The recently released TeleVox Healthy World Report, A Fragile Nation in Poor Health, explores why so many people ignore their doctors’ advice. Across demographic lines, there’s a common finding: the health habits of Southerners are the worst in the United States.

“Although the South is known for its hospitality, there’s really no polite way to say this, but the collective health of the region is ‘going South,’” said Televox President Scott Zimmerman, primary author of the study. “Unfortunately, A Fragile Nation revealed millions of people living in the South are in denial about the state of their personal health. Only 5 percent … consider themselves to be unhealthy.”

According to the annual Unhealthiest States ranking, the worst offenders are Kentucky, Louisiana, Alabama and Arkansas, with Mississippi coming in last place for the tenth consecutive year.

“Despite the fact that so many Americans residing in the southern states are in declining health, they aren’t taking the appropriate actions to become healthier,” said Zimmerman. “In fact,  A Fragile Nation revealed more than eight of 10 Americans (82 percent) residing in the southern states admit they don’t follow treatment plans they’ve been given by their doctor exactly as prescribed.”

Zimmerman, who has been quoted as an industry expert in Fast Company, Wall Street Journal and USA Today, and has penned opinion pieces for American Medical News, Healthcare Finance News, Managed Healthcare Executive and Physician’s Practice magazine, highlighted these study findings:

• The Deep South has been coined “The Diabetes Belt.”
• Widespread diabetes in the South is linked to the region’s high prevalence of obesity and lack of exercise.
• Southerners represent the least active population in the United States.
• Folks in the South have deep relationships with food as evidenced with popular sayings such as “Food is love,” and “If it ain’t fried, it ain’t cooked!”
• Surprisingly, more than half of Southerners (53 percent) consider themselves to be healthy.
• Nearly half (46 percent) of Americans living in the South admit they don’t follow treatment plans as given by their doctor exactly as prescribed. They admit they would more readily follow their prescribed plans if they received reminders from their doctors via email, voice mail, or text telling them to do something specific, like “take medication” or “check blood sugar levels.”

“Southern culinary favorites include grits, soul food, and Memphis style barbecue,” Zimmerman said. “Many of the most popular American soft drinks including Coca-Cola, Pepsi-Cola, Mountain Dew and Dr. Pepper originated in the South. Southerners need physicians to truly partner with them to adopt healthier lifestyles. This is a proud bunch; so a soft touch, along with ongoing education, will go a long way toward helping them adopt healthier habits.”

Zimmerman pointed out not only Southerners have poor health habits. Midwesterners’ waistlines are expanding, partly because they lavish attention on bread and pastries.

“In fact, this region of the county is known as the nation’s ‘breadbasket,’ with favorites that include wheat and honey buns, kolaches, homemade pie, and traditional breads of all kinds,” he said. “The Midwestern diet is also filled with comfort foods such as casseroles, steaks, hamburgers, fried chicken, and pot roast. However, known for being open, honest and straightforward, Midwesterners are realists when it comes to their health.”

The Big Picture

According to the Department of Health and Human Services, a whopping 96 percent of Americans don’t eat their veggies; 40 percent don’t get regular exercise.

“It’s clear Americans have let themselves go,” he said. “As a result, 67 percent of Americans are currently overweight or obese, 27 percent have high blood pressure, and the nation’s population is in a chronic state of poor health.”

In 2008, 107 million Americans — almost one of every two adults age 18 or older — had at least one of six commonly reported chronic illnesses: cardiovascular disease, arthritis, diabetes, asthma, cancer, or chronic obstructive pulmonary disease (COPD).

“Perhaps this is because most Americans aren’t doing all they can to take care of themselves, nor are they getting the support they need from healthcare professionals,” he said. “This report asks why so many people ignore their doctors’ advice. This study is also designed to test the assumptions many of us make about how physicians interact with their patients, and why so many individuals fail to take the necessary steps to improve their personal health. Additionally, it helps to identify solutions that American adults say would most help them to step up and take control of their personal health.”

According to the National Consumers League, not following doctor’s orders for taking prescription drugs is associated with 125,000 patient deaths annually.

“One in three patients never even fills the prescription,” said Zimmerman. “Others forget to pick up their drugs from the pharmacy, skip doses, take their pills at the wrong time or take an incorrect dosage. And even for those who follow recommendations at the start, some eventually stop taking their medication altogether. And, that’s just medicine!”

Zimmerman was surprised to learn how many people fail to change their lifestyle, even after being diagnosed with a serious illness. A 2008 study in the Journal of Clinical Oncology examined the lifestyles of more than 9,000 cancer survivors and found that only a few had made the switch to a healthier lifestyle. Even though most had given up smoking, fewer than 20 percent were consuming five servings of fruits and vegetables daily; less than half were engaging in regular physical activity. Only 1 of 20 survivors routinely followed all three principles of healthful living.

The Doctor’s Point of View

“This lack of follow-through by patients exasperates doctors,” said Zimmerman.  A Fragile Nation revealed 15 percent of healthcare professionals is frustrated because patients don’t follow their treatment plans, and a mere 7 percent feel they’re successfully helping patients become healthier individuals. Although 37 percent of healthcare providers say their patients acknowledge the situation and have good intentions, many patients make excuses as to why they ‘can’t’ take charge of their personal health.”

