Colorado has one of the healthiest populations in the nation, but that doesn’t mean some resolutions aren’t in order for 2020, assuming they haven’t been already attempted and cast aside.
Residents of Logan, Morgan, and Prowers counties may want to consider watching what they eat and shedding a few pounds. Make that a lot of pounds. Residents of Bent, Saguache and Adams counties need to get better at keeping something else out of their mouths — cigarettes.
And residents of Denver, Boulder and pretty much all the ski-resort counties, please do your livers a favor in 2020 and cut back on the binge drinking.
SmartAsset, a personal finance firm, looked at those three behaviors, along with rates of health insurance coverage, longevity and access to a physician to come up with an overall health score that was used to rank 48 of Colorado’s 64 counties. There wasn’t sufficient data in the 16 counties excluded.
“Our study identified the healthiest counties in Colorado by considering length of life, health behaviors and healthcare access,” said AJ Smith, vice president of financial education at SmartAsset.
A goal of the SmartAsset study was to help consumers understand how certain behaviors might impact life insurance premiums in different areas, Smith said. But the study offers a trove of public health information, including a comparison of lifespans.
Douglas County ranked as the healthiest county in the state, followed by Boulder, Pitkin, Broomfield and Eagle counties. Get outside of the ski resort areas, however, and rural residents in Colorado tend to have lower health scores and shorter lifespans.
Rural doesn’t always mean healthier, which may surprise some Front Range city dwellers who aspire to trade the stress of congested roads and demanding workloads for clean air and open vistas.
In Douglas County, which had the highest health score in Colorado, about 3,494 years of life are lost before age 75 per 100,000 residents. Only Pitkin, Summit and Eagle counties show fewer hours of life lost prematurely, in the low 3,000 range.
At the other extreme, Huerfano County residents lost 13,227 years of life prematurely or nearly four times as many as in Douglas. Las Animas County residents lost 12,439 years of life to premature deaths and in Conejos, it is 10,271 years of life lost.
See table at end of story for all rankings
Granted, not everybody gets to live to age 75. But why should someone living in Walsenburg or Trinidad face higher odds of early death than someone in Highlands Ranch or Aspen?
“It is totally tragic,” said Emily Johnson, director of policy analysis at the Colorado Health Institute.
Health and wealth
There is an old saying that people spend their health to accumulate wealth, and then spend their wealth to recover their health. But the reality is that having more wealth allows someone to maintain better health.
What Douglas and the ski resort counties share in common are higher median household incomes, while the counties with the lowest health scores have some of the lowest household incomes in the state. That leads some to conclude that improving health is an economic development question, not just a behavioral one.
“There is a lot there that is pushing you to poor health when you are lower-income,” Johnson said. It ranges from the stress of making the rent to whether a person feels safe going for a jog in their neighborhood.
Higher-income households have better access to resources that promote and maintain health and more options for off-loading stress, she said. And they are more likely to have jobs that come with health insurance.
Douglas County has the lowest uninsured rate in the state at 3.7%, while Broomfield, Gilpin, Clear Creek and Jefferson counties all had uninsured rates below 7%. El Paso, Boulder, and Larimer counties, the larger population centers outside metro Denver, had uninsured rates just above 7%.
At the other extreme, 17.5% of residents in Saguache County lack health insurance coverage, and 15.3% of Garfield County residents aren’t covered. A lack of coverage can cause people to delay visits, allowing chronic conditions to go untreated.
And a lack of health insurance coverage doesn’t necessarily motivate people to take fewer risks with their health, even though the consequences for them are more severe if they don’t stay healthy.
“If we were purposely logical creatures, we would never smoke or drink,” Johnson said.
Behavioral, social, economic
As executive director of the Tri-County Health Department, which covers Douglas, Arapahoe and Adams counties, John Douglas has a front-row seat on how economic differences play out in public health outcomes.
Douglas has Colorado’s highest health score and the nation’s sixth-highest, a top ranking other studies have confirmed. It also has Colorado’s highest median household income at $115,314. Arapahoe ranks 14th in Colorado and 110th nationally on its health score. It holds the 10th spot in Colorado for household income at $73,925. Adams ranks 36th on its health score locally and 722nd nationally. It has the 17th spot in Colorado on household income at $67,575.
Here’s just one example in how county wealth plays out in creating different options to improve health.
Douglas County has 3.7 times the concentration of fitness and recreational sports workers than the country as a whole does, so many it ranks fifth in the U.S., according to the U.S. Bureau of Labor Statistics.
Arapahoe County has 1.85 times the concentration, not as heavy as Douglas, but nearly double the U.S. average. Adams County, by contrast, matches the national average. And Lake and Montrose counties — they have about as half as many fitness workers as would be expected.
When SoulCycle, the trendy indoor cycling chain out of New York, opened its first Colorado location, it didn’t pick Aurora or Thornton. It set up shop in Cherry Creek, Denver’s ritziest retail district.
