Monthly Archives: August 2012

How Healthy Is Houston? Health of Houston Survey 2011

Some of the results are not surprising, but others contradict our assumptions:

  • Houston’s rate of mental illness is twice the national average (twice that of Los Angeles County)
  • Almost half of Houstonians reported difficulty purchasing enough food or paying their mortgages
  • 34% of adults under 65 are uninsured
  • 56% of Hispanic residents are uninsured compared to 14% of whites
  • When undocumented residents are excluded, 46% of Hispanics are uninsured
  • Half of adults have no dental insurance (explains why family doctors see so many dental complaints)
  • 32% of adults are obese
  • 3% were frightened for their safety

A Q&A with Dr. Stephen Linder

Written by: Anissa Anderson Orr  |  Updated: August 28, 2012

As a professor of public health, Dr. Stephen Linder helps inform Houstonians about ways to prevent disease and stay healthy. But diagnosing each community’s health care needs poses a challenge. Studies on the health of Houston-area residents—a diverse population of nearly 6 million people—don’t always show the whole picture.

“Doing a population-based survey was the missing piece in the mosaic of data that Houston needs,” explains Linder, associate director of the Institute for Health Policy at The University of Texas School of Public Health. “We needed a better sense of what the total need for health services is on a community-wide basis, rather than keeping a tally of those who actually get services.”

To fill in the blanks, Linder and his colleagues developed the 2010 Health of Houston Survey, released to the public, and on their website, in November of 2011. With information from more than 5,000 households, and covering 28 areas within Harris County, the population study is the first of its kind to report the health of Houstonians by neighborhood (click here to see where your neighborhood stands).

So how healthy is Houston really? We definitely have some room to improve, Linder says. An estimated 20 percent of Houstonians reported they are in poor or fair health—twice the national average. Lack of health insurance, health care access and increased risk for psychological distress were big problems in some neighborhoods. HealthLeader recently sat down with Linder and asked him what the study results say about Houston.
HealthLeader: Houston has always had a reputation, fair or not, for being unhealthy. But did you expect so many of your study respondents to say they were in fair or poor health?

Dr. Stephen Linder: It was a surprise. Our sense was that the interesting feature of the study would be the geographic disparities—some neighborhoods having more problems than others—and not the deviation from national averages. We thought our local rates would be close to the national average, or at least within 10 percent. Not twice the national rate for certain adverse health conditions.

HL:What else was surprising?

SL: We found that Houston had twice the national rate for risk of psychiatric illness. Not only that, the rate for women was twice as high as for men. We compared it to Los Angeles County, which has similar demographics as Houston. L.A. County had lower than the national rate for the risk of psychiatric illness, and thus less than half of the average in Houston, and it reversed the gender disparity. Men were doing a little better than women were in L.A. County, but we have no idea why. When we repeat the survey in 2013, we are going to ask a more extensive battery of questions about mental health to see if we can sort out the source of that gender disparity.

HL:Were you surprised by the disparities you found in insurance coverage among Houstonians?

SL: We knew the percentage of people who were uninsured was high in Houston, so we expected a high uninsured rate. But, we found that the overall rate of people who were uninsured was 34 percent in Harris County. That’s not only dramatically higher than the national rate; it is also higher than the L.A. County rate, which is 10 points lower than ours. The real surprise, however, was the disparities across population groups. The largest difference in insurance coverage was between whites and Hispanics. About 14 percent of whites were uninsured, but 56 percent of Hispanics were uninsured. If we exclude those who were undocumented, the number dropped to 46 percent. Asians, African-Americans and whites all had better than the area average in insurance coverage.

HL:What did survey respondents think was the biggest problem facing their neighborhood?

SL: Crime wasn’t at the top of the list. Instead, they named stray dogs and cats as their biggest concern. That wasn’t what we expected. It was worst on the east side of Houston. Strays can be a big problem for neighborhoods, because they increase the risk of animal bites and rabies if you have a lot of animals that have not been inoculated. Usually children are at the highest risk for being bitten.

HL:Does Houston rank the best in anything?

SL: We have done well in reducing smoking rates. Our current smoking rate is lower than the national average. Unfortunately, it is not as low as L.A. County. About 17 percent of the Houston population smokes. Nationally, the average is a little over 21 percent, and L.A. County was 13 percent. So they are doing something right in L.A., but it is worth noting that we are doing better than most places. Another area we did well in was breastfeeding. We have already exceeded the U.S. Department of Health and Human Services’ Healthy People 2020 targets for initiation of breastfeeding. For sustaining breastfeeding up to six months, which is what the Centers for Disease Control recommends, we are below the 2020 targets, but we are doing better than the state is, and better than the national average.