So why do millions of Americans fail to follow doctor’s orders?

“Often, people don’t follow their physician’s instructions because they don’t have adequate information regarding their condition or medication,” said Zimmerman. “In many cases, people stop treatment because the side-effects of medication cause more symptoms than the illness. Sometimes people discontinue medications or other forms of treatment as soon as they feel better, assuming they’re cured rather than understanding they feel better because the treatment is working. And, some people never begin treatment or stop treatment early because it’s just too expensive.”

It’s no secret that primary care doctors are suffering from exhaustion, Zimmerman emphasized.

“They often don’t have the time they need to get to know a patient, think about their problem, consult with colleagues, and offer sound advice,” he said, noting that a recent study in the Annals of Internal Medicine showed where large numbers of physicians claim that a lack of control over their work, a hectic work environment, and time constraints during patient visits are negatively impacting their work and the health of their patients. “More than a quarter of primary care doctors complained of burnout, and at least 30 percent indicated they would leave the field within five years.”

Their chief complaint? Not surprisingly, it’s patients’ failure to follow advice or treatment recommendations, according to a recently published online survey of 660 doctors by Consumer Reports. “It’s no wonder doctors are overburdened and dissatisfied,” he said. “Every day, they face patients who aren’t accountable for their personal health nor do these patients take proactive steps toward becoming healthier individuals.”

Demographically Speaking

In general, women focus more attention on the health of their family members than their own health; men suffer silently. For most parents, two words describe them: stressed and tired.

“When parents aren’t working, taking care of the house, or taking kids from one activity to another, they don’t have time or energy to care for themselves,” said Zimmerman. “That means they have a hard time squeezing in exercise and they tend to eat whatever is easiest and quickest. The bottom line is an over-scheduled life leads to weight gain as well as increased rates of stress, anxiety and physical ailments such as headaches, stomach upsets or backaches, skin rashes, recurring colds or flu, or muscle spasms.”

Another important trend: unemployment is making Americans sick – literally!

“The high unemployment rate and lack of jobs is taking its toll on the health of Americans nationwide,” said Zimmerman. “A Fragile Nation revealed the nation’s unemployed report being significantly less healthy than working Americans. Three in five people who are out of work say their overall personal health is lacking, with more than one-quarter of unemployed Americans saying they’re struggling with their health. Conversely, nearly 60 percent of people who are gainfully employed feel good about the state of their personal health.”

When people lose their jobs through no fault of their own, they’re twice as likely to develop a new ailment such as high blood pressure, diabetes or heart disease over the 18 months following being dismissed, compared to people who are continuously employed, added Zimmerman.

Stress and obesity are the two greatest health challenges plaguing Generation Y, primarily because they were born into a world that makes it easy to become overweight and obese.

“They’ve been sitting in front of computers and playing video games since they were children,” Zimmerman pointed out. “They’ve grown up on a steady diet of sugary drinks, processed and fast foods. In addition, their childhood, filled with planned activities, has extended into their adult lives, and they’re very busy and overtaxed. Moreover, longer working hours and fewer opportunities for physical activity in the workplace feed the cycle of stress and poor health habits.”

Also exacerbating the problem, Gen Y patients, who have grown up in a society of instant information, want quick solutions to their problems.

“They expect fast treatment or a ‘quick cure’ for their medical problems, which leads to frustration when they have chronic ailments like stress and weight problems,” said Zimmerman.

Generation X was pushed toward adulthood at an early age. They represent the latchkey generation.

“Gen Xers learned independence early in life as they often found themselves home alone while their parents worked,” noted Zimmerman. “While they were fending for themselves, microwaving was considered cooking and TV dinners were the norm. Unfortunately, processed foods continue to be a staple for Gen X Americans. As a result, they’re more prone to obesity, which puts them at a higher risk for diabetes. It’s no wonder diabetes is one of the worst diseases facing Generation X.”

Baby boomers aren’t faring much better. A Fragile Nation revealed that more than half (56 percent) of American baby boomers don’t feel their overall personal health is in good shape, and one in four say they’re struggling to be healthy.

“This is in large part because millions of baby boomers are overweight and inactive, which leads to an increase in chronic diseases such as heart disease and diabetes,” said Zimmerman. “Excess weight also puts extra wear and tear on the body’s muscles and joints, making it more difficult for boomers to do things they used to take for granted like climb stairs, get up from a chair, or lift their arms over their heads.”

Lasting Solutions

With these challenges in mind, Zimmerman offered three imperatives to healthcare providers for creating a healthier world.

     1. Touch the hearts and minds of patients to drive positive behavior change.

     2. Engage patients with information and encouragement between visits.

     3. Activate patients to make positive behavior changes for a healthier life.

“The driving force behind the goal of creating a healthier world,” he said, “is all of the healthcare professionals around the world who take the time to engage patients with personalized, thoughtful, ongoing interactions that activate healthier habits and encourage them to live healthier lives.”

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