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Oregonians are known for loving the outdoors. But that doesn't necessarily mean we're healthy. By some measures, Oregon is one of the least health states in the West.Chronic diseases such a diabetes, obesity and high blood pressure are the leading cause of death in Oregon and cost Oregonians more than $8 billion dollars each year in medical costs.Oregon Public Broadcasting's Ryan Haas has produced this four-part series that looks at the human and financial costs of Oregon's chronic disease problem, and looks at some solutions.

Oregon’s $8 Billion-A-Year Health Problem: Chronic Disease

Ryan Haas/OPB
Marilyn Hersey, 79, is one of many Oregonians living with chronic disease. State health officials estimate conditions like diabetes and heart disease cost average Oregonians more than $8 billion a year in medical costs alone.

Marilyn Hersey, 79, credits a monster with saving her life.

“It wasn’t like I had to go out and kill the Gila monster before I got [its saliva] or anything like that,” Hersey said. “It was just the idea.”

The saliva from the Gila monster, a venomous lizard that dwells in arid North American deserts like the Sonoran, is a mild but extremely painful neurotoxin. It’s also the key ingredient in medications used to treat type-2 diabetes.

A doctor diagnosed Hersey with diabetes in the early 1970s. She quickly found she was allergic to most medications used to treat the disease. That changed for her in the early 2000s after an epidemiologist isolated a protein in Gila monster saliva that could regulate insulin and glucogen levels in diabetics.

“After all the medications that were tried on me, I was really glad to get it,” Hersey said.

She is one of more than 2.42 million Oregonians, roughly 54 percent of the state’s population, currently living with some type of chronic disease — conditions like diabetes, high blood pressure, high cholesterol or heart disease.

Cancer receives regular media attention and has drawn a billion-dollar research center to Portland, in part funded by Nike founder Phil Knight and his wife Penny. That level of attention is understandable given the devastating ways cancer affects so many people.

And yet, chronic disease is a far larger problem.

Data shows chronic disease affects far more people than cancer, is the leading cause of death in Oregon, and costs Oregonians more than $8 billion a year in medical costs — the equivalent of what NASA plans to spend in its search for alien life on Jupiter’s moons.

But these conditions receive comparatively little media coverage or prevention funding.

“By far, the consequences of chronic disease are the thing that I spend most of my time on,” said Dr. Daniel Rosenberg, a family physician for Providence Medical Group in Portland’s Gateway neighborhood.

The solutions to chronic diseases aren’t that complicated: convince people to eat healthier foods and exercise more. The complication comes in getting people to follow that simple advice in their everyday lives.

Oregon doctors like Rosenberg are facing a veritable tsunami of chronic disease. Despite the state’s reputation as an outdoors activity destination, Oregonians rank among the top Western states for obesity, diabetes, smoking rate and high blood pressure.

Oregon’s poor health factors essentially make it the Alabama of the West — a place where disease has transformed from an affliction of the elderly to embedded culture. Oregon stands out as a hot zone for chronic disease compared to neighboring Washington and California, let alone uber-healthy Colorado.

For example, Oregon’s obesity rate — the number of people with a body mass index above 30 — hovers around 30 percent. Comparatively, Washington sits at around 26 percent, California 24 percent, and Colorado leads the nation at 20.2 percent.

Rosenberg has around 1,600 patients, half of them children. He estimates that nearly all are obese or overweight.

“I often tell my patients that if I could just convince people to engage in a regular program of physical activity and eat a healthy diet, I would probably be out of a job,” he said.

Part of the reason these conditions take up such a disproportionate amount of Rosenberg’s time, and his patient’s money, is because they compound over time.

Think of the choices that lead to chronic disease as akin to a really bad date. Maybe you have that extra slice of cake at work because you’re stressed out. Similarly, maybe you say yes to dinner and a movie with that nice, but kind of annoying co-worker as a way to feel good about yourself.

Neither of those choices has immediate negative consequences. The problem comes when that one bad date turns into a bad weekend at the beach; a bad relationship; a bad marriage.

“The way I think of it is: You can spend a little bit of money now to prevent problems that are going to cost a whole lot of money later on,” Rosenberg said. “Since I also take care of adults, I get to see the enormously expensive consequences down the road.”

