MAY 17 2015

COMMUNITY HEALTH REPORT The strength of our community depends on you

This Counts Revolution: A federal report shows how our community stacks up against others across Indiana and Michigan, as well as the entire United States. In some respects, we’re on the right track, but in others, we have a lot Free health of work to do. Many local leaders are stepping up to say it’s time we get moving. Every little bit we can do counts toward a healthier life. and wellness event Saturday, May 30 Published by: Details on St. Joseph County Health Department Elkhart County Health Department Page 23 LaPorte County Health Department Berrien County Health Department COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 2 contents

Rankings focus on quality of life ...... 3

Our health is at stake Health oficers speak out ...... 4

For the past two decades, communities we serve. Cultural shift ...... 5 the health of our community We are all in this togeth- has been on a steady de- er. The poor health seen in Local resources ...... 6-7 cline. According to the Robert our community is a result of Wood Johnson Foundation’s a continuing cycle that can Health drives our economy ....8 health rankings, St. Joseph only be broke when we all County was the 26th healthi- decide to change. This is a est county in Indiana in 1991. moment for all of us to step Closing the gap ...... 9 Today, we have fallen to 41st up to the challenge and make on the list. What makes this real progress in improving 5 changes you can decline more unsettling is our individual and community make today ...... 10 while we sit in the middle of health. Help us make the Mi- the Indiana rankings, Indiana chiana of tomorrow a healthi- as a whole is one of the er place for everyone. Simple swaps unhealthiest states in the for healthy snacks ...... 11 country.

In St. Joseph County, 21 per- Albert L. Gutierrez, FACHE, MBA How healthy are we? ...... 12-13 cent of our adults smoke, 29 President & Chief Executive Oficer, percent are obese, 25 percent Saint Joseph Health System are reportedly inactive, and Support from others helped 19 percent of adults admit to her quit smoking ...... 14-15 excessive drinking. A closer look at our rankings shows Taking control that 37 percent of all driving of diabetes ...... 16-17 deaths are alcohol related. When we look at the counties Kim Wilson, surrounding St Joseph, the President & Publisher, Small changes, South Bend Tribune numbers are equally bleak. big weight loss ...... 18-19 As leaders in Michiana, we recognize it’s time for us to Mental illness doesn’t hold ourselves accountable ...... 20-21 to improve the health of the deine him

This Counts Revolution ....22-23 COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 3 Rankings focus on ‘quality of life’ A starting point to improve our county’s health

By Alice Culp Most of our region’s counties South Bend Tribune have good access to health care, Community leaders keep looking but most also have a higher per- for strategies to jump-start the local centage of adult smokers, teen economy. birth rates and excessive drinkers Efforts are made to spark innova- than the U.S. median. Most are tion, entrepreneurship and invest- failing in air quality and are at or ment. Other initiatives are trying to above the U.S. median for physi- prepare workers for the future. cal inactivity. Regionally, only two But when it comes to attracting counties — Elkhart and St. Joseph business and workers to the region, — were less obese than the U.S. one component is often mentioned median. This greatly impacts a only in passing because it’s dificult county’s overall rating, since obe- to implement — boosting the overall sity contributes to other conditions health of the community. like diabetes and cardiovascular It is both a medical and an eco- disease. nomic problem. All these factors play into the “Ultimately, if you don’t have most important health outcome, the healthy workers, you don’t have premature death rate, Johnson said. a healthy economy,” said Robin Social and economic factors also Vida, director of health education inluence it. for the St. Joseph County Health “Things like income and poverty Department. She explains that health really matter in health,” Johnson plays a big role in workers’ atten- said. “It affects families’ access to dance and productivity. affordable housing, a living wage Alysia Palm, of South Bend, plays disc golf at Rum Village Park in South Bend. Indiana And the region does have health to be able to buy healthy food and residents are among the most inactive, but we can make a big difference by going outside issues, according to the Robert their ability to pay for good child and doing something. Tribune Photos/ROBERT FRANKLIN Wood Johnson Foundation. The care.” New Jersey-based nonproit produc- Several local counties had a broad- es an annual County Health Rankings er disparity between low-income track their progress. report which compares nearly all the and high-income earners than the But no organization can make a dif- nation’s counties based on the same U.S. median. And the unemployment ference alone, Vida said. It has to be 30 health factors such as diet and rate, while slightly better than several a collaboration. exercise, access to clinical care, edu- years ago, is still an issue. In fact, for Locally, there is a movement to do cation, unemployment and physical the irst time in several years, most of just that called the Community Health environment. Indiana’s surrounding states, includ- Improvement Alliance. It is composed “The idea is to identify those ing Michigan, have lower unemploy- of community leaders, educators, health factors that we can inluence ment rates. business professionals, civic groups, and develop strategies to address In a way, a healthy community is agencies and health care organi- them,” said Stephanie Johnson, an something of a chicken and egg zations in St. Joseph and Elkhart associate researcher with the Univer- problem. counties. The health department, as sity of Wisconsin Population Health Low-paying, low-skilled jobs and a neutral party, facilitates and hosts Institute, which helps compile the higher unemployment result in a bimonthly discussions where the foundation’s study. population with physical and mental group can talk about the goals it is The study ranked St. Joseph Coun- health issues. At the same time, the trying to accomplish, resources it has ty 41st out of Indiana’s 92 counties. population’s health is going to affect and how it can work together to build This is not good, especially since whether companies decide to open, successful programs. a United Health Foundation study relocate or expand in the region. “Everyone deinitely bought in,” ranked Indiana 41st in the nation This is why County Health Rankings Vida said. “We’re working for the are important. The data gives com- same people. We need to move the A group plays basketball at Coquillard Park when it comes to health. Only nine in South Bend. Physical activity is not only states are worse. Michigan is a bit munities a starting point to improve needle together. Stop competing fun but crucial to living a healthy life. better at 34th. their outcomes and provides a way to and start doing.” COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 4 County health oicers speak out We asked the county health oficers of several surrounding counties for their thoughts on the health ratings and what we should do about them. Here are the answers of those who responded.

Dr. Dale Deardorff Tony Mancuso Dr. Daniel Nafziger Dr. Frederick Johansen Interim health oficer at the LaPorte County Health Elkhart County Health Medical director for Berrien St. Joseph County Health Department administrator Department health oficer County Health Department Department and Van Buren/Cass District Health Department

From your observations, get a strategy together, tactics that vironment, like air and water, is also erty. The Horizon Education Alliance what health factors are the we agree on, then you get move- good; we are 22nd in the state. is busy in Elkhart County working Q biggest problems in your ment going forward. That’s what with our schools in impacting edu- county? And what has the county we’re looking for with our partners in Dr. Daniel Nafziger cational factors that can eventually improved upon? the community health alliance that translate into better health. came out of the evaluation that was There are a variety of health done in 2011. About 50 to 60 agen- behaviors that are challenges Dr. Frederick Johansen Dr. Dale Deardorff cies not just in St. Joe County, but in A in Elkhart County. Smoking re- Elkhart County, as well, have come mains the leading cause of prevent- I’m happy that we’re doing The state health department together and are working behind the able death in the United States, and better than all of our com- objectives are reducing obe- scenes and working on issues and our smoking rate of 20 percent is still A parison counties but one. A sity, reducing the smoking making some inroads in those areas. too high. Like many other commu- Preventable hospital stays and dia- rate and reducing neonatal mor- nities, our obesity rate and physical betic monitoring are better in both tality. Those are certainly the ones Tony Mancuso inactivity rates are also too high. Our counties than they were previously. that are called out in our county teen birth rate also exceeds that of Obesity is worse and we already health rankings as actionable items The area we need to work any of our neighboring counties. were fat. In Berrien County, our we know will make a difference most on is premature death. Our health outcomes (premature physical activity is worse. Those two in our health outcomes as we go A That’s what is really hurting in death and low birth weights) tend things (obesity and physical activity) forward. Obesity, as you know, will LaPorte County. We ranked 75 out of to be better on average than most go hand in hand. increase your likelihood of devel- 92 counties (in Indiana). It’s our main counties in Indiana. There isn’t a de- In Cass County, the number of oping diabetes, it will increase your goal this year. Last year, we formed initive explanation for this given that primary care physicians to people likelihood of heart disease and of a neonatal task force to address this. the “health factors” in the report (according to the study) is really bad. hypertension. It also increases your It includes the health department, tend to be worse than average. The But this is an incredibly misleading premature birth rate percentage. both hospitals, the schools, Swanson relatively poor health factor rankings number. Doctors don’t hang shin- There are habits we’ve gotten Center — a couple of agencies are may catch up with us eventually. gles out in Cass County, but we better with. Obviously smoking has involved. We meet together quar- There are areas where we are doing are surrounded by medical care. improved over the past 50 to 60 terly. The state has a grant that we better than average, such as the We’ve done a study on this. People years. But it’s been a struggle in the are going after that would help us monitoring of (blood sugar tests) in in the southeast part of the county county with the smoking ordinance. develop this program. Also, every older diabetics, that suggest phy- go to Elkhart for medical care. In There are people being harmed by Friday, the health department offers sicians and nurse practitioners are the southwest corner, they travel to smoke and secondhand smoke and a free pregnancy test. We’ve taken doing a good job in testing their Niles, South Bend or Elkhart. People it’s relected in the premature deaths a proactive approach and now we patients. in the northeast corner of the county we see in this county. need to expand it more and work There are lots of opportunities for go to Kalamazoo or Sturgis and It’s a challenge for us as a commu- more with the schools on this. us to improve our rankings. Private those in the northwest go to Lake- nity. Are the programs we’re invest- We are 26th in clinical care. We’re industry and government can both land. It’s only about a 15- to 20-min- ing in the programs we’re identifying good there. We have small clinics work at reducing unemployment and ute drive from those corners to their really making a difference? If we can and the hospitals. Our physical en- the number of children living in pov- medical care. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 5 We need to make a cultural shift It takes a whole community’s effort to change a community’s health

