America’s healthiest cities are … where?

The American College of Sports Medicine changes its annual evaluation to comparatively evaluate cites rather than metropolitan areas.

For the past decade, the American College of Sports Medicine has issued its annual American Fitness Index® report that identifies America’s healthiest urban areas.

Until this year, the index included America’s 50 largest metropolitan statistical areas (MSAs), but the decision was made in 2018 to switch to incorporated cities. The new Index covers the 100 largest such entities.

Why was the change made? According to the ACSM, the older approach “provided important and valuable general messages, but limited the ability to provide targeted assistance to city and community leaders that need specific data at the local level.”

In addition to allowing more localized data to be studied, the new approach enables cities in states that weren’t represented at all in previous years to be included.

As for the various health measures comparatively studied, they remain the same – 33 indicators available from up-to-date, publicly accessible sources.

To build the ranking, the 33 indicators were combined to create sub-scores for “personal health” and “community and environment categories. Individual indicators were weighted relative to their impact on community fitness, and then combined to create the ultimate ranking.

The personal health indicators consisted of behaviors like eating habits, exercise and smoking as well as outcomes like health conductions (incidence of obesity, diabetes, heart disease, asthma, etc.)

Community/environment indicators covered factors like the built environment (parkland as a percent of city geographic size, walking/bicycle trails, etc.), recreational facilities (playgrounds, swimming pools, tennis courts, etc.), and policy and funding factors.

Putting it all together, America’s healthiest city achieves a 77.7 overall score (out of a possible 100.0 points). Shown below is the Top Ten ranking among America’s 100 largest cities for the ASCM’s American Fitness Index:

#1. Arlington, VA

#2. Minneapolis, MN

#3. Washington, DC

#4. Madison, WI

#5. Portland, OR

#6. Seattle, WA

#7. Denver, CO

#8. St. Paul, MN

#9. San Jose, CA

#10. Boise, ID

Notice the propensity of cities located in the northern reaches of the United States. Several of these I know first-hand, having lived and worked in the Twin Cities of Minneapolis-St. Paul.  I completely understand that the ACSM’s report means when it cites the following factors for #2-rank Minneapolis:

“Building culture of physical activity isn’t done overnight. Minneapolis, MN reaps the rewards of early planning to set aside important parklands and establish a semiautonomous parks board to maintain and protect the lands, featuring over 6,800 acres in the park system and 102 miles of biking and walking paths.” 

A Minneapolis lake — two miles from downtown.

[It doesn’t hurt that Minneapolis has seven good-sized natural lakes plus a 20-mile meandering creek within the city limits; what else would one do but put parks, green spaces and trails around them?  That would be a no-brainer decision even a century ago, when “fitness” wasn’t quite the same universally accepted aspirational goal.]

Commenting on Arlington as being the #1-ranked city, the ACSM’s report noted:

“Arlington, VA is home to the Pentagon, Arlington National Cemetery, Civil War battlefields, great local parks, as well as many people living healthy lifestyles.”

Arlington, VA: Hugging the Potomac River just south of Washington, DC.

When we dip into the next group of 10 cities on the listing, we do see the appearance of several located in the southern portions of the country:

#11. Oakland, CA

#12. Plano, TX

#13. Irvine, CA

#14. San Francisco, CA

#15. Boston, MA

#16. San Diego, CA

#17. Lincoln, NE

#18. Raleigh, NC

#19. Fremont, CA

#20. Atlanta, GA

Who’s at the bottom of the heap? Some of the cities might not surprise you, but a few seem curious to me.  How can it be that the two largest cities in Oklahoma end up at or near the bottom?  And what’s up with Indianapolis and Louisville?

#91. Tulsa, OK

#92. North Las Vegas, NV

#93. Gilbert, AZ

#94. Fresno, CA

#95. Wichita, KS

#96. Toledo, OH

#97. Detroit, MI

#98. Louisville, KY

#99. Indianapolis, IN

#100. Oklahoma City, OK

Oklahoma City: “Hey, let’s hit the streets for a jog!”

If any readers have insights they can share about these “bottom of the barrel” cities, we’re all ears.

To find out how each of the 100 largest cities ranked in the 2018 ASCM evaluation — along with seeing details on the 33 indicators studied to build the American Fitness Index, click here.

The Business World: Hazardous to your Health?

