ManagedCareSupplement3

GENERATIONS – Journal of the American Society on Aging

and reduce premature deaths is through healthy behaviors. Obesity, physical inactivity, and smoking are the leading causes of many chronic conditions, such as hypertension, heart disease, and diabetes. Other behavioral factors are poor nutrition, including diets low in fruits, vegeta- bles, and whole grains, high in sodium and sat- urated fats, and in alcohol or other drug use. Eating healthily and performing regular physi- cal activity help to prevent, delay, and manage heart disease, diabetes, and other chronic dis- eases. Older adults should aim for moderate physical activity (e.g., brisk walking) for at least 150 minutes a week, and should include exer- cises that build endurance, strength, balance, and flexibility. Smoking and excessive alcohol use also are associated with higher rates of chronic illness. Stopping smoking (or never starting) lowers the risk of serious health problems, such as car- diovascular disease, cancer, type 2 diabetes, and chronic obstructive pulmonary disease, as well as premature death. Over time, exces- sive drinking can lead to high blood pressure, many cancers, heart disease, stroke, and liver disease. By following drinking guidelines or not drinking at all, these health risks can be avoided. People with lower socioeconomic status (SES) experience more chronic illness than those with higher SES. Factors related to SES are income, total wealth, education, employ- ment, and neighborhood; these factors are tied to access and quality of care and people’s health behaviors. For example, experiencing a dearth of venues for purchasing healthy foods (e.g., food deserts), lacking opportunities for recreation and physical activity, and being exposed to toxic environmental conditions, such as lead paint, polluted air and water, unsafe neighborhoods ‘Physical health and mental health conditions are fundamentally linked.’

with few outlets for physical activity, all con- tribute to the development of chronic conditions and premature death. People with lower SES have greater exposure to these conditions, which directly influence their health. Also to consider is genetic predisposition, or family history of a chronic disease, which may make people more likely to develop diseases such as sickle cell anemia, Alzheimer’s disease, or cer- tain types of cancer. Thus, knowing about one’s family history is important to prevent condi- tions, or to identify and treat them early on. Chronic Conditions and Health Disparities Differences in health status or access to health- care among racial, ethnic, geographic, and socioeconomic groups are referred to as health disparities. Health disparities exist in all age groups, including in the older adult cohort. Disparities in the burden of illness and death associated with chronic diseases experienced by African Americans, Hispanics, American Indians/Alaska Natives, and Asian Americans/ Pacific Islanders, compared to the U.S. popula- tion at large, continue to be a problem. Examples include the following: Hypertension : The disparity in hyperten- sion and associated poor outcomes has been recognized for decades in African Americans compared to whites. African Americans experi- ence an earlier onset of the condition and lower rates of control leading to higher rates of stroke, kidney disease, and congestive heart failure (Lackland, 2014). Diabetes : The percentage of the U.S. adult population with diabetes varies significantly by race-ethnicity: American Indians/Alaskan Natives at 15.1 percent, Hispanics at 12.7 percent, and African Americans at 12.1 percent compared to whites at 7.4 percent (CDC, 2017). Cancer : Overall, the United States has expe- rienced declining cancer incidence and mor- tality rates due to reductions in tobacco use, greater uptake of prevention measures, adoption of early detection methods, and improved treat-

10 | Spring 2019

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