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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to

Some Kansans’ health perceptions out of sync with reality

Report says few in state report poor health despite average death rates for heart disease, cancer

By Meg Wingerter | December 22, 2016

Some Kansans’ health perceptions out of sync with reality
Photo by America’s Health Rankings/United Health Foundation A recent report shows that fewer Kansans reported that their physical health was poor for at least two weeks of the past month than residents of Missouri. But that perception may have more to do with employment, poverty and education than with disease, according to a public health researcher.

Kansans have sunny perceptions of their own health despite health outcomes that are only so-so.

One of 10 Kansans reported they had “frequent physical distress,” meaning their physical health was poor for at least two weeks of the past month, according to the recently released America’s Health Rankings Report. Only eight states had fewer residents reporting poor health.

While Kansans’ perceptions might make the state appear to be a picture of health, they are about as likely to develop health problems as the rest of the country.

Comparing neighbors

Overall health ranking

  • Kansas: 27th
  • Missouri: 37th

Poor physical health in the previous month

  • Kansas: ninth, 10 percent of adults
  • Missouri: 41st, 13.9 percent of adults

Cancer deaths per 100,000 people

  • Kansas: 28th, 192.6
  • Missouri: 41st, 209.3

Heart disease deaths per 100,000 people

  • Kansas: 29th, 249.6
  • Missouri: 41st, 283.6

Diabetes rate

  • Kansas: 21st, 9.7 percent of adults
  • Missouri: 39th, 11.5 percent of adults

Source: America’s Health Rankings    

The report found Kansas was near the middle on deaths from heart disease and cancer. The state also was close to average when it came to the number of residents with diabetes, which can cause other health problems such as blindness and kidney failure.

Across the border in Missouri, however, residents’ views of their health aligned more closely with their outcomes. The state ranked 41st in the country on residents’ reports of physical distress, cancer deaths and deaths from heart disease, and 39th on the diabetes rate.

So are Kansans overly optimistic about their health and Missourians stuck in despair? It isn’t that simple.

Poor health means different things to different people, said Shervin Assari, a research investigator in psychiatry and public health at the University of Michigan. In the case of Kansas and Missouri, different perceptions may have more to do with employment, poverty and education than with disease, he said.

“These factors are all heavily influencing health,” he said.

People who live in or are surrounded by poverty perceive their health as worse than more affluent people, even if they have similar medical conditions, Assari said. People with higher incomes and more education tend not to rate their health as poor until they are seriously ill, he said.

That doesn’t mean that poor health is all in low-income people’s heads, however — in the United States, they generally do have more chronic conditions than more affluent people, Assari said. They just may have a lower threshold for determining when those conditions affect their health.

Economic factors might explain why Kansans are feeling better. The state’s unemployment rate hovered between 4 percent and 4.3 percent in 2015, when researchers collected the data on health perceptions. Missouri started 2015 with a 5.4 percent unemployment rate, though it dropped to 4.4 percent over the course of the year.

Missourians also were more likely to be poor in 2015, and Kansans were more likely to have completed high school and earned a bachelor’s degree

None of those factors alone has a massive effect on people’s health perceptions, but they seem to build on one another, Assari said. So a person with a high income and a college degree may see his health substantially differently than someone in poverty who never finished high school.

Perceptions of health also vary based on age, gender  and race, Assari said.

People who are older, male or white who say they are in poor health are at a high risk of death, he said, because they typically didn’t perceive their health as poor until they were extremely sick. But people who are younger, female or black or Hispanic tend to rate their health as poor earlier, when they experience conditions that aren’t life-threatening, like pain or depression, Assari said.

A young person with a medical condition might consider it to be a sign of poor health, but an elderly person with the same condition might shrug it off as part of aging, he said.

“It’s a comparison of expectations,” he said.