By Alice Culp something positive. I think South Bend Tribune the only way to motivate Dr. Brian Moloney has been people is to start a con- a member of our commu- test — a state-wide contest nity for 35 years as a family with everyone involved. physician. He previously Mayors having a battle with practiced at River Park Family other towns. You can pick Medicine in South Bend. He whatever metric you want currently is medical director — smoking, losing weight, for Select Health Network in walking more. Top-of-mind South Bend, a collaboration awareness is really import- between Saint Joseph Health ant. If you start hearing System and more than 750 about something over and area physicians. over again and reading it on Facebook, it’s a fun thing. We feel that we’re How do we com- better than the people in pare to the rest of Fort Wayne. We’re going Q the country when it to show them. It’s cheap. comes to health? The whole state could get behind it. It could be a new Not good. But it’s a form of Hoosier Hysteria statewide thing, not with weekly standings in A just St. Joseph Coun- the media. ty. We’re just a microcosm of the state. According to the Dr. Brian Moloney poses April 29 at Select Health Network in the Commerce Center in South Bend, where he works. Moloney spent 35 years in family medicine before joining Select Health. SBT Photo/BECKY MALEWITZ United Health Foundation, What are some which has been doing state things we could do Q as individuals to ranking for over 25 years, for business, and one of cern about the brain drain. years trying to motivate my improve our health? Indiana is 41st. Twenty-ive our biggest hidden costs is We have many excellent patients and a lot of them years ago Indiana was 26th. our poor health status. For universities. Maybe people changed, but some didn’t We smoke way too We’ve been deteriorating. example, higher insurance are leaving because this isn’t because we’re human be- much. Smoking is not The past three years we’ve premiums for workers and a happy area. ings, we’re weak. I was really A being taken seriously stayed the same and we more absenteeism because a salesman and an educator. and it is the single biggest didn’t lose much ground workers aren’t healthy. And What can we do to But I was competing with ixable health problem during the recession — we then there are those who change things as a better salesmen — Budweis- we’ve got. If you look at the may have gone from 38th work while sick because they Q community? er, Sara Lee and Marlboro. health dollars that are spent to 41st over the last ive or can’t afford not to work. They are very effective sales- because of smoking, it’s six years. We had big losses Their performance tends to men. We’re doing nothing as just phenomenal. Our local much earlier. The question be worse. These costs aren’t Community action a community to counteract government won’t even ban is why are we so much worse as easily calculated. means everyone has those messages. We should smoking like other places — than most of the rest of the Also, a couple of the pa- A to be involved. It’s be. Every politician in our big cities can do it. country? It’s not genetics. rameters in the (2014 Amer- hard for humans to get state should be embarrassed Obesity to a larger extent It’s got to be something that ica’s Health Rankings) study motivated when the people that we’re 41st. would be taken care of if we’re doing or that’s being are created from surveys around them aren’t. If all I think we have to do people would eat better and done to us. of people, asking about your best friends are walking something novel. I know it exercise. It’s not rocket sci- depression. Indiana ranked everyday, you’re going to sounds silly, but I’m se- ence. But the problem is that be more likely to walk with rious about it. Everyone How do poor health 40th in “feeling depressed” we don’t see anything in our them. If all of your friends are likes to think that he’s the rankings affect us as and 39th in “being in good community or our state that health.” We’re not a happy getting together every night best. We live in a society Q a community? espouses the idea of doing state. How much does health to have beer and chips and now that is dominated by these things. We need lead- contribute to that? If you’re watch a sappy movie, you will reality television, social ership at every level to try We’re a state that is feeling good, you’re happier likely join them. It’s hard to media and direct market- to get people to be health- pro business. Our and not depressed. Those get the critical mass to make ing. We could use those ier. When something is top A leadership needs to surveys push our ranking a change. People are not to start getting people of mind awareness, I think think about hidden costs down a little bit. There’s con- motivated by data. I spent 35 to pull together and do you’re more likely to do it. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 6 The help you need is close at hand Here is a list of some of the resources available in our community to help you attain your wellness goals.

DIABETES EDUCATION, nity members. An 8- to 10-week Plymouth Parks and grown food. To aid those with BEHAVIORAL PREVENTION AND IM curriculum on diabetes self-man- Recreation Department diabetes, Unity Gardens provides HEALTH RESOURCES agement. open vegetable gardens and free PROVEMENT PROGRAMS 574-936-2876 gardening classes to increase Bowen Center YMCA of Michiana— Trails, parks, programs, arts and access to healthy, fresh produce. Memorial Hospital of recreation, and other services to 574-936-9646 Diabetes Prevention YMCA of Michiana South Bend—Healthy help community members re- Team of psychologists, psychi- 574-287-9622 Diabetics Program main active. 574-287-9622 atrists, nurses, social workers, 574-647-1350 Designed to help those at high Putting Christian principles into therapists and chemical depen- risk to adopt and maintain St. Joseph County Health practice to build a healthy spirit, dency specialists helping with Each client is assigned a Com- healthy lifestyles and reduce mind and body. Fitness facility a range of concerns, such as munity Health Worker to help Department—Reducing their chances of developing includes personalized wellness inpatient, outpatient, and home with diabetes support and edu- Obesity Coalition Type 2 diabetes. coaching, group itness classes, and school services. Also pro- cation and medication manage- 574-235-9750 cooking/healthy eating classes and vides services for youth issues, ment. Participants are provided students, employee assistance Promotes events to help reduce LIVESTRONG for cancer survivors. a glucometer and test strips. programs, autism and telepsy- NUTRITION & WELLNESS obesity. Provides toolkits, PROGRAMS chiatry. Saint Joseph Health resources and local guides to ALCOHOL AND TOBACCO support healthy lifestyles. RESOURCES System—Diabetes Earthworks Healthy Families Education Program Saint Joseph Health 574-287-0541 574-935-4164 Alcohol and Addictions 574-335-2372 System—55+ Senior Weekly services to families Based on the belief that edu- Resource Center Four group classes and 6 cation is critical in the effort Fit Program in an effort to prevent child 574-234-6024 abuse and neglect. Informa- months of individualized to protect our planet, it offers 574-335-3891 tion and support for domestic follow-up, offered at our Misha- programs for adults and children Provides families and individuals violence, substance abuse, waka and Plymouth campuses. to help them learn how to live Classes at four different loca- an anonymous and conidential post-partum depression, Recommended for individuals sustainably. Offers food co-op tions throughout the week at a resource, which allows for safe immunizations and medical newly diagnosed with diabetes, and classes on eating healthy. variety of times to engage those discussion of alcohol and drug appointments and thoughts those not previously educated Sponsored by the Poor Hand- 55 and older to stay active. issues. in diabetes care, potential pump maids of Jesus Christ. of suicide. candidates or family members of Saint Joseph Health Indiana Tobacco Quitline diabetics. Also provides support Memorial Epworth Center The Food Bank System—Nutritional 1-800-QUIT-NOW groups. and Epworth Hospital of Northern Indiana Counseling for Children (800-784-8669) 574-647-8400 Saint Joseph Health 574-232-9986 574-335-6240 Free cessation coaches help with Memorial Epworth Center and System—Bilingual Diabe- Works with community orga- A pediatric registered dietitian creating an individualized quit provides medical nutrition thera- plan. May provide two weeks of Epworth Hospital make up the tes Program: “Si Yo Puedo nizations to feed the hungry, inpatient psychiatric care increase awareness of the py recommendations based on a free nicotine patches or nicotine Controlar mi Diabetes” uniied body of scientiic research gum. division of Memorial Hospital effects of hunger and alleviate of South Bend. 574-335-2372 hunger. and recognized by the Academy of Nutrition and Dietetics. Memorial Hospital— Diabetes management class for Michiana Behavioral Kroc Center Quit Smoking Spanish-speaking community Health Center members. Includes nutrition 574-233-9471 South Bend Parks and 574-647-1801 education, physical activity and 574-936-3784 Recreation Individual counseling sessions meal plans. Programs and activities for art, education, sports and itness, 574-299-4765 for 30 minutes each week for 5 Acute care services, partial weeks to develop a plan to quit hospitalization and residential designed for the entire family Leisure, health and wellness, hu- St. Joseph County Minori- and for individual age groups. smoking. care services. Also, support man development, environmental and family therapy, education ty Health Coalition— stewardship and other programs. Saint Joseph Health and substance abuse preven- Diabetes Empowerment Marshall County tion. Education Program Neighborhood Center Unity Gardens System—Tobacco-Free 574-232-4234 574-936-3388 574-315-4361 St. Joseph County 574-335-3896 A 20-hour workshop to train Healthy and nutritious options in A network of community gar- health workers to provide diabe- the food pantry, healthy cooking dens to increase the availability Working for smoke-free air and tes education to other commu- classes and other services. and awareness of healthy, locally providing cessation resources. See more resources on Page 7 COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 7