People who do well in life have the resources to better educate themselves about staying healthy, and they likely have a stronger motivation to do so, said Douglas. But the equation is a complex one, with a lot of variables.
A 2007 study published in the New England Journal of Medicine linked about 40% of health outcomes to personal behaviors, such as putting on too many pounds, smoking and substance abuse, said Gabriel Kaplan, chief of the health promotion and chronic disease prevention branch at the Colorado Department of Public Health and Environment.
Genetics, including traits that leave some at a higher risk of cancer or heart disease, explains about 30% of health outcomes. Social conditions such as economic opportunities and educational attainment account for about 15% of the equation. Health care access, something public health officials have focused heavily on, only contributes about 10%, while environmental conditions, such as pollution, contribute about 5% of the mix.
But it is important to note social conditions tie into personal behaviors. Someone born in a town where teenagers smoke at an early age or drink heavily is likely to pick up life-shortening habits and addictions. Likewise, a worker in an area with poor job prospects or a farmer dealing with wild swings in crop prices may try to cope with stress in unhealthy ways.
“If the only store where you can get produce is a convenience store, you are not as likely to have a diet with fruits and vegetables,” Kaplan said. “We need to make sure communities are set up to promote health. It is not just a matter of individual choice.”
Drinking money
Alcohol consumption is one behavior where higher incomes don’t correlate with healthier behaviors. Some of the most well-off counties in Colorado have the highest rates of self-reported excessive drinking.
“We have been talking about this in public health circles,” Douglas said. “It is an underappreciated and ignored health issue.”
Excessive drinking involves drinking heavily in a short period of time with the express goal of becoming intoxicated. The National Institute on Alcohol Abuse and Alcoholism defines it as five or more drinks in a two-hour period for men and four or more drinks for women.
Deaths in the U.S. from binge drinking have more than doubled the past two decades, with the sharpest increases for women and the middle-aged, according to the institute. That statistic that sheds a whole different light on the mommy drinking culture.
Boulder County, despite its reputation as a health mecca, had the second-highest rate of excessive drinking in Colorado at 23.6%, according to SmartAsset. The University of Colorado Boulder, which regularly appears on rankings of the nation’s top party schools, might drive that number up, but students alone aren’t to blame for Boulder’s lack of sobriety.
Only Denver County, with its abundant bars and craft brewers and millennials who frequent them, had a higher rate of people who engage in excessive drinking at 25.7%.
“Denver has a drinking problem,” Douglas said. Good luck, however, getting Denver or Boulder to admit they have a drinking problem.
Outside those two, the next five counties with the highest rates of excessive drinking are all ski resort counties. Drinking after a day on the slopes might be a tradition for many, but it appears the locals keep the party going even when the tourists are gone.
Huerfano County, which ranked 47th out of 48 on its health score, had an excessive drinking rate of 15%, a full 10 percentage points lower than Denver and the second-lowest in the state. It tied with Otero and only trailed Saguache. All three counties are among the poorest in Colorado.
More than resolutions
Every five years, the 53 public health agencies in the state are tasked with putting together a community health assessment which they use to identify the top priorities for the following five years, said Theresa Anselmo, executive director of the Colorado Association of Local Public Health Officials.
Anselmo urged those who look at health statistics and rankings not to play the blame game and realize that for many people, achieving better health requires more than a resolve to do better.
Maybe a community can’t attract a physician no matter how hard it tries and the national grocery chains won’t come anywhere near. That leaves residents with fewer options to eat healthy and fewer resources for one-on-one counseling about weight management.
Rural areas tend to have older populations, who are more prone to health problems, Anselmo notes.
And self-selection plays a part. Colorado’s reputation draws in those looking for a healthy lifestyle, but they tend to settle along the Front Range. And even within the state, people who can afford to do so move into healthier communities.
“Folks that have more means end up living in healthier places,” said Douglas. “You don’t have to live near the Suncor refinery. You can live in Castle Rock.”
While Colorado may do better than other states on physical health measures, mental health remains a challenge, which is reflected in higher rates of suicide and substance abuse, Kaplan said.
Stress is often a driver behind behaviors like smoking, binge drinking, substance abuse and overeating, and the state is focused on providing people with coping skills to deal with stress.
“Behavior is not just a matter of choice for people. We look at strategies that make it easier for people to make healthy choices,” said Kaplan.
For example, the state has invested heavily in the Colorado QuitLine, which helps those who are trying to kick the nicotine habit through coaching and medications. In 2004, 23% of state residents smoked tobacco. Thanks to higher tobacco taxes, indoor smoking bans and more resources dedicated to quitting, that figure is below 15%.
That reduction is part of a larger national trend resulting in a big decline in lung cancer deaths.
“For us, it is all about trying to help everyone in the state to have the chance to have a healthy life, to have a long and fruitful life,” Kaplan said.
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An attribution for the increase in binge drinking deaths was corrected. It came from the National Institute on Alcohol Abuse and Alcoholism, not the Center for Health Progress.
