Obesity in America and Other Public Health Issues

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Throughout history, there have been a number of public health issues facing society. Even though advances in technology and healthcare have helped the majority of people have access to quality care, there are many issues that still plague us. Here, you’ll learn about three of the most common public health issues and the risks associated with each. Plus, discover how obesity has become more prevalent in the United States and ways you can avoid putting on the pounds.

Public Health Issues in the U.S.

The Centers for Disease Control and Prevention (CDC) releases the Prevention Status Reports (PSR) every year that highlights the status of public health policies designed to address important public health issues, which include:
  • Alcohol-related harms
  • Food safety
  • Healthcare-associated infections
  • Heart disease and stroke
  • HIV
  • Motor vehicle injury
  • Nutrition, physical activity, and obesity
  • Prescription drug overdose
  • Teen pregnancy
  • Tobacco use

American Public Health Association (APHA)

The American Public Health Association, or APHA, champions the health of all people and communities by strengthening the public health profession and by speaking out for public health issues and policies backed by science. In addition to the issues mentioned above that the CDC recognizes, the APHA also deals with:
  • Climate change
  • Environmental health
  • Gun violence
  • Health equity
  • Health reform
  • Vaccines

How do experts determine public health threats?

Public health experts keep their finger on the pulse of science to spot red flag health threats. These may impact a community, region, or population(s). To better understand how our public health officials do this, let’s first define public health. The CDC defines public health as the science and art of
  • Preventing health
  • Prolonging life
  • Promoting health
In the United States, the CDC responds to public health threats 24/7. CDC stands for Centers for Disease Control and Prevention. Every year, they release the Prevention Status Reports (PSR). PSRs highlight the status of public health policies. And these policies in turn, aim to address critical public health issues such as: The organized efforts made by experts help people and groups make informed choices. Whether about diet, salmonella, exercise or the risks of exposure to COVID-19.

#1: Tobacco Use

Tobacco use remains the single largest preventable cause of death and disease in the United States and kills more than 480,000 Americans ever year. This includes 41,000 deaths from exposure to secondhand smoke. Smoking-related illnesses in the U.S. costs more than $300 billion a year when you combine direct medical care for adults ($170 billion) and lost productivity ($156 billion). Yet, in 2016 there were still an estimated 37.8 million, or 15.5% of U.S. adults who were current cigarette smokers.

Risks of Smoking Cigarettes

Among some of the many health risks of smoking, the most prevalent are:
  • Smokers are more likely to develop heart disease, stroke, and lung cancer than nonsmokers
  • Smokers have a higher risk of cardiovascular diseases
  • Smoking can cause lung disease by damaging airways and the small air sacs in your lungs
  • Smoking can cause cancer almost anywhere in your body

#2: Vaccines

One of the issues currently facing our society is the legitimacy of vaccines. Both the CDC and the APHA actively support all children getting vaccines to improve the health of our children and our society as a whole. As with all drugs, there are side effects. However, the most common side effects are mild, such as redness and swelling where the shot was given, and go away within a few days. More serious side effects, such as severe allergic reactions, are very rare and doctors and clinic staff are trained to deal with them.

Risks of Not Getting Vaccinated

There are many examples about the benefits of vaccines, including the 2014 outbreak of West Nile virus, which caused thousands of people to become very sick and led to more than 9,000 deaths because there was no vaccine available. However, one of the best examples of the benefits of vaccines is measles. Consider, in the decade before 1963 (when the measles vaccine became available):
  • Nearly all children got measles by the time there were 15
  • 4 million people were infected every year
  • 400-500 people died from measles every year
  • 48,000 hospitalizations due to measles every year
  • 4,000 people suffered from encephalitis, or swelling of the brain
Now, two doses of the measles vaccine is 97% effective at preventing measles if someone is exposed to the virus.

