The state health officer wants to reduce the demand for medical services: tests, doctors and hospitals.

That would mean Kansans were living healthier, more productive and longer lives. It also would relieve the growing burden of health care costs on taxpayers, insurance payers and everyone else.

“As a country, we’ve got a bigger burden than anyone else in the world in having to cover that cost, which is a sixth of our whole economy,” said Dr. Jason Eberhart-Phillips, also health director of the Kansas Department of Health and Environment.

The good news is that there’s a lot public health can do at the local and state levels to reduce demand.

Here’s what he considers the Top 10 health challenges — in no specific order — in Kansas, and how they can be addressed:

1. Tobacco use

One in six Kansans is addicted to tobacco.

Eberhart-Phillips would like to see more activism and advocacy in protecting youths from developing the addiction.

He is hoping the state, with the help of new Gov. Sam Brownback, will increase cigarette taxes to discourage kids from smoking and to give adult smokers the nudge that they need to quit smoking. He has talked to Missouri’s state health officer, who plans to push for a cigarette tax increase as well. Missouri has the lowest cigarette tax in the country.

Also, “we need to preserve, protect and potentially enhance the Indoor Clean Air legislation, and really make it embedded in our culture that public places are not places to release toxic chemicals,” Eberhart-Phillips said.

2. Obesity and the chronic diseases associated with it

Sixty-two percent of Kansas adults are overweight or obese, and one of the most common diseases related to being overweight is diabetes.

“What ought to be a relatively rare disease now affects as many as one in seven Kansas adults,” Eberhart-Phillips said. A new study projects that will increase to one in three by 2050.

He said it can be addressed by improving access to healthy foods at schools, workplaces and restaurants, and by creating infrastructure that encourages walking and bicycling.

“We need more development like Massachusetts Street and less like 23rd Street in our cities, or South Iowa even gets me more annoyed. I cannot go from one store to another unless I first get in my car, even though everything I need is down there,” he said.

3. Fatal injuries

Too many Kansans die before they reach retirement age because of injuries, he said.

He said increased seat-belt use, helmet use and suicide prevention are a few efforts that could help reduce the problem.

In some states, he said, seat-belt use is 90 to 95 percent. In Kansas, it’s 75 to 85 percent.

“In our rural communities where the risks are the highest and the deaths are the most common, it’s much lower than that,” he said.

About one Kansan dies every day from suicide.

“Lawrence has a lot of activists in the area, and they are right,” he said. “This is a problem that we’ve neglected for too long, and it really is going to take some cultural change.”

4. Environment

Eberhart-Phillips said childhood lead poisoning and prairie burning are concerns.

“We had 140 cases of lead poisoning in our most recent year, 2008. Two-thirds of those were under age 2, when it’s going to have the most lifelong impact on their brain development and ability to learn,” he said.

He said the seasonal, controlled prairie fires can push air quality measures to unsafe levels. The state is studying the issue to see whether it is a health risk, especially for people with asthma, heart disease or other illnesses.

“We want to make sure we are not adversely affecting people’s health and find maybe better ways to do that,” he said.

5. Infant mortality

Eberhart-Phillips said the United States has a higher infant mortality rate than other developed countries.

To make matters worse, Kansas’ rate is high among the states.

“We used to do better than the rest of country, and now we are 20 percent higher than the rest of the country,” he said. “That’s pretty alarming.”

6. HIV and STDs

Eberhart-Phillips said there have been significant increases in HIV cases and sexually transmitted diseases.

Ninety new HIV cases were reported in 2008, a 34 percent increase from four years earlier.

There have been 7,700 cases of chlamydia — an STD that can cause infertility and other problems — among young adults ages 15 to 24 per year.

“A lot of work needs to go into it preventing this,” he said.

7. Immunization

Kansas has gone from ninth worst in the country when it comes to immunization rates to seventh best.

Still, he said, there are a lot of unimmunized children, and that can lead to outbreaks. For example, in some parts of the country, whooping cough has surged to levels not seen in 50 years.

“It could well come to Kansas,” he said.

He said the state is “woefully insufficient” in adult vaccination. He is especially disturbed by the number of health providers who don’t receive a flu shot.

“Of all people, they ought to know better,” he said. “So, that certainly is an area of concern.”

8. Oral health

One in four Kansas children suffer from untreated tooth decay, which hinders their ability to perform well in school.

“We are one of the worst states in the nation in terms of fluoridating our water, which would be a cheap and effective way to undo much of that decay,” Eberhart-Phillips said.

Only 44 percent of Kansans get fluoridated water in their homes. City of Lawrence residents get fluoridated water.

Also, many communities lack primary care dental services. Fourteen counties don’t have a dentist, and another 14 don’t have enough dentists to serve their populations.

9. Health care-associated infections

Every year, Americans contract 1.7 million infections while being treated in hospitals. These infections cost the country between $30 and $40 billion per year.

They are associated with about 99,000 deaths annually.

If these were counted as a cause of death, Eberhart-Phillips said it would be the sixth leading cause of death and largely preventable.

“We are going to find out how many there are in Kansas for certain types with a voluntary surveillance system that’s being set up now,” he said.

10. Access to quality care

One in eight Kansans has no health insurance. This doesn’t include those who are underinsured.

“The under-insurance problem, in some ways, is even bigger in that they are not counted as uninsured but they may as well be because the costs are preventing them from getting the care that they need,” Eberhart-Phillips said.

He said the Affordable Care Act’s goal of getting more Americans insured won’t work unless demand for medical services is reduced.

“We can’t add 32 million people if we are all going to be as sick as we are in 2010, because there isn’t enough money to pay for the health care,” Eberhart-Phillips said.

“We have to make it so you have less reason to use hospital services and you get more treatment on an outpatient basis, or you simply don’t need it at all because your environment has so well supported you in your active living and healthy eating and smoke-free lifestyle that you don’t come down with the diseases that are costing us so much now.”