HL:What will the 2013 study look like?

SL: We want to include more questions on mental and dental health and investigate some of the anomalies in the results, such as why the rate of uninsured is so high among Hispanics, and why women are at such higher risk for mental illness. We will start collecting data in 2013, and plan to release the study in the fall of 2014.

HL:What should Houston focus on to improve our citizens’ health?

SL: We need to attend to geographic disparities in health, and to do so in more of an integrated fashion. We should concentrate on those hot spots of need in a way that responds to the full spectrum of needs, as opposed to singling out a disease or condition, like heart disease or diabetes.

There also are inequalities in the burden of illness and access that make some populations more vulnerable to disease. Now we have a way to measure these disparities with the indicators in our survey. Given the scale of the survey and the variety of indicators we have we can understand the problem of health disparities more fully and work toward solutions.
For more information on the Health of Houston survey, visit the UTHealth newsroom.

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Should Lack Of Exercise Be Considered A Medical Condition?

I recently returned from a trip to Portland and Seattle.  The legions of cyclists, runners, and walkers I saw in these two cities inspired me.  Bike lanes and beautiful waterfront walking paths abounded.  A Portland city bus even stopped to let me cross the street.  That would never happen in Houston.

The idea that activity is good is not news to any of us.  But if the solution is so obvious, why aren’t we all moving?

This National Public Radio story from last week attempts to answer this question.

Doctors need to prescribe exercise to patients who don’t get enough exercise, a Mayo Clinic expert says.

“You’ve got a bad case of deconditioning,” the doctor says.

Actually, it would be the rare doctor who would say that to anyone. And though it might sound like something to do with hair, in fact, deconditioning is a familiar and more profound problem: the decidedly unnatural state of being physically inactive.

At some point in the last few decades, the human race went from being a species that is active most of the time to one that is increasingly sedentary. The Lancet recently called it an “inactivity pandemic,” responsible for 1 in 10 deaths worldwide. That’s a major shift, and a major public health problem, many researchers have pointed out. Inactivity is linked to heart disease, diabetes and some types of cancer.

Now Michael Joyner, a physiologist at the Mayo Clinic, argues in a commentary out this month in the Journal of Physiologythat one way to deal with the problem is to make physical inactivity a mainstream medical diagnosis. It’s one of the most common preventable causes of illness and death, and Joyner writes, there is “one universally effective treatment for it — exercise training.”

Shots called up Joyner to get him to elaborate a little more on just why doctors need to get more involved with this problem.

“The entire medical research industrial complex is oriented towards inactivity,” he tells us. Insurance companies will reimburse patients for pills for diseases related to inactivity, but rarely for gym memberships. “Physicians really need to start defining the physically active state as normal,” he says.

Joyner says that he thinks about 30 percent of the responsibility to fight inactivity should fall on the medical community. “Physicians need to interact with patients about being active, and they need to write prescriptions for exercise,” he says.

He points to two of the greatest public health triumphs of the 20th century — improvements in traffic safety and the decline in smoking rates — as models for how we should tackle the inactivity epidemic. About one-third of the behavior change came from individuals who started using seat belts and car seats, and those who quit smoking, and doctors directly influenced that, he says. The rest was up to the public health community — to enact indoor smoking bans and harsh drunken driving laws — that helped support the right behavior.

For inactivity, doctors can push patients to get exercise, and cities and towns can make it easier for them to do it, he says, with more bike lanes and parks that can be an alternative to the gym.

Joyner says he increasingly sees two types of patients in his clinic: the ones who follow health guidelines and keep active; and those whose don’t and see no connection between their behavior and their health outcomes.

“We have to be more innovative and creative to figure out how to help the people who aren’t empowered to exercise for their health,” he says.

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West Nile Virus Hits Texas

This year Texas has seen more human cases of West Nile Virus than in recent years.  The Department of State Health Services reports 455 human cases.  The Dallas area has seen more cases than other Texas counties.  Twenty Texans have died of West Nile Virus in 2012.

What is West Nile virus?
West Nile virus can infect humans, birds, horses and mosquitoes. Infection from this virus is most commonly found in Africa, West Asia and the Middle East.