#3: Health Equity

One of the core values of the APHA is creating health equity, or the ability for everyone to have the opportunity to attain their highest level of health. While this may seem like an easy goal, inequities are everywhere, especially in poor communities, which have barriers to prevent individuals from accessing information and care to reach their full potential. In order to combat inequities, the APHA values all people equally to:
  • Optimize conditions where people live
  • Work with other sectors to improve employment, housing, education, health care, public safety, and food care

Effects of Health Inequities

Poorer communities are more likely to face a number of health issues compared with wealthier and middle class communities for a number of reasons, which include a lack of information, marketing unhealthy products directly to those communities, and the fact that unhealthy foods are cheaper than healthy foods. In fact, statistics show that:
  • Low-income individuals are far more likely to be obese than higher-income individuals
  • 27.4% of children living in households below the poverty level were obese
  • 34% of those with less than a high school education were obese
  • More than a quarter of people living below the poverty line smoke
  • Nearly 32% of adults without a high school diploma smoke
  • Just 22 to 42% of low-income adults 50 or older received recommended preventative care
These issues, plus many others, are the reasons why the APHA places so much emphasis on creating more opportunities for lower-income communities to have access to better healthcare and more information about healthier living.

#4: Alcohol-related harms

Pouring yourself a drink may seem natural. But drinking too much can harm your health. Excessive drinking goes by many names. Binge drinking, heavy drinking and any drinking by pregnant women or people younger than age. It is an alarming issue in the U.S. and the cause of 93,000 deaths. From 2011 – 2015 it was also the cause of 1 in 10 deaths among working age adults aged 20 to 64. Fatality aside, drinking too much shortens lives. The CDC reported it caused 2.7 million years of potential life lost. There are short and long term effects of drinking in excess. Moderate drinking is up to 1 drink per day (women) and up to 2 drinks per day (men). The PSR proposes to deal with these issues by taxes. They want to increase state excise taxes on beer, wine and distilled spirits.

Risks of Drinking Too Much

  • The main short term risk is injury including car crashes, falls, drownings, and burns
  • Excessive drinking is a known cause of violence, homicide, suicide, sexual assault
  • Major long term risks are high blood pressure, heath disease, stroke, liver disease and digestive problems
  • Chronic diseases associated with over use of alcohol are liver cirrhosis, pancreatitis and mouth cancer

#5: Food Safety

Illness from food is a preventable public health problem. Per the CDC, 1 in 6 Americans gets sick from contaminated food or beverages each year. And, 3,000 people die from foodborne illness. Apart from lives lost, foodborne illness cost the U.S. more than $15.6 billion every year. A main cause is bacteria and bacteria strains like Listeria, E.coli, and Salmonella. Viruses and parasites can also be deadly. That’s why three main agencies team up to deal with food safety. The CDC, the U.S. Food and Drug Administration (FDA) and USDA’s Food Safety and Inspection Service. Unfortunately, challenges to food safety are on an uptick. As we change our food production and supply, this may continue.

Risk Factors of Foodborne Illness

  • More than 660,900 people in the United States get sick with resistant Salmonella or Campylobacter (CDC)
  • Antibiotic resistance in foodborne bacteria is growing and made worse by overuse of antibiotics in people and food animals
  • There are new and emerging bacteria and toxins
  • Flour and meal replacement shake mixes are an unexpected new problem with foodborne illness

#6: Health Care Associated Infections (HAIs)

Infections associated with health care are on the rise. The first in the chain of reasons is the move of services from in to outpatient settings. On top of that, there is a lack of infection control oversight. Oversight is what ensures patient safety and stops outbreaks. There have been few studies since 2012. But back then, nearly 1.2 billion outpatient visits took place per year. These took place in imaging centers, oncology and pain clinics. Many also took place at ambulatory surgery centers. This in itself would not be an issue. But procedures performed in these settings are invasive at times. And, carry risk of infections.

