Health status impacts every aspect of a community. In Flint and Genesee County, heart disease, obesity and diabetes are three of the top health issues. But the community – patients, physicians, and other city and medical professionals – has a mission to begin creating a healthier, strategic vision for improving the well-being of those who reside here. We have profiled “The Big 3” health issues with information about each, and also the local initiatives that are in place in the community to motivate those affected to make a change.

Problem 1: Heart Disease

In the U.S.: About 610,000 people die of heart disease every year – that’s one in four deaths. Heart disease is the leading cause of death for both men and women; in 2009, more than half of the deaths due to heart disease were men. Coronary heart disease (CHD) is the most common type, killing over 370,000 people annually. Every year, about 735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 210,000 happen in people who have already had a heart attack.

In Flint & Genesee County:

Cardiovascular disease is the leading cause of death. The mortality rate due to heart disease is 240 per 100,000 population which is greater than Michigan’s average (204.2) with a significant disparity exhibited between heart disease mortality in Caucasians (231.1) compared to African Americans (270).

Source: CDC Heart Disease Fact Sheet
What is the problem?

“A great deal of heart disease is affected by our lifestyle,” says Dr. James Chambers, a cardiologist with the Cardiology Institute of Michigan. “Our lifestyle includes what we’re eating, exercise, smoking. Many of our patients and county residents – and those around the country – have these lifestyles.”

• High blood pressure
• Physical inactivity
• Smoking/tobacco use
• Being obese/overweight
• Unhealthy diet high in cholesterol
• Excessive alcohol use
• Stress

How is it being addressed?

“There’s a great deal of education going on through doctors’ offices and helping people understand the factors that lead to coronary disease and an early death, like the effects of obesity, high blood pres-sure, smoking, and high cholesterol,” says Dr. Chambers. “I, myself, am monitoring blood sugar levels for diabetes to make sure that they’re watching it and being careful to keep it under control. Even though I’m a cardiologist, I’m trying to help people understand the connection between diabetes and the formation of clots in arteries.”

Organizations like Commit to Fit! and the Genesee County Medical Society offer education and events.

Greater Flint Health Coalition’s goal: Encourage and support the adoption of safe, evidence-based, best practice guidelines for cardiovascular disease treatment and prevention, including community-based efforts targeted at reducing risk factors such as smoking, obesity, physical inactivity, and poor diet.

It’s up to the individual. “We bring these issues up to the patients and identify ways that once they come to our office, they know of ways to prevent coronary disease, or to avoid a second heart attack or bypass surgery,” Dr. Chambers states. “Residents control a great deal of the progression of this disease. They have the ability to help reduce their chances by controlling their amount of exercise, blood pressure, cholesterol, and blood sugar. They can do a lot for themselves. We help them realize the things that they can do to reduce this disease in our area.”

Problem 2: Obesity

The rate of obesity in Flint and Genesee County is significantly greater than the state and national averages.

Percent of Genesee County adults (18+) who are obese/overweight in 2011:

• Obese: 26% [BMI 30.0 or higher]
• Overweight: 35% [BMI 25.0 – 29.9]
• Combined obese and overweight: 71%

In 2008, obesity-related costs totaled $3.1 billion statewide; it is expected to be $12.5 billion statewide in 2018. Obesity can lead to other conditions: diabetes, cardiovascular disease, high blood pressure, and stroke.

What is the problem?

“There is a definite association between income and obesity rates,” says Dr. Michael Kia, General Surgeon at McLaren-Flint who specializes in Bariatric Surgery. “Surprisingly, nationwide, areas that have higher income have a higher rate of obesity. Obesity is not correlated to poverty.”

According to the CDC and National Health and Nutrition Examination Survey, 2005-2008: In the U.S., of the approximately 72.5 million adults who are obese, 41% (about 30 million) have incomes at or above 350% of the poverty level, 39% (over 28 million) have incomes between 130% and 350% of the poverty level, and 20% (almost 15 million) have incomes below 130% of the poverty level.

The causes of obesity can be both environmental and biological. “It’s very important for people to recognize that obesity begins early on, but then progresses to a biological disease,” says Dr. Kia. “Science shows that morbid obesity is driven by biological factors. Myths such as lack of willpower, not trying hard enough – those kinds of things are false. Science shows us that the body is not biochemically designed to lose weight; it will biochemically ‘fight back.’ This is something physicians have learned over the past few years.” He adds that historically, obesity has been linked to behavior and not the biochemical; that’s where medicine is heading: the understanding that it’s a metabolic disease.

Dr. Jamal Farhan, MD, Surgical Director at the Hurley Bariatric Center adds, “Obesity is an epidemic in our country. According to the Centers for Disease Control, 36% of adults in Genesee County are obese. The rate of adult obesity for the entire state of Michigan is 31%. That’s more than 1/3 of our population.”