What are the symptoms of West Nile virus infection?
Most people have no symptoms. Others may have only mild symptoms (West Nile fever).  Symptoms usually occur 3 to 14 days after a mosquito bites you and last for 3 to 6 days.

Look for:

  • Skin rash
  • Fever
  • Headache
  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Swollen lymph nodes (lymph glands)
  • An achy feeling in the back and muscles

Symptoms of more severe illness include:

  • A sudden high fever (above 102°F)
  • Severe headache
  • Stiff neck
  • Feeling disoriented or confused
  • Tremors or muscle jerks
  • Seizures
  • Coma
  • Weakness or partial paralysis

Contact your doctor if you have any of these symptoms and have recently been bitten by a mosquito.

How is West Nile virus spread?
West Nile virus is most often spread by mosquitoes that become infected by biting birds that carry the virus. This happens most often in the warm-weather months of spring, summer and early fall. You cannot get West Nile virus from another person or from your pet.

Who is at risk for infection with West Nile virus?
People who live where West Nile virus has been found in humans, birds, horses or mosquitoes are at risk for infection. However, even in these areas, it’s very unlikely that you will get sick from a mosquito bite.  You are at a greater risk if you spend lots of time outdoors during the warmer months or if you don’t protect your skin with an insect repellent with DEET.

Who is most likely to get sick?

People 50 years of age and older and people who have weakened immune systems are at greatest risk of becoming severely ill from West Nile virus. Less than 1% of the people who do get infected with West Nile become severely ill.  Most people who either do not develop symptoms or only get mild symptoms. Less than 1% of those people infected will get a severe infection.   Almost all fully recover.

Is there a treatment for West Nile virus infection?
There is no specific treatment. People with mild symptoms usually get better after a few days without medicine.  People who have severe illness may be hospitalized and given intravenous (IV) fluids.

Can West Nile virus cause any other problems?
In rare cases, West Nile virus causes a disease such as a swelling of the brain called encephalitis or swelling of the membrane around the brain and spinal cord called meningitis.

Is there a vaccine for West Nile virus?
There is no vaccine to prevent West Nile virus in humans.

How can West Nile virus infection be prevented?
The best way to avoid infection with West Nile virus is to reduce the number of mosquitoes around your home and neighborhood.

Your best defense is to practice the “Four Ds”:

  1. Use insect repellent containing DEET (20-30%), picaridin or oil of lemon eucalyptus. Talk to your doctor before you use insect repellent on your child.
  2. Dress in long sleeves and long pants when you are outside.
  3. Stay indoors at dusk and dawn, when mosquitoes are most active.
  4. Drain standing water where mosquitoes breed. Common breeding sites include old tires, flowerpots and clogged rain gutters.

Questions to Ask Your Doctor

  • Is West Nile virus common in this area?
  • Am I at risk of contracting West Nile virus?
  • What can I do to protect myself from West Nile virus?
  • What treatment is best for me?
  • Will cold or flu medicines help?
  • Can my child get West Nile virus from me?
  • What kind of insect repellent should I use?
  • If I start feeling worse, when should I call my doctor?

Sources:  (Full  handout from

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My urine culture is negative, can I still have a bladder infection? « Dr. Jen Gunter

Dr. Gunter nicely summarizes symptoms of urinary tract infections in women.

My urine culture is negative, can I still have a bladder infection? « Dr. Jen Gunter.

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Life On The Rivet

Each day I strive for perfection.  Be a better teacher, husband, father, colleague, or doctor.  I’ve tried for years to back off, but have found relaxing this standard difficult.  What is “good enough”?

Things came to a head at a recent staff meeting.   I was updating the group on two projects.  The topics, though important to our overall mission, were neither popular nor exciting.  I simply wanted to check then off my To Do list and move on.  After a frustrating meeting, I struggled to relax during my afternoon clinic.  I enjoyed seeing patients quite a bit that day.  Several of them were doing better with the problems we had worked to solve; but I could not shake my earlier frustration.

I dreaded going into the hospital the next day, as I could think of many places I would rather be.  However, all the residents were in good moods, that morning’s drop-in delivery went well, and the case allowed me to teach the management of post partum hemorrhage to young physicians who were eager to improve.  That afternoon I was able to break down asthma treatment by physiological mechanism for one of our new interns and see the light bulb go on.

What ever happens on any day, work’s challenges are less frustrating after taking time off.  I leave for the Northwest in a few days to visit family and friends whom I have not seen in years.

When my tea pot is about to boil over, it’s time to for a break.

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