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Addiction, poor diet loom in Alaska deaths

By Rosemary Shinohara
Anchorage, Alaska (AP) March 2010

We know what Alaskans are dying from – mostly diseases such as cancer, heart disease, strokes and respiratory disease, plus injuries and suicide. But why are we dying in those ways?

A new University of Alaska Anchorage report looks at underlying causes of the top 10 Alaska killers.

Addictions and substance abuse play a role in nine of the state’s top 10 causes of death, the researchers found.

Poor diet and nutrition and exposure to harmful pollution are the next most significant factors in Alaska deaths.

The researchers see serious health conditions as rooted in other problems that can often be fixed before they lead to peoples’ deaths, said David Driscoll, UAA professor of health sciences and director of the university’s Institute for Circumpolar Studies.

Driscoll and research associate Bruce Dotterrer did the report, which is a first-of-its kind investigation that pulls together research on seven underlying causes of death in the entire circumpolar region, from Greenland and Iceland to Canada, Alaska, Russia and the Scandinavian countries. Driscoll and Dotterrer incorporated findings from 52 studies.

Besides addiction, diet and pollution, they connect causes of death to these factors: social isolation, access to clean water, global climate change and access to quality health care.

The goal is to guide public policy decisions in areas such as the importance of water and sewer systems in rural Alaska, how to get at what’s behind high teen suicide rates in villages, and how to target public information campaigns.

DIG DOWN

“What we’re talking about is reaching people in the communities prior to being sick, and focusing on what we know are the social and physical factors that cause the health-related problems,” Driscoll said.

Just looking at two of the causes of death – respiratory diseases and suicide – the study shows more than half the deaths could be prevented with more attention to the root problems, said Dotterrer.

The study also shows what factors are not as significant to why people die. For instance, lack of access to health care is linked to only one top cause of death for Alaskans as a whole, suicide. For Alaska Natives, access to health care is a bigger issue due to geographic rather than financial reasons.

The most important factors behind why we die:

Addictions are implicated in each of the top 10 causes of death in Alaska except Alzheimer’s disease. For example, smoking is linked to cancer. A history of substance abuse is associated with suicide. Drinking a lot of alcohol is tied to diabetes.

Environmental problems play into four of the top 10: cancer, heart diseases, injuries and chronic respiratory diseases.

Diet and nutrition are also linked to four reasons for dying: cancer, heart disease, cerebro-vascular disease (strokes) and diabetes.

CULTURAL CLASH AN ISSUE

The researchers separately examined causes of death for Alaska Natives. Suicide ranks higher, fourth versus sixth for all Alaskans, and homicides make the list as No. 7. Homicides are not on the top 10 list for Alaskans as a whole.

Addictions and substance abuse are still most significant, tied to seven of the causes of death for Alaska Natives. But the second-most important factor for Natives is social isolation. It is tied to heart disease, suicide, cerebro-vascular disease, homicide and diabetes.

Here’s an example Driscoll gives to describe social isolation: “With the Alaska Native community, lots of priority is placed on family, respect and care for elders, traditional knowledge and practices. When they try to use that in the larger Alaska community, they’re not successful. They’re in a completely different culture.”

In Bethel, Dr. Joe Klejka, medical director for the Yukon-Kuskokwim Health Corp., says the same thing.

Young people growing up in villages can draw on strong traditions. “Our villages are culturally intact. But everybody watches television. And they’re seeing a whole different set of values,” he said. “Kids get really confused. How are they supposed to know what makes them successful?”

START AT GRASSROOTS

Klejka is especially concerned about suicide rates – seven times the national average for the Yukon-Kuskokwim region, and 17 times the national average for teenagers.

“It’s not a simple solution of do you spend more money. I believe the true solution to suicide is grassroots efforts in the community to go back to their traditions and strengths.”

Two villages are carrying out a project pairing elders with a grandchild, or another young person they have a relationship with, working on problem-solving and planning, he said. They may start with a conversation on how to determine if ice is safe for ice fishing. “Over time, you extrapolate to how do you make the right decision about using alcohol or tobacco.”

In the Kotzebue region, cancers and unintended injuries are top causes of death, each responsible for about 17 percent, followed by suicides and heart disease, said Paul Hensen, Maniilaq Health Center deputy director.

“By far and away, smoking and alcohol are the biggest lifestyle contributers in the region,” said Hensen.

Maniilaq has emphasized tobacco-quitting programs, he said, and he thinks they’re starting to make a dent.

Maniilaq is also trying out some different techniques to prevent suicides, such as sending out letters to check up on people who have tried to kill themselves, and training selected young people on ways to talk to their peers about suicide.

NOT A SIMPLE MATTER

Dr. Jay Butler, who works for the federal Centers for Disease Control but is returning to Alaska as director of community health services at the Alaska Native Tribal Health Consortium, says the public health challenges described in the report are core issues for the 21st century, and not just in Alaska.

“It’s not like measles,” he said, where quarantines and vaccines almost eradicated a disease. Instead, there are addictions related to other addictions – such as nicotine and alcohol – and together, these addictions are contributing to diseases that overlay one another, like cancer and heart disease.

To tackle such problems as nicotine addiction, society has to change what’s normal, he said. An example: the fact that Alaska Native Medical Center made itself a tobacco-free campus. “Ten years ago people thought that there was no way that could happen. ... A new normal is often what it takes to help people make the change that oftentimes they want to make.”

Alaska Commissioner of Health and Social Services Bill Hogan says the Circumpolar Institute study is helpful and informative.

The study confirmed what the department believed regarding six of the seven root causes behind death in Alaska, he said.

As for the seventh root cause, climate change, Hogan said, “I think we are just beginning to understand the impact.”

The state has already had some success with reducing smoking, particularly among young people, and recently reported the fetal alcohol syndrome rate had come down by more than 50 percent, Hogan noted.

But it must do a better job of reducing the rates of obesity, unintended injuries and suicides, among other health concerns, Hogan said.

Driscoll said his experience points to the need for both community-level efforts such as the suicide and addiction prevention efforts described in the Bethel region, and broader public information campaigns, among other efforts.

A national advertising campaign called the “truth campaign,” funded by a tobacco company settlement, shows how effective such efforts can be, said Driscoll, who was an evaluator of that campaign.

The campaign focused on some of the reasons young people smoke.

“That same model can be used for a whole host of problems – sniffing, alcohol – we can provide people with the information they require to change their behavior,” he said.

 

 

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