How has America's health changed during the COVID-19 pandemic? Dr. Rhonda Randall, Chief Medical Officer of UnitedHealthcare E&I, speaks with host Ira Apfel and offers some perspective, using the 2021 America's Health Rankings Annual Report.
The 2021 America's Health Rankings report paints a complex and nuanced picture of America's health during the COVID-19 pandemic, including reversals of longer term trends across several measures. Some figures in the report appear at first glance to be quite alarming, while others appear surprisingly strong. Dr. Rhonda Randall, Chief Medical Officer of UnitedHealthcare E&I, breaks down the findings with host Ira Apfel.
SPEAKERS
Ira Apfel, Dr. Rhonda Randall
Ira Apfel
Hello and welcome to UnitedHealth Group’s Weekly Dose Podcast, where we'll get you up to speed on the latest trends shaping the future of healthcare.
Ira Apfel
Last month, the United Health Foundation, the philanthropic foundation of UnitedHealth Group, released its 32nd annual America's Health Rankings report. The 2021 America's Health Rankings report includes new, publicly available data, and it paints a complex and nuanced picture of America's health during the pandemic, including reversals of longer term trends across several measures. The 2021 edition may be of particular interest because it provides insights into the early effects of COVID-19 on America's health and wellbeing. Some figures in the report appear at first glance to be quite alarming. Other numbers appear surprisingly strong, given the context of global pandemic anyway, you can read the entire report at AmericasHealthRankings.org.
Ira Apfel
But here today to help us make sense of the report's findings is Dr. Rhonda Randall. She's a returning guest to the podcast, and she is Chief Medical Officer for United Healthcare E&I.
Ira Apfel
Dr. Randall, welcome to the podcast.
Dr. Rhonda Randall
Thank you. Happy to be here.
Ira Apfel
Thank you and happy new year to you. I guess the first question is, can you briefly explain the America's health rankings for listeners? What is it?
Dr. Rhonda Randall
Thanks for that question. So America's Health Rankings is the longest standing population health report of its kind. Now in its 32nd edition, the annual report really provides a comprehensive look at our nation's health on a state by state basis, I always ground people that America's Health Rankings is right in the title. This is America's data. It comes from more than three dozen publicly available sources of information. So it's not UnitedHealthcare or UnitedHealth Group's data, I think sometimes because of being produced by the United Health Foundation, folks might think that but this is America's data. Number two, it looks at our health very comprehensively. And it uses the WH OHS definition of health, which is much more than just the absence of disease. It looks at our health, from socio economic factors from our behaviors from the clinical care we receive when we go to the doctor, or the hospital to outcomes and behavioral health, social factors, all of these things into consideration. And then lastly, it's a ranking. So it's rating each of our states in relativity to one another. So what is a state that has ranked the highest for one of those 80 measures in the report? What is the state that is most challenged, or ranked the lowest with each of those majors? So that's America's health rankings, again, more than 80 different majors for more than 30 different public health sources.
Ira Apfel
I imagine that there's some interesting data and interesting information for the 2021 addition, why in your own words is 2021 so important? Why is this addition of particular value to listeners, and physicians and clinicians?
Dr. Rhonda Randall
This year, we really see a significant effects. both direct and indirect of the pandemic are majority of the majors. The most recent available data is from the year 2020. There are a couple of majors in the report that the most recently available data is 2019. So it predates a pandemic. And there are even a few that include 2021, particularly around healthcare workforce measures, but the majority of the measures are through calendar year 2020. So it really gives us some insights as to how that complexity of our health was affected, again, both directly as well as indirectly by the COVID-19 global pandemic.
Ira Apfel
So let's dive into some of those numbers. I guess my first question to you regarding the results, the data from the 2021 Annual Report is, what were the contributing factor factors, pardon me to the historic death rate during the pandemic?
Dr. Rhonda Randall
Yeah, thank you for asking that question. You know, that is really the most devastating piece of data that we see in this year's report is that there is a 17% increase in the death rate in the United States between 2019 and 2020. That comes from the CDC WONDER files for mortality. So, right it's just telling us this year death rate, but we know from looking at other sources from CDC and more, that probably about two thirds of that can be explained by COVID being either the primary or a contributing factor to those increase in death rates. Some of the other things that we see with statistical significance are an increase in drug deaths, there were 93,000 more drug deaths in 2020 versus 2019. So that's quite significant. The report doesn't include this information. But we also saw some published reports that heart disease, and that that may be from delayed care early in the pandemic. And Alzheimer's disease also had some increase in diagnosis and death rates.
Ira Apfel
There are some surprising findings around the prevalence of multiple chronic conditions, including cancer and arthritis and high health status as well. So what do you make of these trends? And will they continue?
Dr. Rhonda Randall
Yeah, that's multiple chronic conditions, you may or may not be surprised to hear it decreased 4%, nationally from last year's report to this year's report, for the second year in a row, it's wrought. And we're concerned that that can't all be explained by less individuals having chronic conditions, and that it is more likely that individuals were skipping a care for those chronic conditions and it wasn't getting documented. So again, this comes from asking individuals, if they've been told by their physician, if they have one of eight chronic conditions, these are things like asthma, cancer, heart disease, arthritis, chronic kidney disease, chronic lung disease, diabetes, depression. And out of all of those, the one that decreased the most was cancer. And we're worried that was because that it may be because there was less detection because we were looking for it less. So we know that during the pandemic, less people got screened for things like breast cancer and colon cancer and others. So this is one we're going to be watching very carefully. And the United Healthcare, we've been very focused over the last two years on making sure that our members returned to care that they get those cancer screenings that for can you know, screenings, like colon cancer, were noninvasive tests can be done easily at home as an alternative to getting a more invasive test in a healthcare setting, that access is available.
