PittsburghToday

Pittsburgh’s steady rate of obesity finally drops below ballooning national average (by Bernard Goldstein and Jennifer Geiselhart)

Among the most alarming national public health figures is the increase in obesity. The CDC Behavioral Risk Factor and Surveillance Study (BRFSS) shows a progressive yearly increase in adults who have a body mass index (BMI) classified as obese, from 22.9% of the population in 2003 to 25.1% of the population in 2006.

Obesity is a well accepted cause of adult onset diabetes, so it is no surprise that there is also a progressive increase in adults across the United States who report ever being diagnosed with diabetes - from 6.5% in 2003 to 7.5% in 2006. The American Diabetes Association calculated that in 2007 the annual cost of diabetes nationally was $176 billion, up $42 billion since 2002.

Comparing our region with the 14 other benchmark areas shows a consistently high level of adults who report ever being diagnosed with diabetes – in each of the four years 2003-2006 we have ranked first, second or third. But the relatively good news is that while the national level of adult diabetes is going up, we are progressively decreasing – from 9.7% in 2003 to 8.0% in 2006.

This could be related to our relative standing among benchmark cities in obesity. We ranked fourth, fifth, sixth and eleventh during this same time period, with eleventh being the most recent year. This is not because we are getting thinner. If the numbers are accurate, we had about the same level of obesity in each of these four years. Because the rest of the country has gotten fatter, the Pittsburgh region has reportedly dropped below both the benchmark and national averages for the first time in recent years.

We found a statistically significant association between obesity and diabetes among all comparison areas – in other words the level of obesity within a city predicted the level of diabetes. However, we caution that the data for the individual benchmark areas are not as robust (in the statistical sense) as the national data, so we must be cautious in interpreting the 2006 BRFSS figures.

It will be interesting to see if these trends continue when the 2007 data become available. Overall, these are impressive findings, suggesting that we may have been at least partially successful in getting the public health message across of the importance of eating healthfully and exercising regularly. Perhaps our proximity to local farm markets and the opportunities for outdoor activities are starting to have a positive effect in locally stabilizing what is an otherwise frightening national trend.

Jennifer Geiselhart, JD, MPH
Center for Public Health Practice
Graduate School of Public Health
University of Pittsburgh

Bernard D. Goldstein, MD
Department of Environmental and Occupational Health
Graduate School of Public Health
University of Pittsburgh

Pittsburgh doing well but slipping somewhat in health care coverage (by Jennifer Geiselhart and Bernard D. Goldstein)

Pittsburgh has been one of the better regions in our comparison group in terms of the percentage of all adults who possess any kind of health care coverage. However, both in absolute and relative terms there are signs of slippage as compared to the past.

The Behavioral Risk Factor Surveillance Survey (BRFSS) of the Centers for Disease Control and Prevention shows that in 2006, 10.5% of Pittsburgh region adults did not have any kind of health care coverage. We were the sixth best in that category among the 15 comparison areas (Minneapolis was the best at only 7.3% lacking coverage, and Charlotte the worst with 15.9% uninsured). These recent results are disappointing when compared with the first three years for which data are available. For 2002, ’03 and ‘04, the Pittsburgh region ranked either second or third best among the comparison areas.

Our best year in terms of absolute percent reported to be without health coverage was 2003 at 6.8%. Thus, our 8th place ranking in 2005 coupled with our 6th place standing for 2006 reveal that the Pittsburgh region is not keeping up with its comparison regions in terms of providing health insurance coverage for adults.

The BRFSS first reported data specific to the 18-64 age group in 2006. Our seven county Pittsburgh region is reported to have 12.8% who do not have coverage within that age group, ranking eighth out of the fifteen comparison areas. Again, Minneapolis is the best with only 8.3% uninsured and Charlotte the worst with 18.3% uninsured.

Data are available for three counties within our seven county region. Westmoreland has the lowest amount of total adult uninsured (8.6%) and among 18-64 year olds (10.0%). Fayette County has the highest amount of both total adult uninsured (14.6%) and among 18-64 year olds (16.4%); while Allegheny County is intermediate with 9.5% for total adult uninsured and 12% for 18-64 year olds.

Jennifer Geiselhart, JD, MPH
Center for Public Health Practice
Graduate School of Public Health
University of Pittsburgh

Bernard D. Goldstein, MD
Department of Environmental and Occupational Health
Graduate School of Public Health
University of Pittsburgh

Pittsburgh Smokes (by Jennifer Geiselhart and Bernard Goldstein)

Adult smoking prevalence is greater in the Pittsburgh 7-county region than in most of our comparison areas and we have more difficulty quitting. According to the 2006 US Centers for Disease Control statistics , we are third highest among the fifteen comparison areas in smoking and are close to the bottom in the percent of our smokers who have quit. Among our adults, 22.2% reported that they smoked as compared to a national average of 20.1%. Only Indianapolis, Cincinnati and Detroit recorded higher adult smoking rates. When compared to smoking rates in 2003, the first year for which there are data for all of our comparison areas, our percent decline in smokers among those who smoked is only 3.1% - less than half the US overall percent decline of 8.6%. Only Detroit is lower among the 14 comparison areas.