Effects of HAIs

  • On any given day, about 1 in 31 hospital patient contracts an HAI
  • Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year
  • Urinary Tract Infections (UTIs) are the most common kind of HAI and about 75% are from a catheter
  • Two other main HAIs are Surgical Site Infection (SSI) and Ventilator Associated Pneumonia (VAP)

#7: Heart disease and stroke

Heart disease causes 1 in 4 deaths in the United States. In fact, it is the leading cause of death in the nation. The term ‘heart disease’ refers to a few heart conditions. The most common of them is coronary artery disease (CAD). CAD affects blood flow to the heart. If this happens, it can lead to heart attack and strokes. One of the reasons heart disease is an issue is that it is often silent. A person may be at risk but not have a diagnosis until they experience symptoms. Chest pain, shortness of breath and extreme fatigue are a few.

Know the Risk Factors for Heart Disease

  • 47% of Americans have at least 1 of 3 risk factors for heart disease (high blood pressure, high cholesterol, smoking)
  • High blood pressure is a “silent killer” but can be lowered with lifestyle changes and / or medication
  • LDL (low density lipoprotein) is the “bad” cholesterol as it can clog the arteries
  • The risk of death from heart disease for adults with diabetes is higher than for those who don’t
  • Drinking alcohol in excess, not enough exercise and a high fat diet put you at risk for heart disease

#8: HIV

HIV infection in humans came from a kind of chimpanzee in Central Africa. Over decades, it made its way to the U.S. since at least the mid to late 1970’s. Human immunodeficiency virus (HIV) weakens a person’s immune system. It does this by destroying the cells that fight disease and infection. Because there is no effective cure for HIV it remains a major health issue. Fortunately, proper medical care can control HIV. That said, certain groups are more likely than others to contract HIV. Factors that boost risk include sex partners, risk behaviors and where one lives. Once infected with HIV, you have it for life. And the only way to know if you have it is to get tested.

Know the Risk Factors and Symptoms of HIV

  • Learning the basics about HIV can help keep you and others healthy
  • Some people have flu like symptoms within 2 to 4 weeks after infection (E.g. fever, chills, swollen lymph nodes, rash)
  • HIV can be transmitted by sexual contact, sharing needs, mother to baby
  • HIV is not transmitted by air or water, saliva, sweat, tears, closed mouth kissing, insects, pets, sharing toilets / food / drinks
  • If at very high risk for HIV, ask your health care provider if pre exposure prophylaxis (PrEP) is right for you

#8: Motor vehicle injury

Motor vehicle crashes are a leading cause of death among those aged 1 to 54 in the U.S. Each year, motor vehicle crashes injure about 3 million people. This is both dangerous and costly. Crash related injuries come with medical expenses and productivity loss. By 2017, these costs were more than $75 million. One of the most effective ways to save lives and reduce injury is seat belt use. That works for adults and older children. But millions do not buckle up. For children, it is crucial to buckle them into age and size appropriate car seats, booster seats and seat belts. Doing so reduces serious and fatal injuries by 80%.

Risks of Motor Vehicle Injury While Driving Impaired

  • Every day, 29 people in the U.S. die in motor vehicle crashes that involve an alcohol impaired driver.
  • The annual cost of alcohol related crashes totals more than $44 billion
  • In 2018, 12 million Americans aged 16 and older reported driving under the influence of marijuana
  • 2.3 million reported driving under the influence of illicit drugs other than marijuana during 2018

#9: Prescription drug overdose

Drug misuse is a huge problem in the U.S. In fact, we now call it an ‘opioid crisis’ which in America is an epidemic. Almost 70% of the more that 67,000 drug overdose deaths in 2018 involved an opioid. Opioids are a class of drugs prescribed to reduce pain. Prescription opioids include oxycodone, Vicodin, morphine and methadone. Fentanyl is a synthetic opioid and vey powerful. Doctors use it to treat severe pain from illness like cancer. The use of illegal fentanyl is on the rise. As is the use of heroin, another illegal opioid.