NAMI (National Alliance Saint Joseph Health Bendix Family Medicine Saint Joseph Health personal fulillment and dignity on Mental Illness) System—Breastfeeding 574-245-4980 System—Family with independence and mobility, including help with transporta- 574-259-3564 Mothers’ Support Group High-quality, cost-effective and Medicine Center tion, Medicaid, Meals on Wheels Education and training for family 574-335-4127 patient-friendly primary care 574-335-6500 and other services. to isolated and underserved members, parents, teachers and Support group for breastfeed- Families and patients are accept- other mental health allies. residents of South Bend and Marshall-Starke ing mothers, meeting from 2 to surrounding areas. Offers a ed based upon medical need 3:30 p.m. on the irst and third sliding-fee scale based on the as openings become available. Development Center Oaklawn Psychiatric Center Wednesday of each month. Each family or individual is 2011 Federal Poverty Levels 574-936-9400 269-781-4271 and serves without regard to a assigned to a licensed physician. Saint Joseph Health patient’s ability to pay. Patients typically see the same Providing choices for individuals Intensive residential services doctor for one to three years with disabilities. Adult ser- for children and adolescents, System—Prenatal while he or she is in residen- vices include supported living, services for adults with serious Breastfeeding Class Marshall County cy. Access to expanded care, community-based volunteer and persistent mental illness and 574-335-6500 Health Department including labs, X-rays, pharmacy and independence activities, treatment of complex addic- 574-935-8565 and other outpatient services. alternative and industrial ser- tions. Also, a range of outpatient Free prenatal breastfeeding vices training and employment services. class the last Tuesday of each Helping avoid potentially dan- Saint Joseph Health placement. Services for children month at 6 p.m. gerous threats to the health, include Head Start and Early Samaritan Family and safety and welfare of the com- System—Mobile Medical Head Start. Health Counseling Center Saint Joseph Health munity. Unit System—Prenatal Care 574-335-3898 Minority Health Coalition 574-277-0274 St. Joseph County Coordination Clinic on wheels provides of St. Joseph County Incorporating mind, body and Health Department preventative mammography spirit to help with relationship 574-335-6500 574-232-4234 574-235-9750 screenings to women. problems, family issues, anxiety, Licensed social worker provides Promoting minority health depression, stress, grief, trauma, free services for low-income Promoting physical and men- through advocacy, service de- addiction and other concerns. and underserved populations, tal health and facilitating the United Health Services livery, public relations, research including insurance enrollment, prevention of disease and injury 574-247-6047 and leadership. Providing repre- for St. Joseph County residents United Health Services— coordinated care up to and Programs to help coordinate sentation for medically under- post-delivery, home visits and through education, environ- served individuals for personal, Suicide Prevention Center mental services, vital records, the efforts of small not-for-prof- clinic appointments, and alert it health-related organizations. family and community health 574-247-6047 Child Protective Services for permits, health insurance infor- problems. mation and more. The programs include the Suicide prevention presenta- babies in jeopardy. Breast Health Programs, Com- tions tailored to the audience. munity Services with All Deaf, Real Services Applied Suicide Intervention Saint Joseph Health Women’s Care Center the Diabetes Resource Center, 574-233-8205 (St. Joseph County) Skills Training and QPR designed the Hearing and Speech Center 877-908-2341 (St. Joseph County) System—Sister Maura 574-936-3175 to teach adults life-saving skills. and the Suicide Prevention (Marshall County) 574-546-2904 (Marshall County) Brannick Health Center, Support groups for those who Center. Services for older adults and are grieving. Pregnancy testing, irst trimes- CSC low-income households, in- ter ultrasounds, prenatal vita- 574-239-5255 cluding energy assistance, legal mins, counseling and mentor- services, Meals on Wheels, trans- YWCA North Medical care, including lab anal- OUTREACH SERVICES ing, parenting classes, cribs and portation and more. Central Indiana ysis, X-rays, pharmacy, dental baby items distributed under an care, bilingual staff members, 574-233-9491 incentive program, emergency food pantry and other nutrition Catholic Charities Saint Joseph Health assistance for babies and young Economic empowerment pro- services for populations without 574-234-3111 System—Health Insurance grams, residential and non-res- children and children’s books. insurance who do not qualify for Adoption, immigration, older Services idential services for women in Medicaid or Medicare. Partner- St. Joseph and Elkhart counties adult services, food, clothing, 574-335-1532 ship with Oaklawn to provide shelter and help to all regard- who are victims of domestic HEALTH-RELATED mental health services. violence or sexual assault, or COMMUNITY SERVICES less of religious afiliation, race, Three convenient resource are struggling with chemical national origin or gender. centers where individuals and dependency. Saint Joseph Health families can learn more about AIDS Ministries System—Saint Joseph Center for the Homeless health insurance options and enroll in the Health Insurance 574-234-2870 Health Center 574-282-8700 PRENATAL/INFANT Marketplace, other commercial HIV/STD/substance abuse risk 574-335-7900 Linking men, women and chil- plans and Medicare. RESOURCES dren with programs, agencies reduction education, as well as The Saint Joseph Health Center and people to help them break free HIV and Hepatitis C testing; in Plymouth is located in the Saint Joseph Health Memorial Hospital— housing for HIV positive individ- the cycle of homelessness. Community Resource Center. System—Senior Services Prenatal classes uals in St. Joseph, Elkhart, Mar- The family nurse practitioner shall, Fulton, Starke and Pulaski 574-335-3891 574 - 647.3540 and staff provide primary and Marshall County counties; food pantry for HIV routine medical care, while Council on Aging Senior navigator assists seniors The Memorial Childbirth Center positive individuals; help with stressing patient education and 574-936-9904 and their families with many offers a variety of classes in- accessing health care and health preventive healthcare. services. Senior Health Insurance cluding preparing for childbirth, insurance; and weekly support Helps give older adults the Program offers free help with breastfeeding and more. group. opportunity to experience Medicare enrollment. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 8