Download smoking_charts.doc

Perhaps most notable is that among all 15 regions we have the lowest percentage of adult smokers who reported having never smoked (49.8%). Surprisingly, we are appreciably lower in “never smokers” than our two tobacco alley comparison areas - Charlotte, NC (57.0%) and Richmond, VA (54.5%). Our pervasive culture of smoking makes our area particularly challenging to tobacco prevention and control organizations.

Tobacco control professionals have been particularly active in advocating smoke free workplaces. Of our 14 comparison cities, nine have smoke-free ordinances that extend to restaurants and bars. Six of these (Minneapolis, Boston, Denver, Baltimore, Philadelphia and Cincinnati) are reasonably effective in that there are few if any loopholes. Three others, (Kansas City, Cleveland and Indianapolis) have ordinances whose effectiveness are as yet limited by extensive loopholes or inadequate enforcement. In 2006, Allegheny County passed an ordinance banning smoking in workplaces and most public places that was rule pre-empted during a legal challenge. The pre-emption challenge, upheld by Commonwealth Court leaves our region with no alternative but to wait for the legislature in Harrisburg to enact a statewide law – which is currently under consideration.

Tobacco industry documents, released through anti-tobacco law suits, show the industry’s awareness of the importance to product sales of observing smokers in favorable circumstances. Promotional activities to the film industry, including payments to Hollywood moviemakers for placement of tobacco products, emphasized that cigarette use should only be shown in positive surroundings. Attending restaurants and bars are usually considered to be positive experiences, while observing smokers huddled around the outdoor doorway of a workplace often leads to pity – particularly during our cold rainy winter. Banning smoking in restaurants and bars not only protects workers and patrons from the adverse effects of environmental tobacco smoke, it also counters the positive reinforcement so desired by tobacco marketers.

A future indicators project will examine how well we are doing in preventing youth and adolescent smoking.

Jennifer Geiselhart, JD, MPH
Center for Public Health Practice
Graduate School of Public Health
University of Pittsburgh

Bernard D. Goldstein, MD
Department of Environmental and Occupational Health
Graduate School of Public Health
University of Pittsburgh

Facts first (by Paul O'Neill)

For our region to thrive, we need to ground our priorities and decisions on a solid foundation of facts, advises former U.S. Treasury Secretary and Alcoa CEO PAUL H. O’NEILL

As our region looks back toward the founding of Pittsburgh 250 years ago and ahead toward a promising but uncertain future, it is important to keep in mind that facts and the context in which they are understood are essential to making good decisions.

This is true in the public sector and the private sector. It is true in the decisions we make for ourselves and in those made by companies and government agencies. And this is the fundamental idea behind the creation of the nonprofit organization Pittsburgh Indicators.

We believe a readily available, rock solid data base about our region, accompanied by contextual information, can improve individual and institutional decision-making in our community. At the PittsburghToday Web site , you will find the current evolution of our work.

I spend a good part of my time working on health and medical care issues so I want to use an illustration from that work to communicate the importance of facts and context in decision making. If I told you that 95 percent of the people treated in the intensive care unit of a hospital do not get an infection from a central line — a catheter inserted into a vein to provide medication or nutrition — you might think that is a remarkable achievement. After all, how many things in your life work well 95 percent of the time? On the other hand, if you happen to be part of the unfortunate 5 percent, you would have a different view. Making this information specific to where we live helps make the point.

Between July 2002 and June 2003, 1,753 patients were cared for in the intensive care units of a Pittsburgh-area hospital. Thirty-seven of those patients contracted a central line infection (which is a better rate than the national average). But here is another fact; 19 of those patients died. The hard numbers speak to us in a different way than the percentages do.

Now here is another fact. By introducing and practicing the ideas of continuous learning and continuous improvement, this local hospital reduced infection rates and deaths so that in the first ten months of 2006, only three of 1,832 patients were infected, and none of them died. (The hospital in this illustration is Allegheny General. The complete story can be found in "The Journal on Quality and Patient Safety," September 2006).

This level of information regarding infections in every medical institution in our region is not yet available on our Web site, but it is our aim to keep adding regional indicators for the economy, the arts, health care, the environment, government and other sectors to provide facts that are actionable and as close as possible to real time. Some of what you will find on the site already is real time. For example, look at the air-quality information in the environmental section.

Pittsburgh Indicators is a work-in-progress and, ideally, it should remain so. To be the vibrant tool we envision, it will inform and influence, and users from all sectors will identify new dimensions of community life that can benefit from being included.

Paul H. O’Neill is the former secretary of the U.S. treasury, the retired CEO of Alcoa Inc. and a member of the organizing committee of Pittsburgh Indicators (www.pittsburghtoday.org). He wrote this for the Pittsburgh Post-Gazette.