Moving the Needle on Health
Healthy Kingsport looks to decrease rates of diabetes, obesity, hypertension and heart disease
By Sarah Colson, Jeff Keeling and Scott Robertson
Numbers don’t lie, and when those numbers pertain to the health of Tennesseans – and particularly to East Tennesseans – they aren’t kind. Alarmingly high rates of adult-onset diabetes, obesity, heart disease and other chronic, largely preventable maladies cost the Tri-Cities area plenty. Costs include high health care spending; lowered quality of life; and missed economic opportunities when employers balk at settling in an otherwise attractive location, or spend more than they should on health costs if they’re already here.
Efforts to combat these issues for the sake of both business and for the population in general have been ongoing, but a recent development has leaders in Kingsport hopeful about truly changing the population health landscape there, and eventually throughout the greater Tri-Cities. It’s Healthy Kingsport’s transition from a half-decade volunteer effort to a funded, high-profile pilot community in Gov. Bill Haslam’s Healthier Tennessee initiative.
Healthy Kingsport’s executive director, Heather Cook, said the infrastructure and opportunities for better health through diet and exercise improvements exist in the form of biking paths, greenways, and quality health systems. The messages that will drive change to a healthier culture, she said, need to be repeated – over and over.
“It’s not about telling people once or about the institution telling the community,” Cook said. “It’s about one source telling people over and over and over what we have to offer and how to improve our health.”
The cost of inaction is frightening to consider, at least according to Cook, Healthy Kingsport Board member and Eastman Chief Human Resources Officer Perry Stuckey, and East Tennessee State University College of Public Health Dean Dr. Randy Wykoff. All three spoke to the Business Journal for this article. They added two related factors into the equation: education and poverty.
“Often the general public looks at health and thinks health care,” Wykoff said. “But the bottom line when you go to an employer is that they need a healthy, educated, drug-free workforce. So behavior is important, education is important, and health care is important. It’s easy to see health care. It’s harder to see behavior change and health promotion.”
Added Stuckey, who in addition to his role with Healthy Kingsport serves on the Healthier Tennessee board and the American Health Policy Institute Board of Governors: “The Nashville region is probably the healthiest (in Tennessee) and you know that lifestyle, education and income determines that.
“For me, this is about emotional health,” Stuckey added. “It’s about managing physical fitness. It’s about lifestyle. One out of three Americans is living from paycheck to paycheck. And the number one cause of that is financial stress. The number one cause of a lot of medical problems in the nation is stress. There’s no secret that for all the good things that go on in this state, that the two most unhealthy regions of the state are West Tennessee and East Tennessee and I think a lot of that is correlated to education and income.”
How bad is it?
Tennessee has the fourth highest adult obesity rate in the nation. In Sullivan County alone, 36.4 percent of adults reported being obese in 2010. Among children and youth, 41 percent of elementary students, 46 percent of middle school students and 41 percent of high school students in Sullivan County are considered overweight or obese. At this rate, for the first time ever, these children are predicted to have shorter life spans than their parents. Similar stark numbers can be found when it comes to rates of other costly, life-shortening, chronic and preventable conditions.
Wykoff: “If you look at things like early death rate, the U.S. is 33rd in the world and Tennessee is 43rd in the U.S., and most of the counties in Northeast Tennessee and Southwest Virginia are worse than the Tennessee rating. So if you take the Tri-Cities area, we are less healthy than the state, which is less healthy than the nation, which is only the 33rd healthiest nation in the world.”
A bit of context and information on Type II (adult-onset) diabetes is instructive. The problem is expensive both financially and emotionally, Cook said, adding that 45 percent of employed people in Sullivan County are either “pre-diabetic” or have Type II.
“The average cost of a diabetic patient for one year is $13,700,” Cook said. “That does not address anything else—any of the other conditions or annual check-ups or anything else, just what it would cost to be treated for pre-diabetic or type II. So if you start multiplying that by almost 50 percent of your workforce, that’s not productive. The healthier the employee, the more productive the employee.
“I think workplaces are well aware of the need to have healthy employees and it’s a cost savings for them,” she said. “It helps their bottom line and of course it increases productivity. If you feel better, you typically enjoy life a little better and so everything is improved when someone is healthy.”