Risks and Statistics of Prescription Opioids

  • In 2018, about 41 people died each day from overdoses involving prescription opioids
  • Anyone who takes prescription opioids can become addicted to them
  • From 1999 to 2017, more than 218,000 people died from overdose related to prescription opioids in the United States
  • Mixing opioids with other drugs is dangerous and increases risk of overdose and death

#10: Teen pregnancy

The U.S. has one of the highest rates of teen pregnancy in the western world. In 2017, a total of 194,377 babies were born to women aged 15–19 years. That’s a birth rate of 18.8 per 1,000 women in this age group.  Still, there is evidence that rates are going down. Birth rates fell 10% for women aged 15–17 years. And 6% for women aged 18–19 years. In both cases, lower rates may mean one of two things. Either teens are having less sex or using more birth control.

Why Prevention Matters

  • Pregnancy and birth impact high school dropout rates among girls
  • About 50% of teen mothers receive a high school diploma by 22 years of age
  • Teen moms are more likely to experience health problems, go to jail and face unemployment
  • Access to education and youth friendly contraceptive services can bring teen pregnancy rates down

#11: Climate change

There are serious public health threats to climate change. For one, climate change intensifies existing issues. Second, new threats emerge as climate change worsens. The way climate change works is to disrupt the ecosystem. When so, it causes respiratory and cardiovascular disease. Plus, injuries and premature deaths. We can also see that climate change affects weather patterns. This then creates food and water borne illness, infectious disease and threats to mental health. One example is wildfire. High temperatures create droughts. These in turn make conditions dry and weaken the forests’ resistance.

Risks of Climate Change

  • Smog is a cause of diminished lung function and leads to emergency room visits for asthma
  • Increases in global temperatures could cause associated rises in premature deaths related to worsened ozone and particle pollution
  • With no regulation, climate change may lead to higher pollen counts and allergies
  • Extreme heat events threaten public health and often increase death rates
  • Forecasts predict climate change will threaten food production and quality

#12: Environmental health

Environmental health is an issue that spans a range of public health threats. From natural disasters and mold. To safe water and radiation emergencies. That’s because the environment is everything around us. Air, water, food, chemicals, microbes, and terrorism related threats. Not to mention hurricanes, earthquakes and floods. The agency that takes care of these issues is the NCEH. Or, National Center for Environmental Health. They research and study to help inform public policy. One of the main concerns is air pollution. There are 6 pollutants that cause damage to the air. Carbon monoxide, lead, nitrogen oxides, ground-level ozone, particle pollution (often referred to as particulate matter), and sulfur oxides.

Risks of Air Pollution

#13: Gun violence

Firearm violence is a serious public health problem in the U.S. It impacts both health and safety. Each year, more than 39,000 people in the United States die as a result of gun violence. And tens of thousands more suffer non-fatal gun injuries. Yet we struggle to prevent it. Guns are widely available and mass shootings are on the rise. Most gun violence does not involve a mass shooting. But in 2019 there were 418 mass shootings, killing 464 people and injuring another 1,710.

Risks of Not Doing Anything About Gun Violence per APHA

  • Guns are the leading method of suicide in the U.S., accounting for half of all suicide deaths
  • Gun violence cost the U.S. $229 billion in 2015, or an average of $700 per gun in America
  • Among U.S. residents ages 15 to 24, homicide is the 4th leading cause of death for non Hispanic whites
  • A public health tactic to preventing gun violence sees that violence is contagious and can become epidemic within a society
  • 82% of firearms deaths occur in the United States and 91% of the deaths to children (aged 0 -14) were from the U.S.

#14: Health reform

Health reform is also known as the Patient Protection and Affordable Care Act. It passed by the House of Representatives on March 21, 2010. Then signed by President Obama on March 23, 2010. The current Admin started to dismantle the Act. In effect, the Act proposed investing $2 billion per year for public health programs. Prevention, wellness, and other public health activities. That included tactics to address workforce gaps in health care. Also, coverage to 32 million uninsured people. Plus, tax credits to about 4 million small businesses. Those were to help cover the cost of insurance for their employees.

