Dr. Clif CleavelandWide disparities in health exist across regions and within individual states. A resident of one county may enjoy years of additional, healthy living compared to a person of similar age in her state who happens to live in a different county.
County Health Rankings (www.countyhealthrankings.org), an invaluable program sponsored jointly by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, recently released its rankings and evaluations of U.S. counties for 2013. This is necessary reading for public officials and anyone interested in the public's health.
The comprehensive study emphasizes that health involves far more than periodic visits to clinics and pharmacies. Twenty-five different factors are analyzed in determining the health
status for populations of each county, including health behaviors, access to clinical care, social and economic factors and physical environment. Data for each county are compared with national benchmarks.
Common to counties with better health are lower rates of obesity, smoking, teenage pregnancies and school dropouts. These counties have better access to primary-care providers and dentists, social support systems, recreational facilities and healthy foods. They have lower rates of unemployment and fewer residents who lack health insurance. Income and educational status, obviously, are major determinants of health status.
While premature death rates have decreased nationally over the past 20 years, residents of the least-healthy counties have rates that are double those of the healthiest. Rates of childhood poverty -- more than 20 percent -- are unchanged compared to year 2000. Violent crime has shown a 50 percent decline since 2000.
In Tennessee, Hamilton County ranks 28th of 95 counties. Neighboring Bradley County ranks 17th; Marion County 90th; Sequatchie County 91st. Common to these counties are disturbingly high rates of children living in poverty, ranging from 28 to 32 percent.
In Georgia, Catoosa County ranks 51st out of 159 counties. Dade County ranks 114th; Walker County comes in at 118. Jackson County, Ala., ranks 48th among that state's 67 counties.
A more detailed portrait of Hamilton County shows:
Poor or fair health: 17 percent;
Smoking: 19 percent;
Excessive alcohol use: 11 percent;
Adult obesity: 30 percent;
Physical inactivity: 27 percent;
Children in single-parent households: 36 percent;
Unemployment: 8.2 percent;
No health insurance: 16 percent.
Many of the counties' statistical portraits are both daunting and grim. But the website offers a section of "Roadmaps" -- programs for engaging political leaders and citizens alike to analyze and reverse unhealthy trends. Collaboration is the key, and successful examples are described.
Leaders in government, business, philanthropy, education and health care convene, adopt a common language, analyze problems and develop solutions based upon the unique challenges of their locale. Since there are no quick fixes, years of patient work may be necessary to build a healthier community. Counties do not exist in isolation from neighbors, so regional remedies must be pursued.
Solutions for the Chattanooga metropolitan area carry the additional challenge of working across state as well as county boundaries. If we can assemble multi-county, tri-state plans for economic development, we should be able to duplicate the effort in addressing health, since the two issues are so closely linked.
A starting point could be innovative, public information programs that emphasized affordable, nutritious diets, exercise, completion of high school and avoidance of tobacco. Think of the possibilities for a Tri-State Health Consortium as you look at County Health Rankings.
Contact Clif Cleaveland at cleaveland1000@comcast.net.