“We have some work to do.”
Reasons for hope exist, though. Wykoff said while the Tri-Cities “health outcomes” are poor, its “health factors” rank better than its outcomes. Those factors are the very things Healthy Kingsport is trying to improve even further. And factors that rank better than outcomes suggest better outcomes in the future.
“That’s consistent with improving health care, improving education, increasing economic development and so on,” Wykoff said. “So what we hope to see over time is our health outcomes improve. That’s what Heather is working on in Kingsport. Activity, decreased smoking, healthier eating, the things the governor’s Healthier Tennessee is working on.”
The scope of work
As a part of Governor Haslam’s Healthier Tennessee initiative, Healthy Kingsport has been working behind the scenes since 2009 and officially launched in April. Initially, a Pioneering Healthier Communities grant from the Robert Wood Johnson Foundation led to a “dream team” traveling to Washington D.C. to learn ways to improve community health. A volunteer organization was formed and named Healthy Kingsport in 2011. Three years later, the team realized that in order to stay organized and effective as one of nine pilot communities in Tennessee, a dedicated staff person needed to be hired. That’s where Cook came in.
“We realized a lot of good work is already going on in Kingsport,” she said. “By being selected a pilot community, we have the ability to get some spotlight from the state, get some additional resources to come in and help us with this issue and that just gives us additional momentum.”
The grant itself was awarded largely because of the structure already in place in Kingsport and the Tri-Cities. With the quality health systems, biking paths, sidewalks, the Green Belt and more, it just made sense for Kingsport to be one of those pilot communities.
Healthy Kingsport’s main components are nutrition, physical activity and tobacco cessation. The third component may come as a surprise, but Cook said at least 29 percent of pregnant women in Sullivan County smoke. Stuckey said he sees this and other grim statistics as a threat to businesses throughout the region.
“When you’re a global company and you’re doing business in 100 countries around the world and when Tennessee is in the top 10 unhealthy states and I’ve got, for example, a highly talented Ph.D. chemist or scientist who’s into fitness and they read the data about our region, they are less likely to want to come relocate to this region for those reasons.”
One byword in the program is “small starts.” Cook said a “Small Starts at Work” effort is designed to give people achievable objectives that, taken together and over time, can lead to better health.
“That’s our overarching philosophy,” she said. “We’re not trying to overthrow or overhaul people’s lives. We’re not trying to go into a workplace and say, ‘You need to start this program, it’s going to cost this much and you have to have this much participation.’ It literally is about small starts. For example, one of them is, ‘do you offer water at your place? Do you offer a break room where people can bring food from home or can store food?’ They’re very simple, very easy, and those small starts lead to big success.”
According to Cook and Stuckey, it’s going to take more than an organization like theirs to convince the community of the importance of its health. It is going to take the combined efforts of school systems, churches and other institutions. Healthy Kingsport has already initiated part of that with the “Morning Mile” program where students and faculty are meeting before school every day to run or walk a mile. Cook said that Sullivan County schools have already seen an increase in test scores.
“For us, we know that to really have the transformation in this region, it’s got to be a regional effort,” Stuckey said. “At the end of the day, if our employees are healthy and their kids are not, it does not help the region. Actually, their kids are our future employees.”
Cook agreed, and added that educating the public about the dangers of processed, packaged and fast foods is also crucial.
“I don’t think people realize how convenience has hurt us,” she said.
One of Stuckey’s goals is to get regional restaurants to buy more locally-produced foods and provide healthier options for customers.
“The restaurants have to be engaged to help people make healthy choices. We’re not trying to legislate what people eat, but we are trying to tell people what’s more healthy for them,” he said.
One way Eastman is getting its employees to adopt healthier lifestyles is by offering $1,000 per family toward a health savings account when employees and their family members each take a health risk assessment. If employees don’t take the assessment, they lose out on that money.
