"Pick your battles" is an old axiom, and one the health care crowd in Montezuma County is taking to heart.
Local nutritionists, clinicians and public health officials gathered at Axis Health System on Friday to assess how the county stacks up and diagnose recurring trouble areas.
Rebecca Larson, a consultant with the Omni Institute, rattled off statistics on obesity, exercise, accidental injury, food safety, pregnancy and smoking, among others. The data, covering 2008-10, was collected by the Colorado Department of Public Health and Environment and highlighted how localities compare to the state average. Over her one-hour presentation, Larson said she only "scratched the surface" of data available.
The meeting was meant to help Lori Cooper, county health director, hone in on the most pressing health concerns facing Montezuma County, to make combating them manageable. Trying to tackle them all at once dilutes the effect, she said.
Like other health directors in Colorado, Cooper is tasked with creating a "public health improvement plan" centered around one or two of CDPHE's 10 "Winnable Battles." She will use it to drive a targeted community campaign over the next few years.
If feedback from the health professionals was any indication, obesity is the top concern. It received twice the number of votes as any other issue.
"By far, obesity. It's a common enemy for all age groups," said Kelly Proctor, a health advocate with the Piñon Project Family Resource Center. "You see more obesity at younger ages now, with Type 2 diabetes in the elementary schools. It didn't used to develop until later in life."
Indeed, Type 2 - where the body does not produce enough insulin to metabolize sugar and it builds up in the bloodstream - was formerly known as "adult-onset" diabetes because it was almost unheard of in children.
One preconception that needs to be broken, Proctor added, is that healthy food is unaffordable for low-income families. Only 8 percent of children in Region 9 (Southwest Colorado) consumed the recommended five daily servings of fruits and vegetables, according to CDPHE.
"I've heard people argue it's cheaper to eat at McDonalds than buy fresh, whole foods from the grocery store," Proctor said. "I don't think that's true, especially when you (consider) long-term health costs and bills."
Kent Helwig, CEO of Southwest Memorial Hospital, agreed.
"Obesity leads to other chronic conditions like diabetes, heart disease and respiratory (malfunction). If we can work on promoting healthy lifestyles, with diet and exercise, it can go a long way toward easing the demand for expensive health services," he said.
Obesity was deemed a top scourge despite Colorado retaining its title as leanest state in the country, with an obesity rate of 20.7 percent. Obesity is defined as having a body mass index of 30 or above.
Even so, the health experts were not impressed. That number is still unacceptably high, they said, and continues to rise. When overweight people (25-30 BMI) are added, the rate rises in Montezuma County from two adults in ten to six in ten. A general consensus emerged: why settle for being the best of the worst?
Unintended pregnancy and poor oral health tied for second place.
In 2008-10, nearly half of all pregnancies in Montezuma County were not intended, meaning they came sooner than desired or were not desired at all. Statewide, Colorado's unintended rate was 38 percent.
Meanwhile, teen pregnancy (among girls 15-17 years old) was more common here than the state and regional averages.
Larson noted that teenage mothers are less likely to earn a high school diploma or GED certificate, and their children are more prone to behavioral, mental health and academic growth problems.
For strategies to bring the rate down, the panel mentioned filling gaps in sex ed curriculum, boosting self-esteem among teenage girls and finding positive role models for them. Too often teen pregnancy, like poverty, becomes a repeating generation-to-generation cycle, they said.
Oral health can be a struggle for many adults here, Cooper said, because in most cases Medicaid does not cover dental care. The health department can provide basic teeth cleaning for pregnant women, but nothing further.
Susan Ciccia, health services director for Montezuma-Cortez School District Re-1, said the schools periodically offer free dental screenings to students, but their parents are often left with few options.
"Some parents can barely make ends meet, so they neglect their own dental health to feed the family," she said. "If they're going to spend $500 a month on rent and food, or their mouth, it's not even a choice."
Most municipalities in the Unites States fluoridate their tap water to prevent tooth decay, but neither Cortez or Montezuma County are among them, the panelists noted.
Some of those assembled were influenced by the demographic they serve: infants and toddlers, teens, senior citizens.
Ciccia, for example, worried about access to infectious disease vaccines and tobacco consumption by youth.
While teenage smoking has declined since the 1990s, Ciccia believes rates are still too high, especially when chewing tobacco is included. She tries to intervene when a student comes to her with prolonged cold-like symptoms.
"If their cough just isn't going away, I ask if they use cigarettes," she said. "I use it as a teachable moment, explaining that the lining of their lungs is struggling to handle the smoke. That's why the cough (lingers)."
Warning of eventual lung cancer that could strike someday make the consequences of smoking seem far-off, making the student less open to quitting. So Ciccia tries to point out the present, immediate signals.
"You give them a graphic example of how smoking is negatively affecting their health here and now," she said.
Much of the data was bleak, but Larson finished on a chipper note. More than nine in 10 county residents self-reported being "satisfied" with their daily lives. She said the optimism was impressive considering that responses came during the height of the Great Recession.
And lots of people are doing just fine, physically.
"It's easy to (conclude) that our community is falling apart. But most people are healthy. Healthy people are the norm," she said. "We just have concerns about (the minority) who aren't."
Cooper said Monday that, after listening to all the input, she opted to keep it simple and concentrate efforts solely on obesity. The county plan should be released by late June.