Overweight Business TravelersWord of two recent medical studies should give pause to those of us in the professional world who do our share of traveling on the job.

First up, researchers at the Mailman School of Public Health at Columbia University are reporting that businesspeople who travel two weeks or more during an average month are significantly more likely to have a higher body mass index and to be obese.

The conclusions were drawn from reviewing data from medical records of ~13,000 participants in a corporate wellness program, as provided by preventive health services firm EHE International.

In comparing frequent business travelers (those who typically travel 20 or more days per month) against light travelers (only 1-6 days per month), not only did the evaluation discover poorer health results for the first group, it also found that those individuals were 260% more likely to rate their own health as “fair” or “poor” compared to the less frequent travelers.

The Columbia University study notes that since ~80% of business travel is carried out using personal automotive transport, often this means long hours of sitting.

Poor food choices on the road are no help, either. Of course, this is a challenge for all business travelers no matter what mode of transport they choose to take, what with the high sodium and fat content of restaurant fare – and oh, would you like sour cream and butter on your baked potato?

Not surprisingly, the Columbia study concludes that those who travel extensively for work “are at increased levels of risk and should be encouraged to monitor their health.”

But if that news isn’t enough, along comes another study that links middle age obesity to mental degradation in later life. As reported in the most recent issue of Neurology, the medical journal of the American Academy of Neurology, researchers in a study conducted at the Karolinska Institutet in Stockholm, Sweden conclude that controlling body weight during the middle years can significantly reduce the risk of developing dementia in later years.

This study analyzed time-lapse information from ~8,500 twins aged 65 or older, and within that sample, evaluated the results from the ~475 individuals diagnosed with dementia or possible dementia against factors such as height, weight and BMI measures that had been recorded 30 years earlier.

The Swedish study found that those who were overweight or obese during midlife were at 80% greater risk of developing dementia or Alzheimer’s disease in later life.

Connecting the dots between these two studies makes things quite clear: If you want to lessen you chances of Alzheimer’s or dementia in old age, keep your weight under control today. And to keep your weight under control today, beware of the traveler’s lifestyle and get off your duff in the office.

Now if you’ll excuse me, I need to go exercise.

Online healthcare and virtual doctor visits: Are we there yet?

Online Physician ConsultationsThe harsh realities of cost are driving healthcare providers, insurance carriers and government agencies to implement policies designed to encourage consumers to take better control over their own health.

More healthcare plans and programs than ever before are including incentives for making lifestyle changes, undergoing preventive care routines, “do-it-yourself” testing as well as online consultations with physicians.

In this regard, it seems everyone is completely on the bandwagon … except perhaps the consumer.

Why is that the case? One reason might be because of what we’ve trained people to expect in the delivery of healthcare services.

For decades, American consumers weren’t given any meaningful incentives for engaging in preventive care or in making lifestyle adjustments. Several generations of Americans were acclimatized to seek out healthcare services when they needed it – and that was when something was wrong. And the billing for those services was sent directly to the insurance company for payment.

In such an environment, preventive health or cost control was the last thing on people’s minds.

I recall being hospitalized for six days back in the early 1980s, along with being given a battery of medical tests conducted by health specialists of every stripe. I’m sure the invoicing associated with my hospitalization and treatment was astronomical … but I never saw a copy of the bill to really know.

My only out-of-pocket expense for the entire week? Thirty dollars for using the television set in the hospital room.

What was surprising to me, even at the time, was that I was kept in hospitalization far longer than I felt I needed to be – my symptoms of infection were gone after just a day or two. If I had been responsible for paying for even a portion of my hospitalization, I’m sure I would have been talking with anyone I could find about how quickly I could be discharged!

Today of course, people are far more aware of skyrocketing healthcare costs – not to mention their concerns about ever-rising health insurance premiums, higher deductibles, and bigger co-pays. Still, when asked about adopting new ways of interfacing with healthcare providers, American consumers seem somewhat ambivalent about them.

A recent online survey of ~1,000 Americans age 18 and over conducted by marketing and research firm Euro RSCG Worldwide found that only ~42% of respondents are comfortable with the idea of having online consultations in lieu of personal visits with their doctors.

[Men are more receptive to this idea (~58%) than women are (~37%) … but women are the ones more apt to make healthcare decisions for their families.]

