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County residents work on getting into shape


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BARTHOLOMEW County residents are already healthier than most in Indiana, and a new report predicts that things will improve even more.

The county ranked 34th out of Indiana’s 92 counties in the most recent release of the County Health Rankings & Roadmaps report, compiled by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The report is part of an effort to spark national conversation about health.

The rankings consider health outcomes, which are based on two measures: how long people live and how healthy they feel.

In health factors — which are an estimate of the future health of a county and consider measures such as the rate of adult smoking and adult obesity, education and access to health care — Bartholomew County ranked 15th in the state.

The Healthy Communities Initiative, started in 1994 with the goal of improving the health and quality of life of Bartholomew County residents, focuses on changing those factors.

“Health behaviors are slow to change and that’s what we’re working on,” director Beth Morris said. “It’s difficult for people to quit smoking, to start exercising more, to eat healthier. Those are all well-ingrained habits that awareness alone is not enough to change.”

But she’s optimistic that Bartholomew County will be ranked in the top 10 in the near future. She feels the county has the potential.

Bartholomew County is ranked 18th for socioeconomic factors including unemployment, graduation and poverty rates.

“Given that socioeconomic factors are the biggest contributor to someone’s health, I would love to see us near the top” she said. “It might take a while, but I certainly believe we can do it.”

Smoking

Bartholomew County residents are smoking less, but Morris said it’s a number that’s slow to move.

The percentage of adults who have smoked more than 100 cigarettes in their lifetime and currently smoke every day or most days has dropped from 25 percent in 2010 to 19 percent this year.

Although a smoking-cessation program is offered through the Bartholomew County Health Department and Columbus Regional Health, Morris said only about 20 percent of adults find success that way.

The same goes for the Indiana Tobacco Quitline, a free phone-based counseling service.

“Nicotine is a very tough addiction to kick, and so the best bet is to keep people from starting in the first place,” Morris said. “It’s really the prevention that’s the key.”

Nathan Ramirez of Columbus said he has tried to kick his pack-a-day habit three times now.

What got in the way?

“Work and friends,” he said.

He said he needs cigarettes to focus on work, which right now includes odd labor jobs; and when all his friends smoke, it is hard to not light one up. He said he has never considered a class because they seem too time-consuming.

The cessation classes aren’t ineffective. They’ve helped Susie Banks of Edinburgh.

The carbon monoxide level in her breath recently dropped below that of a nonsmoker after decades of heavy smoking, she said.

But not all adults are as dedicated as Banks, so Healthy Communities has been making presentations at area schools.

“When those kids are adults, there will be fewer smokers,” Morris said.

Obesity

The County Health Rankings & Roadmaps report shows the obesity rate creeping up over the years — 29 percent of Bartholomew County residents were classified as obese in 2010, compared with 32 percent this year.

But information compiled by Healthy Communities, using a larger sample size, show a trend in the opposite direction.

A 2013 health needs assessment conducted by Professional Research Consultants shows obesity in Bartholomew is actually on the decline. According to that report, 31 percent of Bartholomew County adults were obese in 2009 compared with 27.1 percent in 2012.

Low-income, middle-aged and uninsured men were the most likely to be obese, the study found.

The variance in these numbers comes from the difference in methodology, Morris said.

While the health rankings sources sometimes only use 50 or so participants in a study, the health needs assessment surveyed 500 random adults.

Whether it’s 27.1 percent or 32 percent of the population that’s considered obese, that number is still too high for Morris — and it is hard to change.

Michele Martin, 43, received a wake-up call when she was diagnosed with Type 2 diabetes.

She had tried diet pills and fad diets, but she would always gain it back — until she received her wake-up call.

Martin was diagnosed with Type 2 diabetes and knew she had to make a real change.

“I was sad and scared, and I knew I had to do something about it,” she said.

So she worked out a healthy eating plan and started exercising daily — and lost 100 pounds.

But Morris said individuals should not wait for their own wake-up call.

“We’ve been working a lot on physical activity and nutrition, especially on policy,” she said, referring to school lunch guidelines. “If you can change policy, that can have long-lasting implications.”

Physical activity

The health rankings found more than a quarter of Bartholomew County adults reported participating in no leisure-time physical activity, yet more than half of the population has adequate access to locations for physical activity.

There are 20 miles of People Trails and nearly 1,000 acres of park land. Bike lanes have been added to some major roads around Columbus. There are a handful of gym facilities available to those who can afford a membership.

“All of those things are an important part of supporting the physical activity we’re hoping to see,” Morris said.

So why are only 75 percent taking advantage of the facilities?

