War on West Virginia's flood of chronic disease and obesity

In my Hunt fellowship project, to be published in The Charleston Gazette and aired statewide on West Virginia Public Radio, I plan to explore West Virginia's rising tide of chronic disease and obesity and the considerable efforts by West Virginians to reverse it.

My home state faces staggering health problems. By various measures, we are:

• first or second in obesity and obesity-related disease: diabetes, high blood pressure, cardiac disease, heart attack, toothlessness and preventable hospitalizations.
• among the highest five in cancer deaths, poor physical and mental health days, stroke,  and premature death.
• lowest in physical activity and highest in smoking and smokeless tobacco.

This epidemic affects everyone. Healthcare spending already eats up almost a quarter of our gross state product, according to a recent actuarial study. Chronic disease accounts for three quarters of that spending.

Almost one in three West Virginia adults (31 percent) are obese, according to the CDC, compared with one in four Americans. Our child obesity rate is well over 20 percent.

If nothing changes, West Virginia's chronic disease costs will double by 2018, threatening other state programs, actuaries warn.

When did this happen? How did it happen? Why is it happening? I will track the answers to those questions, in stories, photos, slideshows and video, telling stories of people caught in the epidemic and shadowing people who are trying to reverse it as health care reform unfolds.

West Virginians are famous for their ability to tell a tale, for their humanity, and for their sense of humor in the middle of disaster. I will be looking for that spirit, among patients and healers. I am already moved and educated by the people I am interviewing. I hope to transmit that to readers.

I will travel to different parts of the state, from the distressed coalfields to relatively affluent communities, to find and tell local stories of adults and children struggling with obesity and diabetes. Their stories will be paired with accounts of some remarkable West Virginia health visionaries who are creating cutting-edge, evidence-based programs to help West Virginia become a more healthy state.

I will focus on diabetes, our state's fastest-growing disease. More specifically, I will focus on effective evidence-based efforts to prevent diabetes, especially childhood diabetes. We want to challenge the fatalistic attitude that says essentially, "That's how we are. My grandfather had sugar, my dad had sugar, and I will too." We want to show readers and listeners that it doesn't have to be that way.

I plan to tell the stories through ground-level people (patients, ambulance drivers, health coaches, grocery clerks, mayors, social workers, physician assistants, etc.) in widely varying counties, in towns and up hollers. We will emphasize the way social determinants of health differ from county to county- income, jobs, access to food and exercise, transportation and childcare, rurality and land ownership.

West Virginia has a remarkable group of health visionaries. I want readers and listeners to see what they are doing, to see medical homes that are already demonstrably helping people manage chronic disease. I want them to follow people working with medical teams and health counselors. We will visit places where people are building their own trails, transforming uninviting environments into walkable, bikeable towns. I want them to see what school-based clinics and regular PE can do and find out about the research projects that are tracking all of the above.

I want them to know chronic disease isn't inevitable and it's not hopeless.

One of the big problems of statewide efforts at this point: lack of coordination. Major players are unaware of the efforts of others who are carrying out similar efforts elsewhere. There is unnecessary fragmentation and gaps in services.

To that end, as the year passes, we plan to build practical, useful online pages that catalogue and map successful efforts statewide. In partnership with West Virginia University Extension Service and others, we will create a Web bank of program profiles as a resource for communities, accompanied by short multi-media educational pieces that anyone can use or borrow.

Readers and listeners will be an important part of the project. My stories will alternate with reader/audience feedback/discussion and build on those discussions.

This is a daunting project. I am in the kitchen sink phase, interviewing a long list of people, trying to get my mind around statewide efforts. We expect to start publishing in the fall and continue from there.

I am very lucky to have talented colleagues at the Charleston Gazette and West Virginia Public Radio who care about this project. I am inspired and deeply impressed by the West Virginia health visionaries I have already interviewed. We believe this project will play an important role in the war on this public health emergency.

We want to help declare that war and advance it.