- Health Risks

Preventive Health and Substance Abuse
-- Safe and Nurturing Social Environment --

What are the Most Important Goals?

• Informed populace
• Visionary leaders
• Engaged institutions
• Accessible services
• Good health
• Creative economy
• Continuous education

What Can We Do?

Individuals:
• Eat a balanced diet, with plenty of fresh fruits and vegetables, and avoid foods that are high in calories, fats, cholesterol and sodium.
• Encourage legislators to spend a greater percentage of public health funds on preventive-health measures.
• See a physician regularly.
• Avoid smoking and drugs.
• Limit alcohol consumption.
• Maintain an active lifestyle.
• Maintain a healthy weight.
• Exercise regularly.
• Have regular blood pressure check-ups, and if high, consult a doctor for treatment.
• Try to maintain a positive mental attitude and a sense of humor.

Communities:
• Encourage local and state decision-makers to support community health and nutrition initiatives.
• Support health education in our schools and healthful meals in school cafeterias.
• Support initiatives to make public buildings smoke-free.
• Support initiatives that promote walking and bike riding.

Decision-makers:
• Set a good example for the community in terms of health and behavior.
• Support community health and nutrition initiatives, such as Meals-on-Wheels and health-screening programs.
• Become informed about the public health and economic implications of tobacco and alcohol use.
• Support school lunch and nutrition programs.
• Support exercise and healthscreening programs.

What is this Indicator?

This indicator measures behaviors that are major contributors to poor health. It also updates the 1999 "Rate of Substance Abuse" indicator by including the number of alcohol and substance abuse-related hospitalizations in Barnstable County in 2001; the data on substance-abuse treatment programs have been dropped for this update because further research suggests that only a small percentage of abusers may enroll in treatment programs. Also, a decrease in enrollment might reflect a cut in funding for programs from 1998-2002, rather than a decrease in actual substance abuse.

Most significantly, this indicator adds health-risk data on issues other than substance abuse. Figure 1 shows the comparative incidence on Cape Cod, throughout Massachusetts, and across the United States, of several behaviors that constitute health risks, including smoking, binge drinking (five or more drinks on one occasion in the past month), and heavy drinking (60 or more drinks in the past month).

The indicator also includes statistics on chronic conditions that are related to some of these behaviors, and that are major contributors to morbidity and mortality, such as obesity and hypertension. Finally, it includes statistics on alcohol and drug use among high school students, although the available figures on these statistics represent a region that extends beyond Barnstable County.

Why is this Indicator Important?

This indicator is important because virtually all human beings wish to be healthy, and because the well-being of a society is greatly affected by the health of its citizens. Personal behavior is a great factor in determining our state of health. Positive behaviors such as exercise and good nutrition - and risky behaviors such as smoking and alcohol and drug abuse - correlate with important health indicators such as blood pressure and obesity, and with societal problems such as crime, unemployment and homelessness.

Analysis of Data

The health risk data in Figure 1 were provided by the Massachusetts Department of Public Health, and come from a telephone survey conducted by the U.S. Centers for Disease Control and Prevention and by state health departments. Cape and Islands residents were interviewed in these surveys from 1994 through 1999 and again in 2000 and 2001. The following risk factors were measured:

• Tobacco, a major cause of cancer, coronary disease and stroke, causes more deaths than any other preventable risk factor, and also is a cause of low birthweight. Cape and Islands figures on tobacco use are edging downward.
• Alcohol is a central nervous system depressant that slows reflexes and impairs coordination. While limited alcohol consumption often is recommended for older adults, heavy alcohol abuse is a major risk factor for high blood pressure, contributes to the development of diabetes and neurological disorders, and can interfere with social relationships. Cape and Islands residents rank below state and national averages in binge drinking, but above those averages in heavy drinking.
• Overweight and obese individuals are at increased risk of developing hypertension, heart disease, diabetes, gall bladder disease and osteoarthritis. While the Cape's numbers are below state and national percentages, the proportion of adults who are overweight has been increasing over time. (It should be noted that Cape and Islands percentages of adults who consume at least five servings of fruits and vegetables a day, and those who have regular physical activity - good indicators of preventive health - are above state and national percentages.)
• Hypertension, or high blood pressure, is categorized by the Massachusetts Department of Public Health as a "chronic condition" rather than a "risk factor." But when it is not kept under control - by diet, exercise and perhaps medication - it becomes a significant indicator of future health problems. Hypertension awareness is the first step toward treatment. Cape Codders should be aware, therefore, that hypertension rates here are higher than state-wide rates.

In addition to the risk factors discussed above, the "Rate of Substance Abuse" indicator from the 1999 Sustainability Indicators Report showed that admissions of Cape and Islands residents to Massachusetts hospitals for acute-care treatment of alcohol-related and drug-related diseases decreased from 550 per year in 1992 to just over 400 in 1996. The most recent figure shows that by 1999 the incidence decreased slightly to 391.

In addition to the risk factors discussed above, the "Rate of Substance Abuse" indicator from the 1999 Sustainability Indicators Report showed that admissions of Cape and Islands residents to Massachusetts hospitals for acute-care treatment of alcohol-related and drug-related diseases decreased from 550 per year in 1992 to just over 400 in 1996. The most recent figure shows that by 1999 the incidence decreased slightly to 391.

The social fabric of a community is greatly affected by the health of its members.

If we are to achieve a richer culture, rich in contrasting values, we must recognize the whole gamut of human potentialities, and so weave a less arbitrary social fabric, one in which each diverse human gift will find a fitting place.
— Margaret Mead

What Connections Does This Indicator Have?

Economic
An increase in substance abuse inevitably will be reflected in higher unemployment and reduced income for affected families, as well as mental-health problems and family instability. Alternatively, a drop in substance-abuse rates - and improvement in such areas as diet and exercise - can lead to positive social and economic changes.

Economic productivity is directly affected by increased levels of illness and death resulting from risky health behavior. This correlates with missed days from work, or inability to hold a job or to keep a business going. Ultimately, the community may have to pay higher costs for safety and health services as additional services are required. Furthermore, substance and alcohol abuse among our youth can limit educational achievement and increase the school dropout rate, limiting earning potential and contribution to the workforce.

Environmental
Human beings are part of the natural environment. How people care for themselves sometimes reflects how they will care for the world in which they live. Engaging in risky behaviors or ignoring personal health issues may result in a greater incidence of illness, and thus less time available for civic and social involvement, including environmental pursuits. On a positive note, many healthy pursuits, such as exercise, can involve outdoor recreational activities, which can enhance one's interest in the environment.

Social
Because much of the crime committed on Cape Cod is drug-related, an increase in substance-abuse rates correlates with a rise in public-safety problems. Substance abuse also creates public-health problems. Ultimately, the community is bound to pay higher costs for safety and health services. An unhealthy population in general puts a greater burden on emergency and medical services. Healthy adults provide a good role model for the youth of our community. Decreased longevity resulting from risky behaviors affects families in myriad ways. Substance abuse clearly is linked to the rate of crime. Substance-abuse rates inevitably are reflected in reduced income for affected families, as well as mental-health problems and family instability. Alternatively, a drop in substance-abuse rates - and positive behavior in such areas as diet and exercise - can lead to positive social changes. All of these consequences ultimately affect the social fabric of the community.