Ira Apfel
The Annual Report found a decrease in excessive drinking for 2021, which is inconsistent with reporting from other sources. So why do you think that is?
Dr. Rhonda Randall
Yeah, you know, I think we all saw, you know, high rates of liquor sales happening during the pandemic, this did surprise me, when I saw that saw the decrease in excessive drinking, it's notable that what went down was binge drinking that went down the most. And, in contrast, heavy drinking increased a little bit during the same period of time. So it may be that we saw a shift in drinking patterns, where instead of consuming a large amount of alcohol on a single day, that more people were drinking more heavily throughout the week. You know, and you can, you know, maybe think about bars being closed and college campuses being closed in, you know, did that have some contributing factor? Of course, the report doesn't tell us the cause we just measure the data. But it's, it's a surprising finding.
Ira Apfel
Some experts say that most Americans mental health suffered during the pandemic. So why did frequent mental health distress decrease in the America's health rankings? And also, why did men and women experience such different rates?
Dr. Rhonda Randall
Yeah, you know, we, I think everyone, at a minimum experience more stress over the last two years, frequent mental distress. This comes from the CDC Behavioral Risk surveillance system. It's a telephonic survey, it asks adults, how often over the last 30 days did they experience mental distress, and frequent mental distress is defined as those who said 14 or more days, last month, I experienced mental distress. So a very high number we saw nationally, it decreased 4%, which also surprised us but when you unpack that, you know, often with this report, and the national trends can mask what's going on underneath. So when we look at a state level when we break it down by sub population, What we see is, females experienced a rate of frequent mental distress one and a half times higher than their male counterparts. So, among the females surveyed by the CDC 16%, said that they experienced frequent, well distressed wood, and it was less than 11%. For males, we also saw that for those who are of a higher income level, they experienced significantly less frequent mental distress than those who make less than $25,000 a year. So it was about slightly less than 21% for the population with an income less than 25,000. And less than 9%.
Ira Apfel
You know, one of the other interesting findings from the report was about insufficient sleep. First of all, I was just surprised that insufficient sleep was in the America's health rankings. But it includes a seemingly hopeful or good binding about insufficient sleep. What is that finding? And why is insufficient sleep included in the rankings?
Dr. Rhonda Randall
Yeah, we know, we now know how important sleep is to our overall health. And I'm glad that we have included it in the report, we see that those who get fewer than seven hours of sleep in a 24 hour period there that there is a significant linkage to higher rates of chronic disease, for example. So we saw that insufficient sleep decreased 6%, nationally between 2018 and 2020. So this is looked at over a two year measurement period. But we saw some really significant differences by race. And I think we also saw some pretty significant differences by income levels in this measure as well. So the decrease in insufficient sleep was most notable in Asian adults and adults who identified their races, other guests compared to American Indian and Alaska Native and multiracial adults, they had the highest rates of insufficient sleep. And no, I think a worthy conversation to have here is, you know, we're those who are in careers that were able to telecommute, right. And instead of spending time in their car driving to and from the office, now they're able to get a little bit more sleep, you know, as compared to people who were essential workers. And in Is there something within the data to look at there?
Ira Apfel
I think it's safe to say that COVID-19 has had some unusual impacts on some of the measurements in America's health rankings, particularly obviously, the 2021 edition. So I'm wondering, as for you, as a physician, how hard is it to interpret these findings and use these findings,
Dr. Rhonda Randall
I think it's really important to have a grounding in the overall platform of America's health rankings in the data in the reports and understand and appreciate the nuance, and the complexity, even without a pandemic, right, recognizing that our health is comprehensive. That's why we put this report together, it's a call to action for individuals and their communities, you know, with in each of these things that we see whether they're disappointing, but not surprising or surprising. If you look at it at a state level, and you look at it at the sub population level, that's really where you find the opportunities for improvement in our health.
Ira Apfel
I'm wondering, what do you want listeners to take from America's health rankings? What do you want them to? You know, what's the call to action? What is the thing that you want them to take from it?
Dr. Rhonda Randall
You know, every year that we look at the report, you know, there's clearly some pieces around national calls to action. A really great example of that is around cigarette use. Over the last 32 years, we've seen cigarette smoking in the United States decline from around 30% of US adults to around 16% of US adults, using tobacco products. And that was done by a lot of different factors. There was no single thing that did it but a call to action was, you know, about supporting someone who desire to quit smoking. And, you know, unfortunately, we're now concerned that we're seeing, potentially seeing some of those gains, clawed back by the rise in the use of E cigarettes, for example, but The call to action with this report, it really has to be around mental health, behavioral health and returning to care. So we want to make sure that we are getting children back to get their childhood immunizations, that individuals are getting an annual wellness exam and if they're not comfortable to return to a physician's office to consider telemedicine and other sources of getting those cancer screenings, etc. That's going to be really important. We don't want to replace one problem with another.
Ira Apfel
Dr. Rendell, thank you so much for being on the podcast today.
Dr. Rhonda Randall
Thank you. It was great to be with you.
Ira Apfel
That's it for this episode of UnitedHealth Group's Weekly Dose Podcast. Please subscribe to the weekly this podcast on Apple podcasts and Spotify. And as always, thank you for listening and have a great rest of your week.