A new report by the United Health Foundation shows some good news in Maryland along with concerning trends in chronic conditions.

The America's Health Rankings report found the state ranked 11th overall with positive noted including Marylanders having a low incidence of adults with multiple chronic conditions.

But overall, the report found the number of Americans dealing with chronic conditions has increased, and eight conditions including things such as diabetes, cancer, cardiovascular diseases, COPD and chronic kidney disease reached their highest levels since the foundation began tracking them.

Dr. Marie Kanagie-McAleese, a pediatrician at the University of Maryland's Upper Chesapeake Medical Center, sees the maintenance of chronic conditions as an expensive way to approach the problem.

"When we look at how much money the United States spends on health care, we're looking at about $4 trillion a year," Kanagie-McAleese pointed out. "And it's estimated that about 90% of these health care costs are going towards management of chronic conditions. And so this is critically important for our medical system as a whole right now."

She emphasized the prevention and treatment of chronic diseases through changes in lifestyle would go a long way to reducing costs associated with disease management.

The report showed more than 29 million adults in the U.S. are dealing with three or more chronic conditions. The study's authors also noted in the past year, 15% of adults in the country with two or more chronic conditions avoided needed medical care, including prescription medicines due to high cost.

Kanagie-McAleese is board certified in lifestyle medicine and believes the public has yet to fully appreciate how our habits can affect health.

"There's not enough education for the general public about how tremendously important our lifestyle is at helping to prevent these chronic diseases from occurring," Kanagie-McAleese asserted. "But also once you have any of these chronic diseases, making lifestyle changes can really help in treatment and sometimes even reversal."

She said Type 2 diabetes is one example of a chronic condition which is very responsive to lifestyle changes.

Among the strengths in Maryland the report found a low prevalence of excessive drinking, and few cigarette smokers. Although one of the problem areas for the state was a high prevalence of insufficient sleep. In Maryland, 38% of adults are not getting enough sleep, which is higher than the national average, and ranked the state 39th in the nation for sleep.

Kanagie-McAleese added when people are chronically sleep-deprived, it promotes an increase in inflammation in the body.

"Inflammation is linked to the majority of these chronic diseases that we're seeing," Kanagie-McAleese explained. "Sleep is absolutely an underrepresented factor that can assist in your drive to be healthier, or it can work against you and help to promote some of these chronic diseases."


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As summer kicks into full gear, North Carolina dentists stressed the importance of maintaining children's dental health.

Dr. Miranda Kalaskey, a dentist in Raleigh and member of the North Carolina Dental Society, said with more outdoor activities and changing routines, dental care can often be neglected, leading to cavities and dental trauma. Her advice is for parents to keep up with preventive care and encourage healthier eating habits.

"Try to pick a healthy summer snack. That can be fruit. That can be vegetables. Just not something dry, not something processed," Kalaskey outlined. "And the more processed you have, the more dried it is, the more likely it is to stick to their teeth."

She pointed out left-behind food can cause cavities. Tooth decay is the most common chronic disease among children in the U.S., with more than half of eight-year-olds having had at least one cavity in their baby teeth, according to the Centers for Disease Control and Prevention.

Warmer weather also means more outdoor play. Kalaskey highlighted the rise in dental trauma cases during the summer because of increased outdoor play and sports activities.

"Oftentimes, kids are going and playing basketball, and sometimes high schools are really good about, 'Hey, here's a mouth guard,' or 'You need to get a mouth guard for practice,'" Kalaskey noted. "But during the summer, a lot of times kids will play with other kids, which is great, but making sure they're aware that tooth trauma is a thing."

If a tooth gets knocked out, contact your dentist immediately. If it is after hours, she suggested the ToothSOS app for guidance.

She added another major key to dental hygiene for kids over the summer is a consistent schedule.

"Summer oftentimes is going to change that routine but your brushing, flossing routine does not need a change," Kalaskey recommended. "You still want to do brushing twice a day, flossing at least once a day. So kind of making sure we incorporate that, even though the kids might be waking up at 10 o'clock."

Kalaskey emphasized routine is also important for dental visits. She advised children should be seen by a dentist when they get their first tooth and then every six months afterward. In addition to keeping teeth healthy, she stressed it also builds a good relationship with dental visits in the long term.


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A Virginia community health center is part of a program addressing food scarcity.

The National Association of Community Health Centers' 2024 Innovation Incubator creates ways to expand healthy food access. Tri-Area Community Health Center's Laurel Fork location will have funding and guidance from experts to help them design and test community-based solutions.

Merrill Warschoff Press, senior vice president of partnership, development and innovation for the National Association of Community Health Centers, said the centers are uniquely suited to address local food issues.

"Health centers are highly effective and innovated with integrated models of care," Press explained. "They reach far beyond the walls of the traditional exam room, not only to prevent illness and treat it but to really address the social drivers that may cause poor health."

Food insecurity has grown since pandemic-era programs ended in 2023. Emergency allotments provided SNAP recipients with an added $95 per month for 470,000 families statewide. However, some people are above or below SNAP's qualifying threshold.

Other issues stem from food prices. The Consumer Price Index shows food prices grew between 2022 and 2023 but in recent months, prices have been declining.

A primary goal of the Innovation Incubator is to discover best practices for providing care for millions of people and share them with health centers nationwide. Press noted the methods being worked out can help varying populations.

"There are many health centers who have large populations of patients who come from other countries and are used to certain foods, and have different preferences," Press observed. "Being able to work with them in their own language with the foods that they like and trust is really valuable to improving access to food that'll make a difference in their lives."

Food pantries have been key to reducing food insecurity wherever possible. Virginia food banks saw a 5% to 10% increase in demand at the end of 2022, which is problematic since food banks nationwide are seeing donations decline and reduced commodities from the Emergency Food Assistance Program.

A southeast Arkansas healthcare system is using grant money to help increase its patients' access to healthy foods.

Mainline Health Systems will use the funds to focus on healthy eating habits for people who are expecting.

Work will include showing families how to grow their own fruits and vegetables, and establishing farmers markets that cater specifically to the needs of pregnant women and new mothers.

Health System Registered Dietitian Jane Pelkki said they will teach new moms the basics of eating healthy.

"Eating healthy doesn't have to cost a lot, that it's doable and that there are food assistance programs such as WIC and SNAP, food stamps," said Pelkki. "And we're also going to provide some food to help moms understand what a healthy meal looks like."

Mainline is one of eight health systems nationwide to participate in the National Innovation Incubator program.

It's sponsored by the National Association of Community Health Centers and the global healthcare company, Abbott.

Research shows almost 13% of U.S. households experience food insecurity - or don't have access to an affordable, nutritious diet.

Merrill Warschoff-Press - senior vice president at NACHC - said the facilities play an integral part in improving the overall health of patients, and address social issues that may cause illnesses.

"They reach far beyond the walls of the traditional exam room, not only to prevent illness and treat it, but also to really address the social drivers that may cause poor health," said Warschoff-Press, "so whether it's food insecurity and poor nutrition or even housing, joblessness, mental illness, substance use disorders."

At the end of the six-month pilot program, results will be shared with 1,400 health centers nationwide. That could impact the overall health of more than 31 million patients across the country.