How is it being addressed?

Health professionals are attempting to redevelop and diversify the community both socially and economically. Organizations are educating and encouraging area residents to change personal habits, practice physical activity daily, and improve their nutrition.

The Crim Fitness Foundation

º“They are at the forefront of addressing this problem,” says Dr. Kia. “From a physician’s standpoint, we work one-on-one with our patients, whereas a foundation works to create a population-based program. That’s where some resources are needed to help mitigate and prevent the problem. Obesity often begins with childhood and adolescence, and there are programs to help educate on that level. Encouraging activity and better nutrition is really population-based. We need to support their efforts through legislative programs that promote it.”

The Greater Flint Health Coalition is working to decrease the percentage of adults who are obese/overweight through supportive program development and positive changes to the physical environment, as well as access to healthy food.

Bariatric Surgery

“Surgery, while it can be effective, is only a solution for the individual, not the disease as a whole,” informs Dr. Kia. “We help them start a new life and be a healthier person, but surgical intervention is not the solution for the national epidemic.”

“Hurley Bariatric Center, a Comprehensive Center of Excellence, provides a solution to this epidemic through surgical weight loss,” says Dr. Farhan. “We were the very first surgical weight loss center in Genesee County and have performed nearly 5,000 procedures since the program began in the year 2000. We have helped thousands of people overcome weight-related health concerns, such as diabetes, high blood pressure, sleep apnea, and more. Additionally, we offer a comprehensive post-surgical care program with a dedicated and highly skilled team of professionals to help patients not only achieve their weight-loss goals but also maintain their improved health for years after the initial surgery.”

Source: CDC Behavioral Risk Factor Surveillance System & Michigan Behavioral Risk Factor Surveillance System

Problem 3: Diabetes

Type 2 diabetes is the most common and makes up about 90-95% of diagnosed diabetics. The risk for developing Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. In Genesee County, as of 2009, the percent of adults with diagnosed diabetes is 10.6% (In 2013, the percentage was 12.2%). In Michigan, the rate is 9%, and in the U.S., it’s 8.3%. Diabetes is the leading cause of kidney failure, blindness, and lower limb amputation, and one of the most common causes of heart disease and stroke. Local mortality rates due to diabetes mellitus (35.7 per 100,000 population) show a significant disparity in the mortality rates between Caucasians (32.5) and African Americans (51.4).

What is the problem?

• Diabetes has links to obesity
• “There are many biological factors, but obesity is the number one cause for Type 2 diabetes,” Dr. Kia says. “Although, not every per-son who is obese has Type 2 and not every person who has Type 2 is obese.”

Staggering healthcare costs

Total (direct and indirect) $245 billion; Direct medical costs $ 176 billion; After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes. Indirect costs $69 billion (disability, work loss, premature death).

How is it being addressed?

• Greater Flint Health Coalition has a goal to increase supportive programming at the clinical and community levels to improve disease management, health outcomes, and quality of life.
• Evidence-based programs at clinical and community levels reduce the severity of medical complications associated with diabetes through shared medical appointments; care, education, and support; and self-management behaviors.

Insulin pump and artificial pancreas

Newer research and clinical trials are underway to improve the lives of diabetics through an artificial pancreas. Insulin pumps are more common and prove to be effective for many diabetics.

Diet & Nutrition

• Learning to eat healthy, but also knowing what foods work within their systems.
• “What can I eat?” is a common question when someone is diagnosed with diabetes. Hurley focuses on what you can have, and shows you how to incorporate the things you like along with special foods for special occasions.

◆ The Hurley Diabetes Center (HDC) has been providing outstanding patient education and outreach at the Hurley Eastside campus since 2004.

“Patients leave here empowered and feeling they have the knowledge to manage their diabetes. Certainly, knowledge is a big step toward managing the disease. The HDC gives you the skills in lifestyle and understanding medication that help you do that,” adds Michele Bernreuter, MS, RD, CDE, Program Manager, Hurley Diabetes Center.

In 2008, the Hurley Center for Health Outcomes (HCHO) was developed to help improve the health of our community. Through this initiative, many partnerships developed with programs and agencies with similar goals.

Hurley Community Garden is a lot across from the hospital that is working with Edible Flint and invites the neighborhood to share. Much of the food has been donated to the Food Bank of Eastern Michigan. Hurley has also allowed Edible Flint to use the space as a demonstration and teaching site.

Flint Farmers’ Market produce vendors offer fresh produce for sale to our staff, physicians, patients, volunteers and visitors. This way, they can model their behavior of healthy eating in the community.

Source: Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.