Dr. Kevin Most: How healthy is your county, vaping is it safe and Sitting vs. Standing
We all take a different view of healthcare, for some it may be the ability to see a specialist locally, for others it may be to just have a hospital in the county or just having a way to get to the doctor. When we take a much broader view of health we really get to see a complete picture of healthcare. In the US, one would hope that we have some health equity, meaning regardless of where you live in the US there is some level of equity when it comes to healthcare. Unfortunately that could not be further from the truth.
The Robert Wood Johnson Foundation just published its nationwide county health rankings report, web site is, http://www.countyhealthrankings.org. This report gives us that broad view of the entire country broken down by state and then by county. They take the premise that health is impacted by Policies and Programs these impact Health factors and all roll up into Health Outcomes.
So what does that all mean, we often do not think of housing , transportation, air quality and water quality when thinking of health, yet these set a true foundation. Education, Employment, Social service support and safety in the community also have a large impact. We obviously think of access to medical care and the quality of care delivered, but do we think about tobacco use, dietary options, drug use in the community. Robert Wood Johnson does a statewide look and takes into consideration all of these impacts. They then rate the counties, and it shows that health outcomes vary dramatically from county to county and even from counties that are right next to each other.
For example DuPage County in the western suburbs ranks #1 as the healthiest county in the state, yet just to its east Cook county ranks # 52, and Will to its south ranks # 9. This study takes into consideration 42 different impacts to our health. It then compares them to the state average and to other counties. The results are very interesting. What is more interesting is the disparity we have in this country.
Let’s take the least healthy county in West Virginia and compare it to Cook county, #52 in Illinois. In the quality of life ratings, where we look at poor health, poor mental health days, low birth weights the rates in West Virginia are double those seen in Cook County and in some cases 3-5 times higher than DuPage. Let me explain with some clear numbers, the rate of smoking in this WV county is 28%, while in Cook we see a 14% rate. Obesity in WV 45%, versus 27% in Cook. We all know the shortage we have in mental health providers, well in Cook County we have 440:1 ratio, in McDowell County WV, 3,190:1, that means that per person Cook County has 7 times the number of mental health workers than McDowell County WV. We talk about how under staffed we are with mental health here in Illinois now multiply that shortage by 7 times.
Many of you may be thinking, solving this is like solving world hunger and that may be true. Awareness of these huge discrepancies is needed for any type of healthcare reform to be successful on a national level. I chose WV but the same pattern holds true with almost any state. The web site allows you to compare these counties with objective data and it is eye opening.
Vaping- safe? A way to quit smoking or something else?
Vaping- we talked last week about the FDA and their plans to start to limit the amount of nicotine in cigarettes. The estimates show that by doing this we would see the number of those addicted to cigarettes plummet, we would see the number of those able to quit skyrocket, both of these would have a very powerful impact on the health of our nation.
A few you asked about vaping and wasn’t the premise a long time ago that vaping would do this? It would allow someone to have the nicotine hit but not be exposed to the toxic carcinogens that they have with cigarettes. Recent studies have shown that there are carcinogens in vapor smoke. At one time it was so accepted that in restaurants where smoking was not allowed, vaping was still allowed. Vaping when done correctly does eliminate many of the carcinogens found in cigarettes, and it has helped many to quit smoking. However we still have over 10 million individuals vaping. We are also seeing a change in the entire business of vaping.
In some cases vaping is used as a crutch to stop smoking, but we are finding more and more issues with vaping. One of the biggest concerns is the use of vaping for the delivery of THC. It is becoming one of the most popular ways to inhale cannabis. THC oil used in vaping can reach high levels of concentration. Estimates are that 10-15% of high school students have used vaping for marijuana smoking.
Vaping also has a unique benefit for those who smoke marijuana and don’t want to get caught, the odor which many can easily pick out is not present or masked by artificial flavors like strawberry. Also the oil will look like the common oils used for legal vaping thus they are less likely to be caught with a bag of marijuana.
So you can see what this impact has been on one hand it is helping smokers stay away from the carcinogens found in tobacco while still getting their nicotine fix. On the other hand we are seeing individuals use the tool to smoke marijuana, in some cases this is for medicinal use and appropriate, in other cases it is illegal and a way to smoke marijuana without getting caught as easily.
With the potential legalization of marijuana we may see this grow, in the meantime it should be a message to parents to watch for vaping use in their kids.
Stand Up desks, Healthy??
Standing desks are all the rave. Stand up desks are being ordered by the thousands and are now the number one HR desk request. Many are making the case that standing makes for a healthier workplace but some studies are saying, “Not so fast, they may cause heart disease”. Before we jump to throw away all of the stand-up desks based on a headline you have read, let’s make sure we understand what the studies are showing.
