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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A Chicago mom who lost her son to cancer in 2022 is using the occasion of Mother's Day to call on Illinois lawmakers to pass medical aid-in-dying legislation.

Suzy Flack's 34-year-old son Andrew was a special-education teacher and avid hockey player living in California when he learned his cancer was terminal. Rather than return to his home state, he stayed in California, where medical aid-in-dying is legal.

Now, with such legislation under consideration by Illinois lawmakers, Suzy Flack is using social media to urge its passage.

"Like I said in the video, I didn't realize how horrific cancer was," she said. "So, I would really like to stress that that comfort level that he had because he had the control over his death."

The legislation would allow mentally capable, terminally ill adults with six months or less to live the option to request a prescription for medication they could use to end their life.

According to a 2023 survey by the group Compassion & Choices, more than 70% of Illinois residents support such a law, while 17% would oppose it.

With no legal way to end his life in his home state, Flack said her son was unwilling to leave California because he wanted a peaceful death.

"That option of having the medication was strong enough to keep him there, despite missing his family," she said, "and certainly, it would have been easier for all of us if he had been back in Illinois."

In addition to California, medical aid-in-dying is authorized in ten other states and Washington, D.C., while two additional states - Wisconsin and Massachusetts - are considering legalization. The Chicago-based American Medical Association has not endorsed the legislation.

It's National Nurses Week, and educators and healthcare officials say there just aren't enough of them to go around. A combination of retiring baby boomers and nurses who chose to leave the field after the pandemic has left a projected shortfall of more than 5,400 nurses in Nebraska's hospitals, clinics and long-term care facilities.

Linda Hardy, Nebraska Nurses Association president, explained that the system is not training enough new nurses to fill the vacancies.

"I think across the country we have a nursing shortage," she intoned. "But the other thing we have a shortage of are nurse educators - and also, clinical sites for student nurses to be able to practice their clinical skills."

According to a Nebraska Health Care Workforce Collaborative report, 66 of the state's 93 counties have been declared medically underserved, and nine have no nurses. The report points to degraded "emotional health and well-being" as the main reason for staff shortages.

Hardy added healthcare providers and state officials are studying how to increase the investment in educational facilities and clinical sites to train new healthcare workers, and said one goal is to recruit them when they are young.

"There's a collaborative effort to try and get more healthcare workers, not just nurses but radiology techs, pharmacists, etcetera, into the pipeline from high school kids. So, that's a good thing," she insisted.

Carole Johnson, administrator of the Health Resources and Services Administration, said her mission during National Nurses Week is to highlight the vital role nurses play on the front lines, providing care, comfort and support to patients every day, but added the best way to honor them is to support them from training through retirement.

"You have to be investing in the nursing workforce. And so we're providing scholarships, loan repayment, stipends, upskilling - a whole host of training initiatives to really help ensure that we can recruit people into nursing and that when they're there, that they stay," she continued.


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Birth doulas assist new moms with the stress, uncertainty and anxiety of childbirth, while another type of doula offers similar support to those who are dying.

Death doulas, or end-of-life specialists, give spiritual and emotional support to people nearing death in a nonmedical setting. The word 'doula' comes from the Greek word 'doule,' meaning 'female helper.'

Kim Burgess, end-of-life doula and board certified adult geriatric nurse practitioner for Comforting Transitions, an elder care facility in O'Fallon, said fulfilling a dying person's wish to be in their desired setting is important.

"When I was in the home, primarily geriatric population, people wanted to stay in their home; the comfort of their home, their own surrounding, their own food, their own loved ones," Burgess explained. "I loved to being able to support people in that role."

Training to become an end-of-life doula happens in workshops, with required reading and work-study assignments. Since it is not a federally recognized field, insurance companies do not cover the services. The Illinois Department of Public Health said in 2022, Cook County alone saw nearly 46,000 deaths. Almost 20,000 were between ages 65 and 84.

Death, or what is sometimes called "the other side," can produce feelings of fear, or a sense of denial, especially if a terminal condition has been diagnosed. Burgess observed it is a 24-hour job for loved ones helping someone in their final days or weeks. She has encountered families who are unprepared for the caregiving needs.

"A lot of times, their family is saying, 'We're just overwhelmed, and we have hospice involved, but we still feel like we need some more support,'" Burgess recounted. "An end-of-life doula can be there, giving the family reassurance or making some slight suggestions on how to comfort their loved one."

Doulas can also help plan an advance directive, instructions a person can leave behind about their funeral service or cremation, what to do with a pet or help writing a loving message to family and friends.