Vineyard Gazette Online
http://www.mvgazette.com/news/2005/01/07/island_health_report.php?&format=print

Health Report Unveiled: Depression Rates High, Lyme Disease Epidemic

By JULIA WELLS

Vineyard residents enjoy good health, especially compared with the general population on the mainland. They smoke less, they are thinner and they visit their doctors regularly.

But this picture of health is not unblemished. People who live on the Vineyard also neglect their dental care, they have high rates of thyroid disease and skin cancer, and they suffer from more depression, headaches and allergies than the rest of the population. They drink too much alcohol - way too much.

And the Island community is experiencing a virtual epidemic of tick-borne diseases - especially Lyme disease.

These are the highlights of the Health Report of Martha's Vineyard, a first-of-its-kind comprehensive health study conducted on the Vineyard more than two years ago. Obtained by the Gazette this week, the 150-page final report was completed in September, although it was never released to the public. The full text of the report is posted on the Gazette web site this morning at www.mvgazette.com.

The report is the culmination of a collaborative venture that was supported by nearly every health care organization on the Vineyard, including the Martha's Vineyard Hospital, Martha's Vineyard Community Services, the Dukes County Health Council, Hospice of Martha's Vineyard and the Foundation for Island Health. The six-month project, which took place in 2002 and 2003, included a random sampling of more than 5,000 full-time and part-time Island residents from all six towns and interviews with every health provider on the Vineyard.

The survey did not include children or the non-English speaking population on the Vineyard.

The result is a detailed scientific profile of health and health behaviors for the adult population here. It has the potential to be used for an array of grant applications and planning studies related to health care.

The report was directed by Dr. Diane Becker, a professor of medicine and director of the Center for Health Promotion at Johns Hopkins University in Baltimore, Md.

The response rate to the survey was extraordinarily high - 49 per cent of full-time residents and 22 per cent of part-time residents returned the 26-page detailed surveys that included no open-ended questions save one.

"Never in my entire 25 years of doing research have I seen better than 10 per cent," Dr. Becker said in a telephone interview about the report from her office in Baltimore this week. She said the survey can be accurately extrapolated to the general population of the Vineyard.

Among other things the survey found:

* The Vineyard is health conscious. More than 70 per cent of full-time and 84 per cent of part-time residents saw a doctor for regular health care in the last year.

* The Vineyard is plagued by headaches. Almost a quarter of the population suffers from tension of migraine headaches. The cause was unclear.

* The Vineyard is depressed. When the survey was done, about 14 in every 100 full-time residents had depression in the last two years.

* The Vineyard is alcoholic. Using The Centers For Disease Control's standard for problem drinking - more than five drinks in a single sitting more than two to three times a month - the survey identified almost a tenth of the Vineyard population as problem drinkers. In the survey less than a fifth of respondents said that their doctor had ever addressed alcohol use with them.

Cirrhosis of the liver also occurred in slightly higher rates on the Vineyard than the general population; the rates were highest in Edgartown and Oak Bluffs.

* The Vineyard doesn't smoke much. Less than a fifth of both full and part-time residents were smokers, compared with 22 to 23 per cent of adults in the general population. Smokers in the survey said that they wanted to quit and that their doctors had addressed smoking with them.

* The Vineyard is an incubator for tick diseases. A fifth of the full-time population and a tenth of the part-time population reported having a tick-borne disease. A little over 12 per cent of full-time residents reported having Lyme disease.

* Vineyard residents are neglecting their dental care. While a majority of full-time and part-time residents said they had received dental care in the last year, a majority also said they still had dental work that needed completion, including routine cleaning. A small number of people had urgent dental work that needed attention. High cost and access to a dentist were cited as the main reasons for avoiding dental care.

The survey examined many other topics, including perceptions about health and health care on the Vineyard (most people perceived their health and health care as good), patterns of use at the Martha's Vineyard Hospital (many people use the hospital emergency room as a walk-in clinic), and use of complementary and alternative cares (people use these therapies in addition to, not in place of, traditional care).

The practitioner portion of the survey also revealed detailed information about Vineyard physicians. Most are male and have been practicing for an average of 19 years. There was a strong theme of independence among the doctors - most said they had no interest in joining a managed care organization, nor were they willing to join with other Vineyard physicians in a group practice. The average number of patients seen in a week was 42 - lower than in the rest of the country - and about a third of physicians' practice was devoted to elderly care. Doctors spend an average of 20 minutes with each patient - longer than in the rest of the country.

Valued at $1 million, the health report cost the Vineyard community nothing and involved countless community contributions.

Dr. Becker, a respected researcher who has been doing public health work for 25 years, contributed all of her professional time. Fourth grade students in Vineyard schools stuffed envelopes when the survey was mailed out. Secretaries in the participating organizations volunteered their time to type all the handwritten responses from the surveys.

"This study is totally utilitarian. It is not a research study, but it could be used for a research study if someone wanted, and it could be used for planning and for things like quality improvement," Dr. Becker said.

She said the incidence of tick diseases should sound an alarm.

"It says that it's worse than anyone thinks it is - if you apply it to the total population on the Vineyard, 12 out of every 100 people have had Lyme disease," she said.

Equally troubling, Dr. Becker said, is the high rate of problem drinking, first chronicled 30 years ago by Dr. Milton Mazer in his book People and Predicaments. "What we have learned is that not that much has changed since the Mazer report, where alcohol was reported as a major problem. Even with the arrival of so many services over the years, it is still a pretty prevalent problem," she said.

Dr. Becker said this week that she finished the report in late August and gave it to the Foundation for Island Health with only final proofreading left to do. She did not know why the report had not been released.

Dr. Charles Silberstein, a local psychiatrist who founded the Foundation for Island Health and spearheaded the health report, said he was no longer involved in the report.

"It's been a long time since I was involved in the project, I'm not involved in the health report anymore," Dr. Silberstein said. "I certainly would like to see it out, too," he added.

Foundation executive director Patricia Moore, who was not at the helm of the foundation when the health report was done, said the foundation had planned to put the report out this year.

"We intend to publish the report, we think it's incredibly valuable and we are grateful to Dr. Becker and all of the members for their contributions. We look forward to publishing it in the late winter." Ms. Moore said.