Healthy workers, healthy economy

Seven years ago I made the per- current condition and maybe chart sonal decision that I wanted to be a new course for their own per- healthier. Though I didn’t necessar- sonal health and for that of their ily feel unhealthy, I, like many, had family?” I had to lead by example added a few pounds every year and anxiously signed up for my after college to the point where a assessment. I’m glad I did; it’s what routine health screening at work I needed to get me started. had Nurse Connie put me in the Employee health costs have ris- “obese” category. en faster than virtually every other I didn’t like those words and cost category for businesses. made a conscious decision to not Businesses small and large have let my irst heart attack be the studied and implemented plans thing that convinced me I need to to help combat those rising costs. be healthy. But I didn’t want to be And while cost is an important on a “diet.” Instead, I changed my factor, it’s not the only consid- lifestyle, ate better and exercised. I eration for business. Healthier didn’t try to lose it all at once, and employees have been found to I began a two-year journey where I be more productive, absent less, eventually lost about 80 pounds. less stressed and have a better Though not excited to be the attitude in addition to having less poster child for the fat guy that got expenditures. skinny, my journey was very public Other beneits include having and gave me, as then-mayor of employees with more energy, Mishawaka, many opportunities which helps employees stay more to share my experiences and the focused when they are on the job. highlights and lowlights along the Healthy employees tend to have a way. For me, my progress meant I higher level of self-conidence in felt better. I had more energy, I was themselves and inspire conidence more productive, I handled stress in others around them. Employees better, I even slept better. The who set itness goals and stay moti- community cheered me on and vated to exercise also tend to be encouraged me along the way. more goal-oriented at work. Interesting to think how I en- Indiana traditionally hasn’t countered Nurse Connie in the irst fared well when comparing health place. At the time, like many CEOs, statistics with other states, usually I was concerned about rising health ranking in the bottom 10. Smoking costs in the company and what that and obesity are two of those cat- was doing to the bottom line. Our egories where we score the worst health costs had skyrocketed and and studies indicate a high preva- like many organizations, almost ev- lence of physical inactivity as being ery new dollar was being eaten up a major contributing factor to our by those increasing costs. That left poor rankings. little at the end of the day for other For Indiana and our area to grow things like employee raises, new as we desire, we all have to make a equipment or other key projects. conscious decision to be healthier. The only way to really help The health of our communities is combat this issue long-term was being evaluated by people consid- to have a healthier workforce. So ering Indiana, as it says a lot about I thought, “Why not do simple our state, who we are, and what is assessments for employees where important to us. Let’s change what Jeff Rea is President and CEO of the St. Joseph County Chamber of they could better understand their the rest of the country thinks of us. Commerce. He can be reached at [email protected]. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 9 Closing the gap in health care

By Alice Culp there are no sidewalks. It’s hard to South Bend Tribune ride your bike if you have to ride on a two-lane highway where cars are traveling very fast. And it’s certainly Waldo Mikels-Carrasco is director hard to get your kids to do stuff like of community and population health that. development for Michiana Health All these things can contribute to Information Network. As an applied that ranking. medical anthropologist, he stud- ies health disparities and how they Will the adoption of the inform health policy. Affordable Care Act help Q equalize health outcomes How do social and econom- for lower-income families? ic factors affect health? We haven’t had 100 percent Q of eligible people sign up There are trends that are often A yet. But if you look at preven- recognized as barriers to care. tive care utilization, those numbers A For instance, if you didn’t are way up. That means that of those inish high school, you are going who have signed up, people are us- to wind up in a low-paying job that ing their insurance. We’ve shown that may not have beneits. That can be in cases where people have condi- exacerbated if you have children at tions that would need managed care, home. You may be living in a rental those numbers are good. That’s what property with poor air quality, in an you want. You want people in early unsafe neighborhood that you don’t so you can ind problems before they want your kids to go out and play in. become worse. It’s cheaper to take They’re not getting physical activ- Waldo Mikels-Carrasco stands April 20 to work at Michiana Integrated Health Network in care of expensive patients before ity and you’re not getting physical South Bend. SBT Photo/ROBERT FRANKLIN they become expensive patients. activity. Those who are less insured have You should be eating more fruits infant mortality rates is educational less access to care, so they get more and vegetables, but what you can attainment. If a woman has complet- Those who are less chronic diseases and they don’t afford to get is processed food. May- ed high school or some college, her manage them as well. They wind up be you live in a neighborhood where chances of fetal loss or losing a child insured have less access at the emergency room, which is far there are no fresh fruits and vegeta- in the irst year of life is signiicantly to care, so they get more more expensive than preventive care. bles available at stores, but there is reduced. The emergency room is the most a McDonald’s and a Pizza Hut. With chronic diseases and expensive place to get primary care. the dollar meals, kids go to bed full Why do counties such as they don’t manage them If you get more people insured, they with a warm meal, but it isn’t healthy. Cass and Starke have such have access to preventive care and Or maybe there is a store, but the Q low ratings in some health as well. they should stay out of the emergen- bus line doesn’t run by there. factors? cy room. Transportation is a problem. Let’s Groups that have been historically say you do have Medicaid or some- They’re representative of the because your household income uninsured and have had poor access thing, but in order to go get your challenges of rural health. No- doesn’t support that. Those who live to care also don’t have access to preventive care, you have to take A body ever talks about urban far from town centers or stores where information on what healthy behaviors the bus across town. And if you have health because it’s kind of taken for they can get food or anything else, are and what you should be looking small children, you need someplace granted that medical centers, hos- tend to drive more, so they are more out for. People teach each other how to take them. So, transportation and pitals and clinics are always going sedentary. If you have to drive farther to manage their glucose, their blood childcare are a problem. to be in urban areas. Rural health for everything, you may not have sugar, their insulin. These are things Also, if you’re low income, you are is very different. Look at the time time in your schedule for physical learned in horizontal networks. If more apt to smoke. In Indiana, we it takes to get to your primary care itness. Physical itness and physical nobody is sharing that information on have a huge problem with that. We physician or a critical access hospital. activity are not the same. People good health behaviors, you’re going have an insane amount of pregnant In some cases, we have women who might be working hard, but the work to continue to have poor outcomes. women who smoke. We’re a leader have to drive to the next county or might not have a lot of stretching or For those folks who are now eligible in the country in that. We may not be two over to deliver babies. This could aerobic intensity. for HIP 2.0 or to get insurance through No. 1, but we’re in the top 10. be greatly compromised by the fact Infrastructure has a lot to do with the exchanges, there’s a lot of catch- One of the best predictors for high that you don’t have a second vehicle it, too. It’s hard to go for a walk if up to play on some of these things. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 10 5 health improvements to make today ...

Improving your health and wellness can seem like a daunting task, especially if you know you have some bad health habits to break. Make these changes today for a lifetime payoff. “It starts with you,” says physician assistant Tricia A. Howard, a faculty member at South University, Savan- nah’s College of Health Professions. “You have more control over your health than you think you do.” Here are ive steps you can take today that can have a positive impact on your over- all health and wellness.

1. Stop smoking

Everyone knows smoking is bad for you. In fact, people who smoke have by far the greatest risk of lung cancer — the No. 1 cause of cancer deaths in the U.S. — and increased risk of a cardiac Experts say even a few minutes of exercise a day can make a big difference in your health. event. But, many people don’t support from others is a cru- water at least once between adults. cholesterol can be seen realize that changes in the cial part of the battle. each meal,” she suggests. “That sounds like a lot,” after just a few months.” lungs caused by smoking For a list of resources to And, Howard says, you Howard says. “But, if you can actually improve over help you stop, see Page 6. don’t have to stick to water. break it into 15- or 20-minute 5. Have your time once a smoker quits. Milk, coffee and other daily workouts it’s much easi- cholesterol checked “Even if you’ve smoked for drinks that contain a lot of er to it into your schedule.” 2. Drink more water many years, you can reduce water and not a lot of calo- You might be surprised to your lung cancer risks just by Sixty percent of your body ries count toward your daily 4. Adopt the learn that you should begin quitting,” Howard says. “And weight is water. Your body luid intake. Mediterranean diet having your cholesterol mon- this isn’t just about your depends on water to carry itored by a doctor at age 20. own health. Smoking puts nutrients to cells and to lush 3. Exercise The Mediterranean diet But since coronary artery the ones you love at risk, toxins out of vital organs, so is a diet rich in fruits, veg- disease is the No. 1 cause because even secondhand getting the right amount of “Exercise reduces your risk etables, olive oil, nuts and of death in the U.S., it’s a smoke can cause cancer. So, luids each day is crucial. for chronic disease, improves ish. The results of numer- recommendation you should quitting is a win-win for you Howard says men should balance and coordination ous studies show long-term take seriously. and those you love.” drink 3 liters, or 13 cups, per and helps with weight loss,” health beneits to adopting Howard says levels that are Howard says people who day. For women, the recom- Howard says. “Exercise is a the diet. too high can be controlled by want to quit smoking do mendation is 2.2 liters, or key part of living a healthy “This is a diet illed with diet, quitting smoking, exer- better when they set a target nine cups, per day. If that life.” antioxidants and anti-inlam- cise and prescription drugs. date to quit. She also advis- recommendation seems Howard says the U.S. matories,” Howard explains. “There are so many things es working with your primary tough to follow, Howard says Department of Health and “This diet has been shown we can do to improve not health care provider who to divide it up throughout Human Services recommends to reduce the risk of heart only the length of our life, can actually individualize a the day. 150 minutes a week of moder- disease and cancer when ad- but the quality of those stop-smoking plan for you. “Make sure you have water ate exercise, or 90 minutes of hered to long-term. Weight years,” Howard says. “Don’t And, Howard says, getting with every meal and drink vigorous exercise a week, for loss and improvement in wait.” COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 11 ... and 6 simple swaps for a healthier life

