Sunday, October 24, 2010

Health and income: "what's new?" or a good resource

This is a guest post by Kim Kimminau, PhD, Associate Professor of Family Medicine at the University of Kansas School of Medicine and Director of the Center for Community Health Research.

I come from a family where my parents, one a first generation American and the other a child immigrant, and the first in their families to complete high school, would say to me “so, somebody actually pays you to do that?”, and the “that” was my life’s work – the study of human health through time and space (aka, biological anthropology) and to conduct research. For them and so many others, reading the titles of research grants or peer reviewed articles was an exercise in a delightfully sardonic mix of tongue-twisted, mispronounced terms, outright mockery and guessing what and why anyone would want to spend “good money” (as my father would say) to study such things.

Apparently, the time has come. I have become my parents.

In the online Robert Wood Johnson Foundation’s News Digest on public health I learned from a UPI story that a Gallup poll was recently conducted among 200,000 U.S. adults over the span of nine months ( ). This alone is pretty mind-boggling – a huge poll by almost any standard. I read on. What was learned from the survey was that “the more money Americans make, the better physical emotional and fiscal well being they report.” Really? Who could possibly be surprised at this finding? Using my parent’s lexicon, more importantly, who would waste good money on measuring this?

The article went on to say that poor adults are three times more likely to smoke, eat less healthy options and exercise infrequently. Those with lower incomes are more likely to report having been told they have a chronic disease and, more than their more affluent counterparts, poor Americans report being obese and having twice as many colds and flu. So I braced myself, waiting some intrinsic “blame the victim message” – if only “those people” (and yes, I detest such speech) would stop eating fast food, get a job, stop wasting their money on cigarettes and cell phones, and take care of themselves, these statistics would be very different. But wait, this information was put out by the Robert Wood Johnson Foundation….surely a more valuable lesson about determinants of health was imbedded in the UPI report? But no, the article ended.

So I did some digging. I took some time to learn that Gallup entered a 25-year partnership in 2008 with Healthways (a publicly traded NASDAQ company, headquartered in Tennessee and led by CEO Ben Leedle (who, interestingly, has ties to Wichita, KS)). They conduct a daily nationwide survey that produces the Gallup-Healthways Well-Being Index. Not only is this the largest “behavioral economic database ever created” the Well-Being Index can be used to drill down to associated state, congressional district and city level reports. Eureka! While I was busy dissing the effort, I actually uncovered a fascinating resource that monitors the pulse of the nation on a variety of indicators that I should have been paying attention to over the past two years.

The methodology being used is commendable. Each daily sample includes a minimum quota of 150 cell phone respondents and 850 landline respondents, with additional minimums to ensure representative gender within each region. Using Current Population Survey figures for the 18 year old and older non-institutionalized adult population and including Spanish language interviews, they have a 98% representative adult sample. They measure 6 domains of well-being: emotional health, physical health, healthy behavior, work environment, basic access, and a sixth called “life evaluation” (it includes 2 questions that use the Cantril Ladder scale (Cantril, 1965)). As with any rating system, our first inclination is to look at where we fall on the scale, so in this case, I clicked on “Kansas” to review the most recent summary report (the report includes data collected during 2009. You can also click on “snapshot findings” to see data collected during the most recent 6 months. What that profile tells you is that you should be happy if you don’t live in West Virginia.)

The Kansas report can be found at: . (And Nebraska at, and you get the drill!) You may be surprised that our state is the last state in the top quintile for overall well-being (up from 22nd in 2008). What’s more, among our three largest cities, Topeka (not Wichita or Kansas City) ranks worst on overall rank. Finally, if I were running for political office in the 1st Congressional District, I’d be worried about the fact that constituents report the worst life evaluation scores compared to the other three districts by a long shot.

But back to the bigger picture. I’d urge you to go to the well-being index home page and click on the “daily pulse” tab of the dashboard. I’m a numbers person, but just looking at the daily distance between the orange line of those “thriving” and the green line of those “suffering” should give us all a reason to reflect on why poor people smoke, eat empty calories and at times feel hopeless and helpless. The distance between those doing well and not well is enormous, and the need to close the disparities gap couldn’t be clearer. I plan to return regularly to this page to review how health reform implementation begins to bend these curves, especially on the “basic access” and the “physical health” tabs for the index.

While I’m happy that I inherited the genetic predisposition of skepticism from my parents, I’m equally happy that my training has made me a data dumpster diver and that this superficial article yielded a great return of a new resource for me.

Live and learn. That was another of my parent’s favorite sayings.

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