There is a dichotomy in the attitude of many Americans regarding how health care should be provided, to whom, who should pay for it--and ultimately, who is responsible for the overall health of the nation. While one in four working-age Americans reported going without health insurance during 2011 (Morgan, 2012), the entire issue of health care reform remains a hotly debated political football in this election year. There has been a huge outcry against the current state of health care reform, particularly mandating health insurance for all individuals. In fact, by the time you read this, the Supreme Court will have ruled on the law's constitutionality. A recent Reuters/Ipsos poll reports that 56% of Americans oppose the current Affordable Care Act, while 44% favor it. Interestingly, the majority of those polled strongly favored many reforms in the law (allowing children to remain on parents' health insurance until age 26, requiring companies with more than 50 employees to provide insurance to employees, and banning insurance companies from denying coverage of pre-existing conditions) (Zengerie, 2012).
Nearly 69% of adults in the United States and 32% of children are either overweight or obese (Institute of Medicine [IOM], 2012). Colorado is the only state in the nation with an obesity rate of less than 20%, 12 states have an obesity rate greater than 30%, and 38 states have an obesity rate greater than 25%. I live in Florida, where the obesity rate is 26.1% (Trust for America's Health, 2011). In my county of 916,500 residents, 63% of adults and 30% of all children are overweight or obese (Centers for Disease Control and Prevention [CDC], 2012a). Between the years 1980 to 2008, obesity rates doubled for adults and tripled for children (CDC, 2012b). No state met the nation's Healthy People 2010 goal of lowering obesity rates to 15%. Just 20 years ago, not a single state's obesity rate was greater than 15%. The problem spans all age groups, all cultures and races, and all socioeconomic groups.
Obesity has long been associated with chronic disease and early death. Overall annual medical costs related to obesity in the U.S. are now estimated at $190.2 billion (IOM, 2012). Excess weight is known to increase the risk of heart disease, stroke, hypertension, type 2 diabetes mellitus, cancer, hyperlipidemia, liver and gallbladder disease, sleep apnea, degenerative joint disease, and the list goes on (CDC, 2012b). In 1995, only four states had diabetes mellitus rates greater than 4%. Today, 43 states have diabetes rates over 7%. Every state in the nation has hypertension rates above 20%, with nine states greater than 30% (Trust for America's Health, 2011).
The CDC has recently released findings on health statistics for 2011, and the highlights are quite revealing. Self-reported obesity for 2011 was 28.7%; 10% of adults 45 to 64 years of age were diabetic; 20% of adults over 65 years of age had diabetes; 48.4% of adults reported doing aerobic exercise (highest percentage ever reported); and only 2.4% of Americans ranked their own personal health as poor (CDC, 2012c; Reinberg, 2012).
An analysis of health care spending in the U.S. published in May 2012 compared supply, utilization, prices, and quality of U.S. health care with 13 other industrialized countries using Organization for Economic Cooperation and Development (OECD) 2011 data. Findings noted that the U.S. spends far more on health care than any other country--$8,000 per person annually (17.4% of the gross domestic product [GDP]). The median health care spending was slightly over $3,000 per person annually (9.5% of GDP). The significantly increased spending for health care in the U.S. could not be attributed to higher income (Norway, the wealthiest study country, spent only 9.6% of GDP on health insurance). The U.S. has a smaller older adult population and fewer smokers than other countries, but a higher obesity rate. The U.S. has below-average supply and utilization of health care providers and hospital beds at much greater cost than other countries. Prices for prescription drugs, and outpatient medical care and procedures were highest in the U.S., and the use of expensive medical technology was more common than in other countries. Finally, the quality of health care in the U.S. varies widely and is not remarkably superior to other study countries spending far less (Squires, 2012).
None of us can solve the health care dilemma singlehandedly. There are no easy and simple solutions to either the health care conundrum or the obesity epidemic in the United States. However, we can see the value in personal accountability and help ourselves, our families, and our patients move toward a healthier lifestyle. Indeed, we need a health care system that includes everyone without bankrupting the country. But with approximately one-third of American adults considered obese and more than two-thirds overweight/obese (and our children not far behind), we can't have our cake and eat it, too.
References
Centers for Disease Control and Prevention (CDC). (2012a). Communities putting prevention to work: Community profile: Pinellas County, Florida, obesity prevention. Retrieved from http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/ communities/profiles/obesity-fl_pinellas-county.htm
Centers for Disease Control and Prevention (CDC). (2012b). Overweight and obesity. Retrieved from http://www.cdc.gov/obesity/ data/adult.html
Centers for Disease Control and Prevention (CDC). (2012c). Early release of selected estimates based on data from the 2011 National Health Interview Survey. Retrieved from http://www.cdc.gov/ nchs/nhis/released201206.htm
Institute of Medicine (IOM). (2012). IOM report: Accelerating progress in obesity prevention: Solving the weight of the nation. Retrieved from http://iom.edu/Reports/2012/Accelerating -Progress-in-Obesity-Prevention/Report-Brief.aspx
Morgan, D. (2012). One in f our Americans without health coverage: A study. Retrieved from http://www.reuters.com/article/2012/04/19/ us-usa-healthcare-insurance-idUSBRE83117420120419
Reinberg, S. (2012). Health of Americans a mixed bag: CDC report. Retrieved from http://consumer.healthday.com/Article.asp?AID=665876
Squires, D. (2012). Explaining high health care spending in the United States: An international comparison of supply, utilization, prices, and quality. Retrieved from http://www.commonwealthfund.org/ ~/media/Files/Publications/Issue%20Brief/2012/May/1595 Squires explaining_high_hit_care_spending_intl_brief.pdf
Trust for America's Health. (2011). Report: F as in fat: How obesity threatens America's future 2011. Retrieved from http://www.healthyamericans.org/report/88/
Zengerie, P. (2012). Most Americans oppose health law but like provisions. Retrieved from http://www.reuters.com/ assets/print?aid=USBRE85N01M20120624
Kaye K. Gaines, MS, ARNP, FNP-BC, CUNP Urologic Nursing Editorial Board Member