Superfood Trailmix Makes 2 cups Ingredients: 1/2 cup raw almonds, 1 tablespoon natural chopped rice vinegar 1 tablespoon chia 1 tablespoon honey seeds 1/8 teaspoon sea salt 1 cup puffed brown Dash cayenne pepper rice cereal (optional) 1/4 cup pumpkin 1 teaspoon coconut seeds oil 1/4 cup raisins

Directions: In a small bowl, mix natural rice vinegar, honey, salt and cayenne. In a 10-inch skillet over medium-low heat, warm oil and add the vinegar mix, almonds and chia seeds. Cook for 6 minutes, stirring constantly, until all excess liquid is gone. Pour onto a parchment paper-lined baking sheet and let cool in the refrigerator for 15 minutes to set. Toss al- monds with brown rice cereal, pumpkin seeds and raisins. Nutrition (1/4 cup): 110 calories, 6 g total fat, 1 g saturated fat, 0 g cholesterol, 60 mg sodi- um, 12 g carbs, 2 g iber, 6 g sugar, 3 g protein

Recipe created exclusively for Mizkan by Dawn Jackson Blatner at dawnjacksonblatner.com.

Americans are more concerned 1. Boardroom conference This 5-minute routine burns calo- increase their nutritional value and than ever before about living a ries and keeps you from mindlessly serves as a great alternative to ingre- healthy lifestyle. vs. walking meeting munching. dients that are high in saturated fat. Implementing dietary changes and Swap your sedentary internal ofice Avocados offer a subtle lavor and adopting an exercise routine, how- meeting for a “walking meeting.” 4. Salad dressing creamy texture to any recipe. ever, can prove to be overwhelming. Instead of meeting in a conference vs. rice vinegar A recent Gallup poll found that room for 30 minutes, make a few 6. Mid-morning snack nine out of 10 consumers say they trips around the ofice building. make it a point to try to include Replace heavy salad dressing with vs. almonds a light vinaigrette. Simply whisk fruits and vegetables on their plates, Control hunger by eating a few but they are not necessarily suc- 2. Online shopping together natural rice vinegar, garlic salt, mustard powder, sesame oil, almonds instead of the mid-morn- ceeding. vs. mall ing pastry. A study published in the “Simple everyday swaps can make sesame seeds and canola oil in a measuring cup. Pour over arugula European Journal of Nutrition found the difference in achieving a healthy While online shopping has made life that almonds helped control appe- lifestyle,” says registered dietitian more convenient, it has eliminated and tomato halves for a delicious salad. tite and resulted in reduced calorie Dawn Jackson Blatner, author of another opportunity to realize the intake. “The Flexitarian Diet.” “We live in a health beneits of walking. Another simple swap is to incor- busy society, and no one diet its all. 5. Butter and oil porate healthier options into your Focus on small daily shortcuts that 3. Gym vs. 5-minute vs. avocado afternoon snack routine and cut are realistic and will have a lasting routine the fat. It’s an opportunity to start impac t.” Instead of making your favorite the week by adding a zesty lavor Try these quick and simple swaps, Eliminate the guilt of missing a day baked goods with oil or butter, use alternative into your diet. Look for which can actually make a difference at the gym. Do jumping jacks or mashed avocado. The substitution recipes that are quick and easy, such in realizing your goals: crunches during TV commercials. of avocado in baked goods helps as this Superfood Trailmix recipe. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 12 - 13

The annual County Health Rankings & Roadmaps report How Healthy Are We? uses 30 factors to compare the health of nearly every HEALTH OUTCOMES CLINICAL CARE county in the nation. Here’s Indiana County rankings — Michigan County rankings Mental Health providers Ratio of population to one mental health provider how local counties compare out of 92 counties — out of 83 counties Michigan — 487 Indiana — 750 Marshall — 1,240 to the U.S. median, top 10 Elkhart County – 20 Berrien County – 58 U.S. — 1,128 Berrien — 639 Elkhart — 872 St. Joseph — 510 LaPorte County – 75 Cass County – 44 Top — 386 Cass — 1,180 LaPorte — 1,250 Starke — 7,732 percent of counties Marshall County – 9 in the nation and St. Joseph County – 41 SOURCE: CMS, National Provider Identification file (2014) Starke County – 90 the state as a SOCIAL & ECONOMIC FACTORS whole. Premature death Low birth weight Children in poverty Injury deaths Years of potential life lost before Percent of live births where the age 75 per 100,000 population baby weighed less than 5.8 pounds Percent of children Number of deaths because under age 18 in poverty of injury per 100,000 population U.S. median — 7,681 U.S. — 8 percent Top U.S. counties — 5,200 Top — 5.9 percent U.S. — 24 percent U.S. — 73.8 Top — 13 percent Top — 50 Michigan — 7,218 Michigan — 8.4 percent Berrien — 7,789 Berrien — 8.4 percent Michigan — 24 percent Michigan — 60 Cass — 6,713 Cass — 7.8 percent Berrien — 26 percent Berrien — 59 Indiana — 7,525 Indiana — 8.2 percent Cass — 25 percent Cass — 65 Elkhart — 6,524 Elkhart — 7.4 percent Indiana — 22 percent Indiana — 62 LaPorte — 8,893 LaPorte — 9.5 percent Elkhart — 20 percent Elkhart -— 51 Marshall — 6,765 Marshall — 6.4 percent LaPorte — 27 percent LaPorte — 70 St. Joseph — 7,424 St. Joseph — 8.3 percent Marshall — 18 percent Marshall — 60 Starke — 11,783 Starke — 7.4 percent St. Joseph — 29 percent St. Joseph — 55 SOURCE: National Center for SOURCE: National Center for Health Statistics – Starke — 28 percent Starke — 105 HEALTH BEHAVIORS Health Statistics – Mortality files (2010-2012) Natality files (2006-2012) SOURCE: Small Area Income and Poverty Estimates, 2013 SOURCE: CDC WONDER mortality data, 2008-2012 Alcohol-impaired Sexually transmitted Physical inactivity Adult obesity Access to exercise activities Adult Smokers driving deaths infections Percent of adults who are current smokers Percent of adults over age 20 Percent of adults that report a BMI greater than or equal to 30 Percent of population with adequate access to reporting no leisure-time locations for physical activity such as parks, Percent of motor vehicle crash deaths U.S. — 31 percent Indiana — 31 percent Number of newly diagnosed chlamydia U.S. median — 21 percent Indiana — 23 percent physical activity recreational facilities, gyms, dance classes, etc. with alcohol involvement Top — 14 percent Elkhart — 30 percent cases per 100,000 population Top U.S. counties — Elkhart — 20 percent U.S. — 31 percent U.S. — 27 percent LaPorte — 34 percent U.S. — 65 percent 5.9 percent LaPorte — 27 percent Michigan — Top — 14 percent U.S. — 291 Top — 20 percent Marshall — 32 percent Top — 92 percent Marshall — 21 percent 32 percent Top — 138 Michigan — 20 percent Michigan — 23 percent St. Joseph — 29 Michigan — 83 percent Michigan — 31 percent St. Joseph — 21 percent Berrien — Michigan — 481 Berrien — 20 percent Berrien — 28 percent percent Berrien — 77 percent Berrien — 30 percent Starke — 33 percent 36 percent Berrien — 603 Cass — 24 percent Cass — 26 percent Starke — 35 Cass — 63 percent Cass — 20 percent Cass — Cass — 195 Indiana — 27 percent percent Indiana — 75 percent Indiana — 36 percent 36 percent Indiana — 451 Elkhart — 27 percent Elkhart — 64 percent Elkhart — 24 percent Elkhart — 397 LaPorte — 27 percent LaPorte — 74 percent LaPorte — 35 percent LaPorte — 47 Marshall — 27 percent Marshall — 62 percent Marshall — 10 percent SOURCE: CDC Diabetes St. Joseph — 37 percent Marshall — 138 St. Joseph — 25 percent Interactive Atlas (2011) St. Joseph — 77 percent St. Joseph — 407 Starke — 37 percent Starke — 61 percent Starke — 31 percent Starke — 82 SOURCE: CDC Diabetes Interactive SOURCE: Business Analyst, Delorme map data, ESRI and SOURCE: Fatality Analysis Reporting System Atlas (2011) US Census Tigerline Files (2010, 2013) SOURCE: National Center for HIV/AIDS, Viral (2009-2013) SOURCE: Behavioral Risk Factor Surveillance System (2006-2012) Hepatitis, STD and TB Prevention (2012) COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 14 Going smoke-free got her life back

