For U.P. residents, some health data to provoke chest pains

If you want to be shocked, or at least provoked, look up the Center for Disease Control and Prevention statistics for acute myocardial infarction (AMI, commonly known as heart attack) for the U.P.

The AMI rates for the entire western U.P. and eastern U.P. (Schoolcraft and Chippewa) for 2008-2010 were at the highest level for the top five categories the CDC tracks. Schoolcraft, in particular, had the highest number of heart attack deaths per 100,000 population for the entire state. For coronary heart disease, the counties of the western U.P. are in the worst category for coronary heart disease mortality with Gogebic fourth in the state.

My initial response was disappointment with regional health care. Hospitals seemed to blame, or at least Yoopers’ distance from them in the large, sparsely populated region.

Then I spoke with a paramedic who explained that critical risk factors for heart attack include obesity, smoking, poor eating habits, geographical access-to-care issues, and climates that encourage inactive lifestyles. That combination, common in the U.P., is killing its residents.

But the cure isn’t in old health care formulas. Dr. Teresa Frankovich, the Western Upper Peninsula Health Department medical director, covering the region from the Western U.P. to Marquette County, explains, "Historically, healthcare has focused on diagnosis and treatment of disease. There is now a growing understanding that a focus on prevention is cost-effective and key to changing the health status of our population. Preventing obesity, for example, would have a profound impact on the burden of diabetes, heart disease and cancer.”

So if the answer is in prevention, we’ve just shifted the focus from hospital settings to U.P. homes. The burden doesn’t fall on the hospital, but rather the patient.

That gave me a whole new perspective on the problem. Inadequate health care, poor EMS response times, medical mistakes and apathy – definite issues that could be problematic – seemed secondary.

Frankovich is skeptical of the statistics though, and believes higher U.P. death rates are “the effect of an aged population.”

But she does agree that issues need to be addressed in U.P. heart disease prevention. This means community-cooperative organization. Frankovich recommends multiple options that work in tandem for effective results. Grants for community improvement such as gardens, hiking and bike trails, and parks help increase physical activity.

Frankovich points out that Michigan is among the nation’s fattest states. Only Mississippi, Louisiana, West Virginia and Alabama are worse. Colorado, the state with the lowest obesity rate, is known for its health-conscious cities. The U.P. needs to follow Colorado’s example of emphasizing exercise, smoking prevention, reducing alcohol consumption and healthier eating.

“How often when you turn on the TV do you see a commercial for broccoli?” said Frankovich. “These are not healthy prompts.”

These issues are wrapped up in the U.P.’s poverty.

Ontonagon, Baraga, Schoolcraft and Keweenaw counties have some of the highest unemployment numbers in the state. Move in any direction from Marquette County and the U.P. gets older, poorer and more rural. Heart disease mortality subsequently increases.

What’s more, those rural communities do not have the acute care access that Marquette County provides, placing even further emphasis on prevention. Only Marquette, Dickinson, and Chippewa have cardiovascular disease physicians and only Marquette has neurosurgeons.

Rural poverty needs to be addressed with medical eligibility, furthering of food stamp and supplemental nutrition assistance, health screening, outreach programs and medical education, and overall transformation of attitudes towards food, smoking, alcohol, and exercise.

Or it may be that in the end, the U.P.’s problems are those of the entire state. Frankovich cites the Western Upper Peninsula Health Department’s community health assessment, pointing out that “age-adjusted death rate from heart disease almost exactly mirrors that of the State of Michigan.”

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Fri, 03/14/2014 - 2:10pm
Cold winters encourage inactive lifestyles which results in health problems, seems to be a problem throughout the state, and then there is Colorado which certainly has cold winters but apparently a different mindset from Michigan.
Tue, 03/18/2014 - 9:23am
Interestingly enough, Minnesota is one of the healthiest states in the union, so that theory might not hold up so well.
Ray Sharp
Tue, 04/01/2014 - 2:17pm
I believe the point Dr. Frankovitch was making was not given adequate weight in this article. There are two ways to calculate a death rate by heart attack or any other cause. Either you simply divide the number of deaths in a year by the total population and get a simple, gross rate, or you adjust the population data in the denominator (I won't explain the details here, Google it) to match the age distribution of the United States from Census data, which is called the "age-adjusted rate." That way, you are comparing apples and apples, comparing the death rates as if there were the same demographpics in each population frame being analyzed. This is not some kind of gimick, it's a statistically valid way to assess mortality. Imagine two counties, each with 100,000 people. County A has 13,000 people over age 65. County B has 26,000 people over 65. In county A, there are 300 deaths by heart attack. The gross rate is 300/100,000. In County B, there are 600 deaths, for a rate of 600/100,000. But wait, when we calculate the age-adjusted rate, the two counties have the same death rates. This is exactly the case with rates of heart disease and mortality in Michigan. Michigan as a whole is about 13.8% age 65 and older. Some of the U.P. counties, and a few in NE lower MI, have 25-30 percent over age 65, because younger people have left in search of economic opprtunity. And what happens to old people? They die more frequently than young people.