Most studies have shown that using a stand up desk appropriately has large health benefits. Like many other things in life, just because a little is good a lot is not necessarily better. The studies you may have seen recently talking about stand up desks and heart disease have a few nuances. One study looked at individuals who did not have the option to sit at all, individuals who stand 8-10 hours behind a counter, at a cash register, as a bank teller. These individuals had an increased risk of heart disease. Why? The main reason is standing, without activity puts a stress on our heart by making it harder for the heart to circulate the pooled blood in your legs. The heart is working against gravity and without the activity of the leg muscles helping move the blood along the heart gets stressed. This long standing with minimal movement will also increase your chance of varicose veins, which can be painful as well as unsightly. So from a heart point of view, standing for 8-10 hours with minimal activity is not good for your heart. If you need to stand for your job, move around as much as you can and for your lunch break, sit.
Many who are forced to stand in one area also will have pain in their back, this pain is more muscular than disc related ( as we see in sitting ) These individuals need a couple of things to help minimize discomfort. One is a good padded floor mat and the other is a foot stool or foot rail. The ability to lift a leg and place it on the foot rail actually takes tension off your back and allows you some comfort. Folk lore has it that this was noted by bar owners years ago and placed a foot rail to keep patrons comfortable and give them no reason to leave, thus increasing sales. Regardless of where it began it is true from a musculoskeletal and nerves science point of view. Everyone has probably noticed that raising one leg after standing for a while helps you stay comfortable.
So although there was a study that caught some attention, we still need to highlight that when used correctly the stand-up desk does improve health in some degree. Now I would not use it as a weight loss technique as there are much better ways to burn calories in the workplace, a simple example is walking for a portion of your lunch hour, this will burn 3 times as many calories as standing for that time would.
So those of you considering a stand up desk, the key to success from a health view, is make sure it is positioned correctly. You don’t want to trade off one benefit for another ailment. Back and neck strain can occur if the monitor is not placed at the correct level, make sure we don’t put your wrist in a position to increase the chance of carpal tunnel, standing in high heels each of these may also do more harm and outweigh the other benefits.
One other controversy is around back pain, first we all should understand that back pain is a very generic term and can be caused by Muscle strain, ligament strain, disc problems and even simple bad posture. We all assume that sitting is good for back pain when in fact back pain due to a bulging disc is worsened by sitting as it loads more pressure on our low back. Standing hunched over or reaching too far will cause muscle pain in the upper back, lower back or both. So if you want to minimize your back pain with a standing desk make sure it is ergonomically correct. The correct positioning will protect your back, your eyes and your wrists.
We all know the importance of core body strength and standing clearly helps your core strength which is another way to help with back pain. We know that standing also firms up your glutes and helps your flexibility
Other benefits include improving your circulation which will help minimize the chance of blood clots. We also know that standing helps strengthen bones. When bones are stressed the body amazingly goes to protect the bone by increasing its strength. The same thing happens when we don’t use our bones as lying in bed for long lengths of time or flying in space will lead to weaker bones.
There have been other benefits that are a bit softer and with less science behind the claims, better creativity, more focus, increase brain activity and improving your mood are also claims that are made towards this.
So what happens if you can’t stand at work? What else can you do in the desk setting that can help your health. If you have an inner office or a cube that does not receive any natural light and feel exhausted at the end of the day, or more depressed consider a SAD light. Seasonal effective disorder for many people is impacted by the lack of natural light and winters in Chicago can be difficult. Going to work in the dark and coming home in the dark keeps our bodies away from the light course that is needed to help with SAD. The boxes are available everywhere but talk to your doctor to see if he agrees it may help. Some people may end up with eye strain or headaches from the lights so watch out for that. Many others feel more energy and attitude improvement with the use of the lamps.
Probably the most over looked and unappreciated piece of health equipment in your office is your desk chair. Often desk chairs are bought in mass and just placed in an office or cube. The company looking for a durable, affordable chair that looks nice The “new” chairs are often replacing bad old chairs that needed to go, but are the new chairs there to look nice? To look uniform? Did thought go into the new chairs? Think about your car seat and how now must cars have 15 ways to make it more comfortable for you to drive to work for 30 minutes yet we just throw in a chair for the other 8 hours we are sitting.
Most Americans will have back pain at some time in their life and we often equate it an injury from lifting or a bad golf swing, the fact is that many Americans have chronic low back pain because of their office chair. It gives them bad support and places them in a posture that will cause back strain and in some cases disc herniation. A good office chair will give proper support, be adjustable for height and have the correct arm rests heights. Now I am sure you have seen the prices of many of these chairs and that will scare some off, but if you have records on employee wellness, sick time or back problems of the employees it may make sense to revisit the purchase of chairs.