By Alice Culp said she’s learned that there’s no such South Bend Tribune thing as smoking a little. MISHAWAKA — The arrival of “None of it’s healthy,” she said. warm weather means Julie Verheye Verheye practices family law and is can get out and take 20-mile bike a St. Joseph County public defender. rides in the countryside around Mish- Though some former smokers talk awaka. about missing their irst cigarette She expects to enjoy them more and cup of coffee in the morning, she since she quit smoking Jan. 1. said, it was the cigarette she had after “After just two weeks of not smok- a long day at work that she misses ing, I felt faster and less winded while most. riding my bike.” When the smoking ordinance in Her decision to stop smoking was St. Joseph County went into effect, an easy one, she explained. Both of Verheye found fewer and fewer places her parents died of cancer and her to smoke. It helped her cut back. She father, who smoked, died at age 50. even quit for a year and a half at one “I realized I didn’t want to die that point, but a stressful case caused her young.” to reach for the cigarettes again. The Though the decision was easy, lapse made her feel guilty. quitting was a bit more dificult. She quit again — “cold turkey” — Verheye began smoking in col- Jan. 1. It was a good time, she said, lege because she thought it was because there were no major stressors cool. She wouldn’t classify herself at work or in her personal life and she as a heavy smoker — she felt it would be her chance to really smoked only two to succeed. three packs per A friend, who had successfully quit, week — recommended the Tobacco Cessa- but tion Program at Saint Joseph Health System, and Verheye decided to attend. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 15

Support from others helped Stop smoking tips Mishawaka woman quit l Identify why you want to stop. l Have a plan as to how you will succeed.

“I thought I needed something l Let friends and coworkers know you’re a little more organized to help me quitting. Support and accountability helps. actually stick with it,” she ex- “After just two weeks of plained. The eight-session class is mod- not smoking, I felt faster l Get rid of all your smoking stuff, such as eled after the Freedom from and less winded while ashtrays and lighters. Smoking program put together by the American Lung Association. A riding my bike.” facilitator walks the class through a — Julie Verheye l Break patterns. If your routine was a cup workbook and invites guest speak- of coffee and a cigarette irst thing in the ers to provide more in-depth tools on various topics. For example, morning, drop the coffee or replace it with someone from the health depart- something else so you break that association. ment talked about nutrition and the Maybe have tea instead. importance of portion control and “She said you shouldn’t let a someone from the YMCA talked failure or a slip get in the way of about physical activity that can be succeeding at your goal,” Verheye l Drink lots of water. It gives you something to done around the house. A massage said. It was something she needed do with your hands and to put in your mouth, therapist even visited the class one to hear after her earlier lapse. day. By the time she entered the pro- and it won’t cause you to gain weight. “If you’re staying on track with gram, she hadn’t had a cigarette in your goal, you should set little three weeks. That’s a bit unusual. l Don’t replace one bad habit with another. rewards for yourself,” Verheye Most participants select a stop explained, “as a way to say you’re date during the program — usually doing a good job.” in week four, Greene said. For a list of programs to help you quit The class also provided motiva- “We really want a person to look smoking, see Page 6. tors to stop smoking. In one ses- at what has been their smoking sion, participants igured out how habit or pattern,” she explained. much they’d spent on cigarettes “Once they understand why they Sources: Julie Verheye and Latorya Greene over the years. want that cigarette, they can come “They’re expensive and when up with ways to avoid that pattern, you think about how much money alter it or come up with alternative you’re blowing — literally — you to it.” might as well take your money and When she gets the urge to burn it,” Verheye said. “One of the smoke, Verheye walks her two fellows in our class was going to dogs, washes dishes or plays with use whatever he was saving to take a stop-smoking app on her phone, his family on a trip.” which sends her reminders of why Verheye’s class had about eight she quit. Her husband usually does people in it. This is a typical group most of the cooking, she said, “but size, said Latorya Greene, the I’ve started ixing dinners a little tobacco education coordinator for more often just because it does the program. give me something to do.” “It really creates a group dynam- And she still rides her bike. ic, a camaraderie, where they are It’s an ongoing struggle, but Ver- actually able to support one anoth- heye is determined to succeed. er,” Greene said. “We hope they “The last couple of weeks have have support at home, but if they been stressful and I’ve seriously don’t, this is a great opportunity to thought about having one, but I’m ind it.” not going to do that again,” she Verheye appreciated that sup- said. “You will always have stress in port and Greene’s upbeat, positive your life and smoking is not going attitude. to make it go away.”

Photo courtesy of ThinkStock COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 16

Sharon Roth, a registered medical assistant, takes Guillermo Morales’ vital signs during his April 28 appointment at Saint Joseph Health Center in Plymouth. Morales goes to the clinic as part of his plan to monitor his diabetes. SBT Photo/BECKY MALEWITZ How to take control of your diabetes Morales’ acceptance of his condition helped him understand and manage it

By Landa Bagley Although he loved his sisters’ plate with not much more than a bite is unable to produce insulin or his Tribune Correspondent cooking and appreciated their ef- eaten,” said Morales, 64, of LaPaz. “I body is unable to use insulin proper- fort, his slice of pie would go mostly knew I didn’t like the way I felt after I ly. If not addressed, Type 2 diabetes LAPAZ — Lemon meringue pie untouched while others heartily ate certain types of food. But I didn’t can lead to other serious medical was Guillermo Morales’ favorite des- enjoyed theirs. Morales said he had know what was wrong with me at the problems such as kidney failure, sert, although he was never much started to notice how “bad, physi- time.” blindness and neuropathy. of a sweets eater. His sisters used cally” he felt after having too many Morales was 40 years old when he Today, Morales is managing his to take turns making this pie for his sweets. was diagnosed with Type 2 diabetes, diabetes with proper diet, exercise birthday. “So, I would let my slice sit on the meaning that either his pancreas and medication. His blood sugar COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 17 Diabetes tips

With Type 2 diabetes, the pancreas is either unable to produce insulin Morales credits the staf at the Saint Joseph Health or the body is unable to use insulin properly. Center in Plymouth for motivating him and supporting Dr. Michael Deery, a volunteer at him. “The nurses, doctors, volunteers and the manager Saint Joseph Health Center in Plym- outh, offers a few tips. — everyone there cares about the patients. They l Consult your physician for a course actually listen to the patients. They motivate me and of action that’s tailored speciically for your health issues, and before chang- challenge me to live a more healthy life and to take ing your diet or physical activity level.

control of my situation the best way that I can.” l If you ind that you have elevated blood sugar levels, take it seriously. Talk to your doctor about it.

