of that problem, but we know that law enforcement still needs to play a role. We have already expanded our treatment programs, and that will help; however, recovering from an addiction is a lifelong struggle. Further investment in prevention strategies is key. To prevent something, you need to understand why people are attracted to experimenting with and using it in the first place, as well as the societal pressures and norms that contribute to use and abuse.
BK: I see that there’s a program coming up in early August at the UW Center for Civic Engagement on Substance Abuse Prevention Training. That’s a start to helping local law enforcement, counselors, school administrators, and others understand some of the factors involved.
JT: Yes, that’s a great resource for local professionals. But it’s a complicated issue, and one of the areas we are only beginning to understand is the long-term impacts of Adverse Childhood Experiences (ACEs). Whether it’s opioids, or some other drug that is in fashion at the time, to be effective in drug abuse prevention, we need to better understand the whole person and what has happened and is happening in their life that makes some form of escape seem vital, even though they may be well aware of the risks. Resolving the opioid and meth crisis is not going to be easy. There’s no single solution.
BK: So, then, I have to ask, What do we do better in Marathon County than the rest of Wisconsin?
JT: Well, there are quite a few things we can be proud of, including:
- Less adult smoking
- Fewer alcohol-impaired deaths
- Fewer children in poverty
- Less violent crime
- Fewer teen births
- Fewer low birthweight babies
- A lower number of sexually transmitted diseases
- More children in two-parent households
- Less unsafe housing
- Fewer injury deaths…
BK: I think I get it… So, while we do have areas of concern that we all can focus on, the overall state of public health in Marathon County is clearly getting BETTER and there’s a lot for us to be optimistic about. Would you agree?
JT: Indeed, our quality of life has improved. We simply have an overload of information that contributes to us questioning if things are getting worse and that leads us to expect quick fixes to very complex problems. It’s important to remind ourselves that, today in America, babies are being born healthier, children are not dying from polio and other childhood diseases, and families can breathe smoke-free air when dining in public. Those are BIG successes for public health.
BK: Thanks, Joan. What I’d most like people in Marathon County to remember is that if you just focus on isolated stories in the news, it might seem like the state of public health is on the decline. But in reality, the news for humanity in this modern era is quite good for Americans: We’re living longer, healthier lives; we have clean water and famines are gone; we’re living in a time of relative peace and safety throughout the world… It’s the best of times to be alive!
Marathon County Administrator
In his Administrator role, Brad Karger leads an organization with 700+ employees and an annual budget of more than $165 million. Brad has been in leadership positions with Marathon County for the past 30 years. He is known statewide for generating innovative ideas and solutions to problems, openness and transparency, and a commitment to community service that extends well beyond the normal workday. Email Brad Karger.
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