Risks to Dismantling Health Reform and What to Do

  • Access to health care means you may live 15 years longer than others with no access
  • Income level may add 10 years to life expectancy, education 9 years, and race 7 years
  • There’s an unequal impact of Covid-19 on lower income groups
  • If concerned, contact your member of Congress to urge them to make public health a priority

#15: Nutrition, physical activity, and obesity

In the U.S., obesity is a common, serious and costly disease. In the years 2017 to 2018, 42% of people were obese. Obesity means a person has a body mass index (BMI) at or above the 95th percentile of the CDC growth chart. One of the reasons that obesity is harmful is it can cause other conditions. Heart disease, stroke, type 2 diabetes, some types of cancer. Another main concern is the risks to children and adolescents. About 13.7 million young people aged 2 to 19 years of age are obese. Also, there is no single way to end the obesity epidemic. To do so requires policy makers, leaders, teachers and others to unite in their strategy.

Ways to Lower Risks of Obesity

  • Children and adolescents aged 6 to 17 should do 60 minutes or more of aerobic activity
  • Positive effects of exercise for children include improved heart and body health, lower rate of depression
  • Adults aged 18 to 64 should get 2 hours and 30 minutes of moderate activity (E.g. brisk walking) every week
  • Apart from better functional health, exercise helps adults lower risk of cancer and hip fractures while boosting memory
  • Poor nutrition contributes to obesity, heart disease and some cancers
Obesity as a Financial Issue The obesity crisis costs the United States more than $150 billion in healthcare costs annually and billions more due to lost productivity.

What Is Considered Obese?

Obesity, currently one of the important public health issues, is defined as an amount of body fat that exceeds the level generally considered healthy for a particular height. Body mass index (BMI), an inexpensive and easy to calculate method, is typically used as a proxy. For adults, the following weight classifications are associated with specific BMI levels:
  • Below 18.5 = Underweight
  • 18.5 – 24.9 = Normal weight
  • 25.0 – 29.9 = Overweight
  • 30.0 – 39.9 = Obese
  • 40.0+ = Class 3 obese (also referred to as severe obesity or morbid obesity)
Because children ages 2-19 are continuously growing, the chart uses BMI percentiles to determine obesity, which is as follows:
  • Below 5th percentile = Underweight
  • 5th to 84.9th percentile = Normal weight
  • 85th to 94.9th percentile = Overweight
  • 95th percentile = Obese

How Many Americans Are Obese?

Using BMI, the CDC reported that in 2015-16 the obesity rates were:
  • 39.8% in adults
  • 18.5% in youth
According to the same study, the rates of obesity were higher among middle-aged adults (42.8%) than among younger adults (35.7%).

Obesity Rates by State

According to the State of Obesity, an annual report that has been published for the past 14 years (formerly call F as in Fat), the most obese rates by state are listed below by percentage of obese adults from highest to lowest.
RankState% of Obese Adults
2West Virginia39.5%
8North Dakota35.1%
14South Carolina34.3%
20North Carolina33.0%
22New Mexico32.3%
30South Dakota30.1%
32New Hampshire29.6%
40Rhode Island27.7%
41New York27.6%
43New Jersey27.4%
49District of Columbia24.7%
You may notice that none of the states listed have an obesity rate that matches the national average. How is this possible? According to The State of Obesity 2017 study, it’s because the people do not always accurately report their height and weight. State obesity rates are collected by the Behavioral Risk Factor Surveillance System (BRFSS), which relies on self-reported height and weight. On the other hand, the National Health and Nutrition Examination Survey (NHANES), which is where the national obesity rate is derived, is calculated based on physical examinations of respondents. Therefore, the NHANES is likely a more accurate reflection of the true obesity rates in the country.

Why Are Americans Fat?

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