l Those with a family history of dia- betes should check blood sugar levels on a regular basis. That could mean testing done with a glucose meter, or levels are about a third of what they were A positive attitude, yet another part of taking A1C tests at least annually. An previously — a good sign, as far as his Morales’ approach to dealing with his di- A1C test measures a person’s blood health is concerned. abetes, is also important, according to Dr. sugar levels over the past two or Even his high blood pressure, which is Michael Deery. three months. Because each person is unrelated to his diabetes, has been well Deery, a volunteer at the Saint Joseph different, it’s best to consult a doctor under control since he made changes in Health Center in Plymouth, treats Morales. about how frequently to get tested. his diet and exercise and continued with The center offers low-cost, affordable his medication and medical care. healthcare to those low-income Marshall l Consider lifestyle changes, such as But he didn’t immediately take that ap- County residents who meet the inancial eating healthy foods (and consuming proach to his diabetes diagnosis. qualiications. sugar, fats and carbohydrates in mod- “When I was told I am a diabetic, I “He’s motivated,” the doctor said about eration) and boosting your physical pushed it aside. I took my life for granted. Morales. “He has taken ownership of his activity. For a while, I had started to just eat what I problem and he’s doing something about wanted and how much I wanted,” Morales it. He’s getting good results. l Work toward your ideal weight said. “It took me a while before I accepted “Assuming you take care of your diabe- or body mass index (BMI), which is my medical problem. I understand it now, tes, you can live a normal life — and a long igured based on your height, gender and I have been trying to do something life,” Deery added. and age. Consult with your doctor’s about it.” Morales credits the staff at the health ofice to determine your ideal weight These days, Morales consumes much center in Plymouth for motivating him or BMI range. Making healthy food less sugar, fats, carbohydrates and sodium and supporting him. “The nurses, doc- choices, eating moderate amounts than he did prior to his diagnosis. “All in tors, volunteers and the manager — ev- and exercise are the best ways to get moderation,” he added. eryone there cares about the patients. to your goal weight. Start with small, Morales said he drinks a lot of water, eats They actually listen to the patients. They attainable weight-loss goals at irst, if salads sometimes and makes healthy food motivate me and challenge me to live a necessary. substitutions that work for him, such as more healthy life and to take control of my eating wheat bread instead of white bread. situation the best way that I can.” l Take your medication. If the medi- He checks his blood sugar levels and Given the support he gets at the center, cine you are prescribed is not working blood pressure levels on a regular basis. the love he gets from his family and friends or there is a problem, talk with your Boosting physical activity is another way and the kindness of his sisters who used to doctor. Your doctor might be able to he effectively deals with diabetes. take turns making his favorite dessert for adjust the dosage or strength, or ind Morales, a retiree, has become more his birthday, Morales doesn’t mind leaving you a different medication that works physically active — as much as he can his slice of lemon meringue pie virtually for you. handle with his foot problems and back untouched, he said. problems. “I decided that I have a good life, and I To learn more about diabetes, and In addition, he has a part-time, on-call want to live as long as I can,” Morales add- treatment and care for diabetic pa- driving job. ed. “Life, itself, is sweet.” tients, visit the American Diabetes Association at www.diabetes.org. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 18 Small changes, big weight loss

BEFORE

Scott Starkweather, of Mishawaka, lost 200 pounds in three years. He did it by simply eating healthier foods and exercising daily. His wife, Traci, supported him in his efforts and found that she also lost weight. Photo provided.

By Landa Bagley wake-up call that things had to and he uses half the air pressure with weight issues and/or who is Tribune Correspondent change,” said Starkweather, a he previously needed for his sleep deemed to be “morbidly obese.” Mishawaka husband and father of apnea machine. Starkweather’s approach to his MISHAWAKA — Scott Stark- three. “He just decided he was going health crisis may not be the answer weather’s weight was the highest it That was three years ago. to change his life, and he did it. for all people. Still, Starkweather has ever been: 425 pounds. At that Now, Starkweather weighs approx- This was, and remains, a priori- has chosen to share his story in time, he was diagnosed as a Type imately 225 pounds and is 45 years ty for him,” said Starkweather’s hopes that his journey can some- 2 diabetic with high blood pres- old. doctor, Michelle Pearson. Pearson how help someone else. sure, high cholesterol and severe He lost 200 pounds without as- practices at Our Lady of the Ro- So, how did he shed 200 sleep apnea. sistance of surgery, medication or sary Health Center in South Bend. pounds? Starkweather said he He was classiied as “morbidly dietary supplements. Scott no lon- Our Lady of the Rosary is part of made signiicant, permanent life- obese.” ger needs medication for diabetes Saint Joseph Physician Network. style changes. He made healthier “I thought I’d be lucky to make and cholesterol. He takes a much The story and details are differ- food choices, consumed food in it to 45 (years old). This was my milder blood pressure medication, ent for each person who battles moderation and exercised just COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 19 Creating “When you’re morbidly obese, you lose some control over your life. You don’t have total healthy habits control over where you shop for clothes, what car you drive, where you can walk. You avoid crowds because it’s often hard to maneuver yourself through crowds. In a sense, l Replace unhealthy and fattening foods with your weight, and your weight loss, afects the whole family.” — Scott Starkweather healthier alternatives, such as whole grains, fruits and vegetables. AFTER Eat lower-calorie foods with a healthier balance of nutrients. It may be easier to make one food substitution at a time. For example, switch from whole milk to skim milk.

l Reduce your food portions.

l Eat meals and snacks at or about the same time each day. Do not skip meals.

l Eat your vegetables irst, then go on to the rest of your meal. This will help ill your stom- ach with fewer calories and lots of iber.

l Eat slower. It takes time for your body to recognize that you have eaten, and for the feeling of hunger to go Traci and Scott Starkweather walk along the Mishawaka Riverwalk at Beutter Park. SBT Photo/GREG SWIERCZ away. about every day. maneuver yourself through crowds. In obese,” Traci has been dealing with l Drink plenty of water or another calorie-free Starkweather wakes up in the pre- a sense, your weight, and your weight her longtime struggle with weight, drink while eating. This dawn hours to do his itness machine loss, affects the whole family,” he she said. She lost 50 pounds in a year, will help you feel fuller workout in the exercise room in his added. and has been able to keep those faster. home. Starkweather and his wife, Even though Scott had seen some pounds off. Traci, often go for walks together. success attaining goals for a healthy Like Scott, she changed her l Don’t reward yourself Little things also help, such as park- weight several times previously, he lifestyle — making healthier food with food or use it for ing a little farther from the front door struggled with maintaining them. choices, eating certain foods in comfort. or walking around in a store before “For me, that’s because I didn’t moderation and boosting physical shopping, he added. address the real issues of why I was activity (such as walking). The two Consult your physician Being well-over a healthy weight overeating: I’m an emotional eat- offer support to one another as they before beginning an affected him more than just physical- er — glad, sad, mad … whatever,” make and maintain these changes, exercise routine, increas- ly, according to Scott. Scott said. “I had to change the way I they said. ing your physical activity “It’s hard for me to put into words looked at food and what I was putting Traci summed up the pair’s mes- or making signiicant how I feel when I am the biggest per- in my body.” sage for those battling major weight changes to your daily son in the room. You feel like every- Traci offered additional insight issues: “You’re never too far gone to diet. If you have been body’s looking at you. And you can’t about the added importance food come back, and you’re never alone. given the OK to imple- go and hide,” Scott said. had in their lives. “Food was our life. Get informed about your speciic ment these changes, “When you’re morbidly obese, you ‘Where are we going to eat?’ was one situation. Talk to your doctor. Make you can get some good lose some control over your life. You of the biggest questions of each day better decisions. Make the commit- tips from Saint Joseph don’t have total control over where for us. We lived to eat. Now, we eat to ment, and do the work. Health System’s web- you shop for clothes, what car you stay alive.” “Yes, everybody’s story is differ- site: sjmed.com/care- guides. drive, where you can walk. You avoid Although she has never reached ent. But maybe your story can have a crowds because it’s often hard to the point of being deemed “morbidly happy ending.” COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 20 Mental illness doesn’t deine him

“I’m a person with a men- tal illness, not a mental illness who just happens to be a person.”

“I have positive things to offer and I am a good person. Left unchecked, my disorder and addic- tion may mask those positive things, but they don’t take away the good in me.”

“If you have a mental illness, it’s possible to live a normal life — or close to normal life, with proper treatment and a commitment to stick to your treatment.”

— David Smail

David Smail stands inside Burton’s Laundry in Mishawaka. SBT Photo/ROBERT FRANKLIN Mishawaka man gets his life back on track

By Landa Bagley Tribune Correspondent has challenges. Mine can be over- Illness’ (NAMI) website. good person. Left unchecked, my whelming, but I’m OK.” Lifestyle changes, medication, disorder and addiction may mask MISHAWAKA — David Smail Smail has bipolar disorder and professional treatment, personal those positive things, but they doesn’t mind deining his mental is a recovering alcoholic. He has commitment, plus the support of don’t take away the good in me.” illness and addiction when asked been taking medication for his family and friends help Smail keep Smail was diagnosed as being about them. disorder since he was diagnosed his condition in check. bipolar in 2001. Maybe that’s because he doesn’t more than a decade ago. He has “Life is easier these days. Be- His diagnosis stemmed from let his mental illness and addiction been sober for three years. cause of my illness, I don’t normally a doctor’s appointment Smail’s deine him. Bipolar disorder is a chronic con- deal well with stress. But when I’m mother made for him after he told “I’m a person with a mental dition that causes dramatic shifts fully medicated and sober, I can her his plans to storm the beach- illness, not a mental illness who in a person’s mood, energy and handle everyday stresses and dis- es of Benton Harbor and march just happens to be a person,” said ability to think clearly, according appointments,” Smail said. “I have to Detroit with the help of some Smail, 44, of Mishawaka. “Everyone to the National Alliance on Mental positive things to offer and I am a famous people. COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 21 For more Before Smail got the care he needed, he would abstain from drinking alcohol information for a while and later start up again. It was some time before he took his drinking problem seriously. To learn more about mental illnesses — common symptoms, treatments, resources, etc. — visit NAMI’s website: www.nami. org or call: 800-950-6264 (This number is not a crisis line.)