On the other hand, here’s an interesting additional insight from the survey: When told that having an online consultation with their physician might result in lower expenses, ~77% of those same respondents reported that they’d be open to trying it.

What about the concept of “do-it-yourself” testing? Close to half of the respondents in the survey (~48%) reported that they’re receptive to the idea of using mobile apps to run their own tests and checkups at home. Checking blood pressure was the most popular DIY test, along with tracking and reporting on symptoms.

Of course, as time moves forward, technology is no longer the big obstacle it once was for turning “virtual visits” and “remote care” into a reality. Instead, it’s consumer attitudes and a willingness to adapt. And to accomplish that, the purveyors of modern healthcare must try to undo several generations of “learned” behavior that’s nearly the polar opposite.

Denise Murtagh, a planning director at Euro RSCG, mentions another factor as well: the doctors themselves. “A lot will depend on how facile physicians are with the technology, and how comfortable they are with it.”

And let’s not forget age demographics, too. The survey underscores that Gen-X and Gen-Y consumers are far more comfortable with the idea of physician remote care (47% – 52% positive) than Baby Boomers and those born earlier are (only 33% – 39% positive).

It looks like we’ll need to give this trend a bit more time to come into full flower.

Electronics Before Bed = Up All Night?

It’s common knowledge that Americans are getting too little sleep on a daily basis. Studies have shown that the average hours of sleep have been declining pretty steadily in recent years. The National Sleep Foundation estimates that three out of four Americans are sleep deprived. Often, people scrimp on sleep each night of the week … then try to make it up on the weekends.

No wonder hospitals and other organizations are doing a land-office business in sleep studies. In fact, polysomnography is one of the biggest growth segments in the healthcare field.

Now, here comes along a new idea as to what might be contributing to our sleep-deprived state. It’s the cornucopia of consumer electronics we use – computers, laptops, smartphones and iPads – up until the moment we hit the sack.

With these devices shining brightly into our eyes, it turns out they’re tricking our bodies into thinking it’s still daytime.

According to sleep specialists, exposure to these electronic devices can disturb sleep patterns and contribute to insomnia. Phyllis Zee, a neuroscience expert and director of the Center for Sleep & Circadian Biology at Northwestern University, is one who contends that light emanating from an iPad or a laptop “can be sufficiently stimulating to the brain to make it more awake and delay your ability to sleep.”

The iPad, Apple’s latest sensation, comes in for special attention, as it’s a device many people like to use when reading before bed … at the very time the brain thinks the environment should be dark. Unlike the Kindle, the iPad’s light-emitting screen shines directly into the reader’s eye, making it more likely to disrupt sleep patterns.

Not surprisingly, people are affected differently. Elements like the brightness of the light and whether there is extensive blue light – which is common during the day but also emitted from computer screens – are seen to play a role. One way to counteract the “blue light effect” is to wear orange sunglasses which are purported to negate the effect of the blue light; although this might help, it probably won’t do anything for the wearer’s fashion sense!

An easier but equally effective approach might be to simply swear off the computer, iPad or smartphone in the last hour before bedtime. Chances are, your body will thank you in the morning.

No froth in the beer industry …

Can it be possible? The Beer Institute trade association is reporting that U.S. beer sales are actually declining.

Chalk up one more piece of evidence showing that this economic downturn is a vastly different animal. In previous periods of recession, beer sales did not really suffer. Perhaps that’s because it’s been a relatively inexpensive discretionary item. If you’re feeling down about the economy or your personal finances, why not drown your sorrows in a nice cold one?

Not so this time around. The Beer Institute reports that domestic brew sales have declined 4% in the first two months of 2009 compared to the same period last year, while import beer sales are off a whopping 19%. Not only that, foreign beer sales registered a decline for the entire year of 2008 as well.

Shipments from Mexico have fallen nearly 14% so far this year compared to last, led by Corona. But Corona is still America’s top-selling foreign brew, beating Heineken by a long shot. Speaking of which … beer sales from Holland have declined by an even bigger percentage (more than 25%).

What should we make of these statistics? Are Americans now tightening their belts on absolutely everything?

Or maybe we’re doing for our health what we’re also doing for our personal savings rate. Perhaps switching to something better than brewskies – like heart-healthy red wine? We’ll have to wait for the latest statistics from the National Association of American Wineries to find out.