For instance, Kentucky and
New Hampshire have high rates of death by accidental poisoning, which includes
drug overdose. In response, Kentucky has begun a
program to monitor the prescribing of addictive painkillers. It has also
expanded the availability of treatment for substance abuse.
New Hampshire Gov. Maggie Hassan,
a Democrat, signed a bill in January calling for stiffer penalties for drug
dealers and more tracking of prescription drugs, calling the epidemic of heroin and prescription
painkillers “the most pressing public health and public safety issue facing our
state.”
Sometimes states can only do
so much about higher incidents of mortality. Take suicide, for example. Guns
often are more available in some Western states, said Catherine Barber, who
directs the Means Matter Campaign at Harvard University. Their prevalence can
drive up suicide rates, she said, not because gun owners are more likely to be
suicidal — but because guns are more lethal if a person decides to commit
suicide.
Data Drives Action
After noticing a stubbornly
high rate of liver disease, intoxicated-driving and other causes of
alcohol-related deaths, New Mexico’s Health Department this year began an
alcohol-awareness programthat focuses on areas of the state where the problem
is most acute.
“The rate was not improving
over time,” said Rosa Isabel Lopez, health data dissemination coordinator for
the state health agency. “The decision was made to create more data points for
community audiences and get this information into the hands of our
neighborhoods.”
The state also launched a
public website last year that displays data on health issues
in small areas of the state, which communities can use to understand problems
and target them.
Local detail, plenty of data,
and plain language for policymakers are important aspects of successful state
efforts to prevent deaths, said Ross Brownson, an epidemiologist at Washington
University in St. Louis who wrote a 2010 guide on
the subject.
“We like to say, ‘What gets
measured gets solved,’ ” Brownson said. Until recently, he said, communities
often didn’t have enough details about health problems to make policy
decisions.
In the last few years, he
said, there’s been improvement nationally in collecting and distributing health
data. The University of Wisconsin’s Population Health Institute, for instance,
introduced county health rankings for Wisconsin in 2003, and then expanded them
nationwide in 2010.
The rankings noted drug
overdose deaths “reaching epidemic proportions” in some areas such as northern
Appalachia, and rising 79 percent nationwide since 2002. The Stateline analysis
also found high rates of accidental poisoning, which includes drug overdoses,
in Massachusetts and New Hampshire.
Deadly Puzzle
In Wisconsin and nearby Iowa and Minnesota, there are disproportionate instances of accidental falls that are fatal. It’s a phenomenon that has puzzled researchers for years, said Patrick Remington, an associate dean at the School of Medicine and Public Health at the University of Wisconsin.
“We’ve supposed that it’s due
to cloudy weather, no sun and so no vitamin D [which promotes bone health], but
there’s not been a good answer yet,” Remington said. Wisconsin’s Health
Department has a fall prevention program,
which points out that the elderly are particularly susceptible to falling.
Elizabeth Stein, a preventive
medicine resident at the University of Wisconsin medical school, said low
vitamin D levels can lead to both fatal falls and dementia in older people,
though studies have yet to confirm a link between those causes of death and the
area’s cloudy weather.
Washington state prepared a plan to address Alzheimer’s disease last year after
data indicated it was the state’s third leading cause of death, killing people
at a rate two-thirds higher than the national average. Worse, Alzheimer’s was
on the rise while other top killers like cancer and heart disease were in
decline.
But the apparent rise could
be attributed to better data. Washington has a more rigorous method of
collecting and verifying death data than some other states. States’ totals for
all deaths from dementia, which includes Alzheimer’s, suggests that many might
not be reporting the disease as carefully as Washington.
Differences between the
states in recognizing and coding the cause of death can muddy the picture, said
Francis Boscoe, a research scientist at the New York State Cancer Registry who used differing
death rates by state as a “conversation starter” about state-specific mortality
issues.
“It seems entirely plausible
that physicians or coroners in Washington could be coding as Alzheimer’s what
other states might call pneumonia or something else,” Boscoe said. “There are
explicit rules for all this, but that does not mean they are all being followed
the same way.”
After Boscoe wrote last
year about peculiar death patterns in states, he said he heard plenty of
feedback about data-collection issues that can make for misleading numbers.
Flawed Death Certificates
As Stateline has
reported, how the cause of death is recorded on death certificates, from which
officials draw data, can vary widely
even within a state.
In Kansas, for instance, what
appeared to be the most distinctive cause of death — hardening of the arteries,
or atherosclerosis, killing people there at seven times the national rate — was
actually more of a data-recording problem than a medical one.
“This is a classification
issue,” said Cassie Sparks, of the Kansas Department of Health and Environment.
She said the state plans to emphasize better reporting and classification in
training materials for medical examiners and others who sign death
certificates.
But even if some data is
flawed, cities and states can get life-saving or life-extending results by
taking action on the evidence of health problems that do emerge. Brownson of
Washington University in St. Louis points to New York City as an example.
The life expectancy in the
city grew faster than the national average, paced by drops in heart disease,
cancer and HIV from 2001 to 2010, a study published in the current Journal of
Public Health Management & Practice found.
New York has focused in
recent years on using health trends to guide new, albeit sometimes
controversial, public policy — from restrictions on trans fats and tobacco to
unsuccessful bans on oversized portions of sweetened drinks.
“The city health department
is really a prime example of evidence-based policy, of making the policy
dependent on the data,” Brownson said.