It goes back to the well-

ingrained habits that are hard to break, Morris said.

Although there are efforts to make physical activity more appealing or accessible to adults — the Columbus Bike Co-op, a community bike garage that is open to the public among them — Healthy Communities has opted to focus resources

on youth.

The organization is attempting to raise funds for a bike camp that would teach children with physical and cognitive disabilities how to ride a bicycle.

Bike to School Day, which took place May 7 as part of Bike Month showed students that there are other ways to get to school than in a bus or a car.

Nearly 1,000 children participated in the Kids Fun Run last year during Mill Race Marathon activities in late September.

Not only did the profits from that event benefit Healthy Communities, but it showed some participants that running can be fun.

Organizers of the Mill Race Marathon are placing a larger emphasis on youth during this year’s event, but Morris said all aspects of the event are making a difference.

“Just look outside and you’ll see more people on the People Trails,” she said. “I do think the culture is shifting.”

Nutrition

Happy hours, “fourthmeal,” and late-night food specials — Morris said they are all examples of marketing campaigns making it socially acceptable to slip in extra meals to a diet.

Healthy Communities is trying to change that mindset.

“We still have a food environment where there’s food everywhere and anywhere,” she said. “I think as a population we’ve forgotten how to eat when we’re hungry, and we tend to eat when something’s in front of us.”

Tyler Evans, who is home in Columbus for the summer during Indiana University’s summer break, said he fell victim to that food environment. At college, he relied on processed and convenient foods. He would cook up a snack between classes,

while studying or after a night out.

“I was living on ramen noodles and pizza rolls,” he said. “It made me feel so sluggish.”

A few weeks ago he started the Whole30 Challenge, a program designed to strip “psychologically unhealthy, hormone-unbalancing, gut-

disrupting, inflammatory food groups for a full 30 days,” according to the website promoting the plan.

Eggs, meat, vegetables and some fruits — that is pretty much all he can eat until June 10.

“I have so much more energy now,” he said. “I won’t continue this strict of a diet, but it’s taught me a lot about how foods really affect my body beyond weight.”

Healthy Communities is making several efforts to change the food environment for more of the population:

Encouraging workplaces to reconsider refreshments at meetings. Are doughnuts and soft drinks necessary?

Offering fruit and vegetable tastings in schools to show students that salads can be tasty.

Conducting cooking lessons with fresh ingredients instead of prepackaged and processed ones.

Starting community gardens around town and encouraging residents and businesses to do the same.

Working with the Love Chapel food pantry to encourage donations of healthier choices.

Providing breast-feeding “Nurse ‘n’ Chat” sessions, because babies who are breast-fed are shown to be able to control their appetite better.

Healthy Communities used proceeds from last year’s Mill Race Marathon to conduct a local food study, which explored how to put more locally grown fruits and vegetables on the plates of Bartholomew County residents.

Morris said the farmers markets in Columbus connect the farmers and residents well, but Healthy Communities wants to do more to connect the dots.

One possibility: A website that allowed restaurant owners to log on and see what farmers had available for that evening’s special.

“Many of the local restaurants are excited about the possibilities,” Morris said. “The intent is there, but there are some barriers that need to be addressed.”

The technology has not been introduced in Columbus yet, and some area operations may not have the manpower to pick up fresh produce every morning, she said.

Clinical care

Bartholomew County is ranked 10th in the state for clinical care, which considers the number of uninsured patients and how accessible primary care physicians, dentists and mental health providers are to residents.

“The hospital and health system take great pride in making sure all interventions are evidence-based,” Morris said. “They use the latest approach that’s been shown to be effective.”

An example is a diabetes health coaching demonstration project, which has resulted in a 30 percent relative risk reduction and a drop in the number of preventable hospital stays. The health coaches spend time with patients, one-

on-one, to encourage healthy eating, being active, taking medication and blood sugar monitoring.

Access to health care is a key focus area for Healthy Communities, and representatives are serving on a new task force examining mental health and substance abuse.

“We’re not sure what will come out with recommendations from that, but we’re at the table,” Morris said.

The rankings found there are 772 people to each mental health provider in Bartholomew County, which is a smaller ratio than the state average.

Morris said there is tremendous potential for the Affordable Care Act to improve the clinical care factors for those who are uninsured.

Currently 17 percent of Bartholomew County residents do not have health insurance. The number of people enrolled in the

health exchange marketplace has not been released, but the legislation has the potential to decrease the number of uninsured residents drastically.

“That could ultimately alter some of these other health outcomes,” Morris said. “If people are insured and getting regular care, that should impact health in a positive way.”

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