Transcript of interview with Rhonda Randall, DO, chief medical officer of UnitedHealthcare Employer and Individual Retiree Solutions
Interview conducted by Alexandra Dixon for The Nation’s Health newspaper.
Listen to this interview as a recording on our podcast page.
Can you explain what the America’s Health Ranking Senior Report is and how is it a resource for public health professionals?
So America’s Health Seniors Report builds on the longstanding success of America’s Health Rankings Annual Report. The Annual Report has been in publication for over 25 years and it’s the longest running population health report of its kind and it gives us a very good look at trends overtime.
Over three years ago the UnitedHealth Foundation asked themselves the question – could a community be healthy if the seniors who lived there were not? And because of the desire to answer that question and understand the data, particularly focused on the health care of seniors, the Senior Report was started.
So this is the third year it’s been in publication and we have some new findings that we’re looking at this year, in addition to looking at the health of seniors 65 and older. We’re also doing a spotlight on those middle-aged Americans who are about to age into their senior years. So getting a glimpse of what the next generation of seniors’ health challenges and successes are going to look like.
I would encourage you and your readers to go to our website americashealthrankings.org. There’s a wealth of more detailed information in that report. There’s also some nice tools where you can look at the disparities, where some of the problems may be more magnified within people who have a certain degree of education, whether they live in a rural or urban area, their culture or ethnicity, men versus women etc. So there’s some good information and some nice tools on the website americashealthrankings.org.
So this year’s report, as you say, was comparing the health of seniors in 2014 to the same age cohort in 1999. Can you tell me what kind of picture this comparison paints for the future of U.S. senior health?
We looked at four measures in particular to compare those two groups. We looked at the rates of smoking, diabetes, obesity and health status. And what we found was one thing very much going in the right direction was that middle-aged Americans, people aged 55 to 64 have smoking 50 percent less than the generation before them. That’s great news. But there’s also some troubling news in this report. The other three measures are going in the wrong direction. A 9 percent lower prevalence of rating their own health as “very good” or “excellent,” a 25 percent increase in obesity and an alarming 55 percent increase in diabetes.
What are some of the short term successes this report highlights in senior health across the United States this year?
Well this report looks at 35 different measures of health. They come from 12 different well-respected data sources, government agencies and other health care data repositories.
And what we see from a national standpoint is that there is a decrease in preventable hospitalizations by 9 percent, a decrease in seniors having teeth extracted – a very important measure of health, whether or not we’re keeping our own teeth — that decreased by 8 percent. A decrease in hip fractures by 5 percent, that’s very important because seniors who have a hip fracture have a much higher chance of mortality in the next six to 12 months, as a result of immobility following that hip fracture. So that’s great to see that down.
We also see a greater use of home health care. Showing that we’re giving more access to care for seniors, particularly in their own home. We also saw the use of hospice care increase and deaths in the hospital decrease. And why those two measures are important is because as we age and develop chronic diseases that often become advanced illnesses and terminal illnesses. When we survey Americans 90 percent of them tell us that they prefer to die in their own home if they have the choice. Yet 80 percent of us die in an institution. So we’re seeing that number start to change as more people elect to have the last days of their life cared for in the comfort of their own home.
And then we’re also seeing, which is really terrific, is an improved rate of their own health status. So we spoke a little earlier about the future seniors saying their health status has decreased. Current seniors are saying their health status has increased by 7 percent —7 percent more this year than last year rating their own health as good or excellent.
That’s excellent to hear. Can you highlight any of the areas that are in need of improvement?
Yep. There are some areas that are still in need of improvement. Probably the one that I would highlight the most is obesity. That’s a challenge for both the future seniors and the current seniors. People age 65 and older saw an increase in obesity of 9 percent, it went from 25.3 to 27.5 percent of people age 65 and older.
We also saw that community spending decreased 7 percent in the last year for people over the age of 65 who are at, or below the federal poverty level. We saw a decrease in home-delivered meals by 7 percent and at the same time an increase in food insecurity — so people saying that they worry about access to food. And then a 10 percent decrease in the SNAP program reach. The program that provides — often called food stamps for example.
APHA has a goal of creating the healthiest nation in one generation. So what must public health do to ensure better health outcomes and quality of life for the next generation of seniors?
Well I think that we can really build on the success that we’ve had as a nation, particularly around smoking, to focus on the big challenges that we have for the next generation of seniors. And those really fall around lifestyle choices.
So we see that rating of our own health worse, an increase in obesity, an increase in diabetes and we’re also seeing in the national report some concerns overtime of decreased physical activity or increased physical inactivity, depending on how you want to look at that. If we really are focused on healthier lifestyles for this next generation, it’s going to make a significant difference to their outlook, their length of life and also the quality of their life.
This next generation of seniors really is going to affect us just by their demographics. Half of the states, 25 states are going to have a greater than 50 percent increase in the number of seniors living in those states. And some of those states are also going to have alarming increases in things like obesity and diabetes. So it’s a significant challenge. We really need to put a lot of focus on it. That comes from many areas working together at the same time. It comes from individuals making the choice that they’re going to change their lifestyle habits, it comes from their communities and loved ones giving them the support and encouragement that they need in order to do that. It comes from public health officials and policy makers putting in place policies that make it easier to access healthier foods and get exercise for example. And finally it comes from our health care system continuing to provide better and better care.
But I’ll leave with saying this: we can’t medicalize ourselves out of this problem. There is too many people turning 65 that have diabetes and other chronic conditions and as improved as our health care system has gotten year over year over year in taking care of people with chronic diseases, we don’t have enough doctors and other health care professionals to take care of the volume of individuals coming in to Medicare with those chronic diseases already present.