Stuckey is asking what he and his colleagues can do to reduce stress and anxiety in his employees. He said most of that stress is caused by financial burdens that plague much of this region. To that end, Healthy Kingsport and the state as a whole are trying to be as realistic as possible. The popular move toward organic eating is not cheap. He said if any single parent, for example, living below the poverty line is trying to feed a family of five, they most likely know that canned food is not the healthiest option, but it is the cheapest.
“We have to do something to equalize a way for our people in our community who are making $25,000 a year or less, to help them make healthy choices and give them fresh fruits and vegetables so they’re not buying a bunch of canned goods full of sodium,” Stuckey said.
One example of Healthy Kingsport’s small steps turning into something great is Healthy Kingsport’s partnership with the University of Tennessee’s Agricultural Extension Office in Blountville. Staff member Jennifer Banks reached out to Cook a few months ago to ask if her team would like to participate in “Walk Across Tennessee,” a program designed to raise up teams of walkers to record their mileage in an effort to promote physical fitness in the workplace. Banks’ original goal was 15-20 teams. When The Business Journal spoke with Cook only three weeks into the eight-week program, 131 teams had signed up and 94 million steps had been taken. That’s enough steps, according to Cook, to walk to New Zealand and back, or to walk across the state of Tennessee 35 times.
“This is a perfect example of how people are excited about the effort,” Cook said. “They are joining the effort and what better way to talk about a collective impact model, which is our philosophy, than the fact that this isn’t our program. We’re just supporting someone else.”
Hoping for big change, knowing it will take time
These examples are encouraging to folks like Stuckey, who care deeply about making sure their employees are not just productive, but as productive and healthy as they can be.
“I really, fundamentally believe that if we crack the code in this region, we can be a model for the rest of the nation,” he said. “It’s going to help economic development because if we can get our region more educated with what the governor’s trying to do through the Tennessee Promise Program, and also with what we’re trying to do around health and wellness, and with no state income tax, this can be a very attractive place for a corporation to relocate.”
It attracted him several years ago from another part of the country, and he sees no reason the region couldn’t heighten its desirability through the kinds of changes for which Healthy Kingsport is striving.
“I love it here,” Stuckey said. “This is a beautiful part of the country and every time I fly back here on the plane and I see those mountains and how beautiful it is and how friendly the people are, I am glad I’m here. I want to help this region excel, so I’m very happy about this.”
Cook said she’s looking forward to getting some longitudinal data on the program’s work.
“We’ve been trying to establish baselines so in a couple of years we’ll be able to say if we’ve made any significant progress. Everyone wants to know if the obesity rate has dropped.
“We have to wait two years to get county health rankings to see if we’re making a difference, so we are trying to be proactive in that area to determine leading indicators, like, ‘are farmer’s market sales up or down? Are sugary beverages up or down? Sale of tobacco, up or down? Gym membership and usage of that membership?’”
She doesn’t lack confidence as to what is possible. “I strongly believe that health is a thread that permeates every piece of a thriving community. Economic development… people want to relocate here if you have healthy citizens. Quality of life. If you eat right and move more, you feel better. So you get out and participate more. A healthy student is a more productive student. If kids have the opportunity to eat breakfast in the morning or move more throughout the day, there’s not a study that doesn’t show they’re not better.”
Wykoff, too, sees reason for hope.
“I don’t think I have ever been anywhere where there are more people who care about improving health than here. It resonates for people, and I think you see it across the Tri-Cities. Employers know you need a healthy, educated, drug-free workforce. Schools understand you need healthy teachers and students. We have elected officials who focus on health. We have businesses who focus on health. Many of our largest employers in the region are health and/or education related.
“We have incredible resources here. We are battling, if you will, long-standing issues of poverty and lack of opportunity. Those things don’t change overnight. But as you start seeing more people finishing high school, more people going to college, more and better jobs, the growth of the healthcare industry, those are all good signs.”
Wykoff said if health outcomes do indeed improve, as the area’s health factors suggest they will, good things should follow.
“As this region gets healthier, suddenly the region becomes much more attractive to business. You have the infrastructure already. You have good weather, good transportation, central location. So imagine being able to add to all those factors a vibrant, health-focused community. You could see a lot more businesses saying, ‘This is where we want to be.’ That’s what I find exciting.”