St. Joseph County, Ind., also has a

David Smail uses a washing machine April 27 inside Burton’s Laundry in Mishawaka. Smail was diagnosed as being bipolar in 2001, but NAMI says recovery is possible with proper treatment and a commitment to the treatment. SBT Photo/ROBERT FRANKLIN chapter: www.namisjc. “After I talked with my mother for The 5-foot-11, strawberry blond Smail has several positive things go- org or call a while, she realized I was not OK at with a large handlebar mustache ing for him, such as his parents’ in- that time. She probably had noticed that almost blocks his friendly smile volvement in getting him treatment 574-259- other unusual behavior from me pri- appears to have reclaimed his health at the very start. 3564 (This is or to that conversation. Anyway, she and his life. “He also has support from many not a crisis convinced me to go see a trained But nothing is perfect. Smail points others,” Monagle said. “And, David professional. She made the ap- out that occasionally, he has manic is smart. He seems to understand his line. Leave a pointment for me,” Smail explained. episodes. But with adjustments to illness. conidential “Looking back, I’m glad she did.” his medication made by his doctor, “Many people don’t understand Before Smail got the care he need- management of his illness is back on that mental illness is a biologically message and ed, he would abstain from drinking track. based illness — a chemical imbal- your call will alcohol for a while and later start up Smail, a 1993 graduate of Wabash ance in the brain,” Monagle added. again. It was some time before he took College — where he majored in “In some cases, it’s genetic. It’s not be returned.) his drinking problem seriously, he said: speech/rhetoric — is quick to tell his due to bad parenting or that sort “But when I did, it wasn’t too late to get story if he thinks he can help someone, of thing. It’s treatable and there is my life back on track,” he said. he said. Smail teaches NAMI’s “Peer to hope.” By his own account, Smail went Peer” classes, for adults with mental ill- Smail agrees. through extreme mental highs and ness, at the Elkhart County Jail. “Recovery from something major lows — manic episodes followed by Recently, Smail was elected to the is possible,” he said. “If you have a bouts of deep depression. All of this St. Joseph County Board of Directors mental illness, it’s possible to live a has gotten him into trouble, such as for NAMI. normal life — or close to normal life, getting arrested for public intoxica- Kris Monagle, also on the NAMI with proper treatment and a commit- tion and resisting arrest. board for St. Joseph County, said ment to stick to your treatment.” COMMUNITY HEALTH REPORT South Bend TRIBUNE I SUNDAY, May 17, 2015 I 22 This Counts Revolution

In 2014, Saint Joseph Health Sys- easy. Often, the hardest part is just tem partnered with other organiza- getting started. This Counts empha- tions to form This Counts. Today, 50 sizes that you remain patient and nonproits, health agencies, schools kind to yourself as you work toward and businesses have joined the This your goal. Simply making the choice Counts movement to encourage to start living a healthier lifestyle is better health by using the tools we the most important step. all have available. If you want to join the movement, At its heart, This Counts uses visit ThisCounts.org to view videos on encouragement to promote healthy how other members of the com- activities that can be achieved by munity are starting their wellness everyone. Taking out the trash, park- journey. You can also upload your ing at the back of the lot or choos- own video and tell your story to ing to eat an apple instead of a encourage others or join the conver- chocolate bar are perfect examples sation on Facebook and follow This of healthy steps we can all take — Counts. and they all count toward a greater If you are struggling to make these wellness goal. By doing what we can wellness decisions, the This Counts today, we’re building a foundation partners are here to help. All of the this together. have and do what you can. Just start for growth and greater wellness partners have committed to joining We’re all capable of living a moving. tomorrow. the journey to better wellness and healthier life. It’s no more unique to Remember the goal isn’t to inish This Counts also recognizes that are taking steps to making Michiana us than breathing. You just have to irst; it’s to stay in it as long as you making the decision to live well isn’t a healthier place to live. We are all in start where you are, use what you can.

“Younger Next Year” author coaching a healthier lifestyle

By Landa Bagley the book made the New York Times Tribune Correspondent “We need to stop putting garbage in our Best Sellers List. Crowley and Lodge also wrote a “Younger Next Year” SOUTH BEND — Who hasn’t bodies and get moving, get more physically book speciically for women. been lectured about making active if we’re able to. We can live longer, In 2013, Crowley teamed up with healthier food choices and Jen Sacheck, a Tufts University pro- exercising more? happier lives.” fessor of nutrition and muscle phys- Somehow, it sounds different iology, to co-author another book, coming from Chris Crowley. “Thinner This Year.” With emphasis Crowley, a renowned speak- “Science does back this up. held twice on May 30 — starting on nutrition and exercise, “Thinner er and best-selling co-author It’s absolutely rock-solid, I at 9 a.m. at Plymouth High School, This Year” offers an in-depth explo- on health and itness issues, Crowley tell you!” and again at 2 p.m. at Penn High ration of major issues mentioned in speaks in a direct, no-non- Crowley is the featured School. “Younger Next Year.” sense manner with zeal and speaker at the “This After retiring from a 25-year long “These days, a lot of the focus sincerity — like a good friend who Counts Revolution” event, present- career as a New York City trial lawyer seems to be about what to do when calls it as he sees it. ed by Saint Joseph Health System many years ago, Crowley turned his you get sick. But shouldn’t the focus “We need to stop putting garbage on May 30. The event is free and attention to another of his interests: be on you NOT getting sick in the in our bodies and get moving, get open to the public. Event attendees health and wellness. irst place?” Crowley said. “The more physically active if we’re able can also get free health and wellness He teamed up with leading New ‘This Counts Revolution’ is a good to. We can live longer, happier lives,” screenings and have their questions York medical internist Dr. Henry S. irst step at learning about staying Crowley said in a recent telephone answered by a panel of local health Lodge to write “Younger Next Year,” well. At this event, you’ll have fun interview, fresh off of a multi-city experts. an advice book about health, well- and you’ll laugh — and, it just might national speaking engagement. “This Counts Revolution” will be ness and itness. Published in 2004, change your life.” PRESENTED BY SAINT JOSEPH HEALTH SYSTEM

ThisCounts. rg Saturday, May 30 Plymouth High School, 9 am REVOLUTION Penn High School, 2 pm NEW YORK TIMES BEST SELLER CHRIS CROWLEY, Registration is requested but not CO-AUTHOR YOUNGER NEXT YEAR required. Call (855) 88-SJMED. ALSO FEATURING: FREE HEALTH AND WELLNESS SCREENINGS Register by May 28 for a chance to win AND A LOCAL PANEL OF HEALTH EXPERTS lunch with Chris or one of five Fitbits! Getting healthy together. ThisCounts. rg

This Counts is a community wellness initiative brought to Michiana with the partnership and support of the following organizations: • Allied Physicians • O’Brien Fitness Center • Saint Joseph High School • American Cancer Society • Ofice of Sustainability, City of South Bend • Saint Joseph High School Athletics • Bendix Family Physicians • Penn-Harris-Madison Educational • Samaritan Counseling Center • Burkhart Advertising Foundation • Select Health Network • Center for Hospice Care • Race Play Michiana • ServiceMaster Clean • Center for the Homeless • Reducing Obesity Coalition • Smoke Free St. Joe • Girls on the Run • Reins of Life, Inc. • South Bend Parks and Recreation • Hannah’s House • RiverBend Cancer Services • South Bend Cubs • Harper Cancer Research Institute • Saint Joseph County Health • St. Vincent de Paul • Holy Cross College Department • The Medical Foundation • Kelly Cares Foundation • Saint Joseph County Minority Health • United Health Services Coalition • La Casa de Amistad • Whole Foods • Saint Joseph Health System • Marian High School • WNDU 16 ~ Holy Cross • Meijer • WNIT Public Television ~ Mishawaka Medical Center • Michiana CRAN • WSBT 22 ~ Plymouth Medical Center • Michiana Hematology Oncology, PC • YMCA ~ Saint Joseph Physician Network • Mishawaka Catholic • Youth Service Bureau ~ St. Paul’s • Newton Park ~ Trinity Tower • Notre Dame Athletics ~ VNA Homecare • Oaklawn Psychiatric Center

Visit to get involved.

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