The Human Costs

Though the financial costs of chronic disease in Oregon are astronomical, the human costs are often even greater.

Hersey, who lives at a tranquil retirement community along the banks of the Willamette River in Milwaukie, remembers thinking diabetes wouldn’t have much effect on her life when she was diagnosed in the 1970s.

“When I was first diagnosed, I didn’t feel bad,” she said. “And I just thought, ‘Well, I’ll just do what I’m told to do and be on top of it.’”

That quickly changed for the Klamath Falls native.

“I got sick easier. I had more things wrong,” Hersey said. “It’s hard to have as much energy, and I was a pretty energetic person that kept going, but it was harder.”

Hersey said when she was fresh out of college, she traveled a lot with her friends and tried to model her life after her favorite musical, “Chicago.”

“That was my roaring 20s,” she said.

But her diagnosis dimmed the neon lights on her good times just a bit. She spent more time on the sidelines or resting in hotel rooms as her friends swam along golden beaches in Hawaii and sought new adventures.

Still, the loss of energy and the weeks-long colds have been relatively minor setbacks for Hersey. Like most Oregonians, chronic disease has touched her life in more grim ways.

In 2016, her oldest daughter, Kimberly Jesu, went for a hike with her husband. When the couple returned home, Jesu said she was tired and went to bed while her partner stayed up to watch television.

Later that night, he found Jesu dead.

“It was her heart,” Hersey said. “Her heart had quit working.”

Hersey’s daughter had lived a vibrant life. She was a playful child who often played jokes on people. Later, she traveled the world, worked for the BBC in Hong Kong, and taught biology at California State University.

And then with no real warning, she was gone. She had died at 59 of an undiagnosed heart disease.

Jesu had not told her family about any health problems before her death, possibly because she was unaware.

Chronic conditions can accumulate slowly over time, and a person may not be aware just how at risk their life is unless they have a medical checkup.

Jesu’s untimely death underscores why health issues Oregonians tend to put off addressing, such as extra weight or high blood pressure, are among the most serious problems this state faces.

In 2016, the American Heart Association estimated more than 800,000 Americans died from cardiovascular disease. That’s around one in every three deaths in the country.

“Often times, I would think how lucky I was because [my children’s] health had been good,” Hersey said. “I just didn’t think this was going to happen to us.”

Simple Answers — Or Are They?

The science around these conditions can be confusing, and at times contradictory. That helps explain why chronic disease has thrived in the United States – and in Oregon in particular.

For decades, traditional nutrition advice from trusted organizations like the American Heart Association and the U.S. Department of Agriculture has been to avoid fatty and salty foods because they lead to heart disease and high blood pressure.

But there’s notable dissent to those theories now. A 2015 meta-analysis of dozens of studies, published in the British Medical Journal, concluded there is not clear evidence to conclude saturated fats necessarily lead to heart disease. And even the American Heart Association has acknowledged sodium’s role in blood pressure is more complex than once thought.

General healthy food and exercise guidelines still apply, said Emily Ho, a nutrition researcher at Oregon State University.

“I think a lot of people are looking for quick answers,” Ho said, “and really there is no one magic diet that is the answer for everybody.”

Her basic advice to Oregonians is to follow wisdom “your grandmother gave you” — move more and eat lots of vegetables and whole foods while limiting high-fat, high-sugar processed foods.

For the Oregon Health Department, convincing people to follow that sage advice is a complex balancing act.

Oregon currently relies largely on educational materials and support hotlines it produces to help people lead healthier lives — a low-cost and passive approach that hinges on the willpower of Oregonians to make better choices for themselves.

But at the same time, well-funded tobacco and junk food corporations are waging massive advertising campaigns to keep their customers and recruit children to be the next generation of consumers.  

The alternative approach for Oregon would be to dump a large amount of money into getting taxes and regulations passed that could forcibly change people’s behavior. But the state could then be opening itself to nanny state criticisms and possible lawsuits. That’s what happened when New York City tried to ban gigantic sodas.

What’s clear, ultimately, is that Oregon’s current strategy isn’t working. More people are becoming sick here every year, and that trend shows no sign of slowing.

Copyright 2017 Oregon Public Broadcasting