Social inputs on health care: Non-traditional factors become silent health risks

Northern Colorado and the Boulder Valley are great places to live, but we are also victims of our own success. The high-performing region with university-educated residents has resulted in escalated real estate costs and brutal commutes along the Front Range. These two dynamics alone may sound like urban planning or development issues, but they are also becoming factors that influence the quality of health among the region’s residents.

Non-health-related factors that influence health — also known as social determinants of health — are becoming more prevalent in the region. Transportation, housing, food, fitness, substance use — these are all lifestyle issues that, if problematic or left unchecked, contribute significantly to chronic and deadly health conditions.

Dr. Austin Bailey, medical director of primary care at UCHealth Medical Group, said there are more people than one might think affected physically and mentally by environmental and social stress. There are also unnoticed populations that are highly affected by certain societal factors.

“Seniors, for example,” Bailey said. “They are on a fixed, limited income and it’s not unusual to have conversations with them about which medications can be stopped because affordability is a problem. They don’t have enough money to buy rent, food and medication.”

Scrimping on sustenance

Less-obvious factors in health quality present specifically to an individual neighborhood or community. For example, the downtown Safeway grocery store in Fort Collins has closed, and a higher-end chain — Lucky’s Market — is slated to move in. It could be viewed as a plus to some residents of that neighborhood, but a senior-living complex is located around the corner, and there isn’t another affordable grocery store that is within walking distance for residents that don’t or can’t drive.

“Suddenly, a more-expensive store limits their ability in what they can buy to eat in a healthy way,” Bailey said. “We call these areas food deserts. A lot of times, we assume people have transportation to get out of a neighborhood, but they really don’t. When you look at what is available to them in their neighborhood that’s healthy, you find it’s not affordable, or the food that is available (at the corner gas station, for instance) holds little nutritional value.”

Bailey noted that the average American’s income has increased only 7 percent in the last five years, “so just about everybody is on some sort of fixed budget.”

As the cost of basic components to survival increases, some people will start to scrimp on food. They will look for the cheapest option, but the most economical food is not always the healthiest food.

“It is possible to eat healthy economically, but it’s not obvious. It’s not user-friendly,” Bailey said. “Not everyone knows how or has time to cook from scratch. That’s something that people have to be taught to do.”

So, people choose cheap and convenient, such as ramen noodles or Taco Bell, particularly if one has to work extended hours or more than one job to makes ends meet. They find the convenience outweighs the benefits of budgeting the money and time to eat healthy. And, they include their children in this cycle.

Mobility crisis

The same concept applies to mobility and fitness. The way a neighborhood is designed or the condition of a certain area can also affect health quality in a negative way. If there are no sidewalks, or if there’s a lot of traffic, people with disabilities have a harder time getting around, and if there are no safe and accessible places to exercise, residents will forgo an important component of good health.

Another connected issue is commuting. According to the Boulder Valley Comprehensive Plan, there are 64,000 commuters coming in and out of Boulder every weekday. Commuting daily along the congested Front Range for two to four hours a day is horrid on the body, Bailey says. It takes away time that could be spent preparing a healthy meal or exercising. The sedentary lifestyle added to a poor diet directly contributes to chronic conditions such as hypertension, obesity, diabetes, and heart disease.

These environmental and societal issues not only affect people physically, but also take a mental toll, too — which again, contributes to the decline of good physical health.

Stuck to the screen

Kevin Unger, president and CEO of UCHealth Poudre Valley Hospital and UCHealth Medical Center of the Rockies, points to technology as a significant social determinant. For example, Millennials would really prefer not to leave their house for medical care if possible, so they are very open to using online patient portals or engaging in Skype visits with their provider.

“There are a lot of benefits to the Internet, but it can play back into the sedentary lifestyle,” Unger said. “Were all having more screen time, which is a con. Also, not everyone can afford Internet access, so those people miss out on the benefits of online information and access to health care available to them.”

Bailey noted that some research is showing that the human attention span is shortening as screen time increases. He adds that the Internet is a great way to stay connected with people, though, which is imperative to a better feeling of well-being.

“There are pros and cons,” Bailey said. “And we don’t fully appreciate the depth of that yet.”

The silent tragedy

Unger said there are two dynamics affecting Northern Colorado that are not often considered when evaluating the health of the community — suicide and a substantial decrease in birth rate.

“If you’re a young family, it can become a real issue in trying to find affordable housing in Northern Colorado, Unger said. “There’s aren’t a lot of good options. Our community is aging, but we’re not seeing that repopulated with younger people because they can’t afford to live in this region.”

Northern Colorado also has a higher-than-average suicide rate.

“When you live in a high-performing society, where people are so highly educated, those pressures can mount,” Unger said. “There are a lot of social pressures that occur within Northern Colorado.”

Bailey added that racism is considerable in the region, “not nearly as flagrant in Northern Colorado as in other parts of the state, yet, it still exists here,” he said. “Especially in Fort Collins, Loveland and Greeley. There are things that need to be addressed.”

Comfort in numbers

The take-away message is not necessarily to be aware that there are people out there that are disadvantaged and need help or empathy. The reality is that almost everybody in Northern Colorado is struggling with survival and lifestyle issues that are subtly, or sometimes aggressively, taking shots at the quality of our physical and mental health.

“It’s an assumption that everyone is happy in Colorado — good jobs, active life — but there are a lot of families in Northern Colorado that are under a lot of stress right now, sort of suffering in silence,” Bailey said. “You are not alone. Talk about it with your health-care provider. Social determinants are not something we normally screen for, so physicians may not initially pick up on it. That way, your doctor can know what factors are influencing your personal health and advise specific courses of action and tangible options.”

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