Assessing health of local counties

According to the fourth annual County Health Rankings by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, Michigan counties are actively working on improving health factors and outcomes, but still need work.

Dickinson and Iron counties placed 29th and 50th respectively, reports the Dickinson-Iron District Health Department. The study provides a snapshot of each of the nation’s counties and ranks them against other counties within their state.

The report addresses not only health care but other subjects such as health behaviors and the social and economic well-being of a county’s residents.

“From a public health perspective, I appreciate the effort to provide communities with these snapshots of health-related indicators that can be used to supplement local assessments,” said Dr. Teresa Frankovich, Medical Director for the Dickinson-Iron District Health Department.

“The data allows us to look for trends within our own communities,” Dr. Frankovich said in a statement.

Since 2010, the County Health Rankings report allows nearly all counties in the Unites States to compare themselves with other counties within their state on their health outcomes, which are measured by mortality (how long we live) and morbidity (our health-related quality of life).

Counties are also ranked by Health Factors which influence our long-term well-being. These factors include health behaviors such as smoking, alcohol use, diet and exercise, as well as access to clinical care, social/economic factors and the physical environment.

This year, a new indicator reported is the number of dentists per person within a county.

Although the rankings allow for comparisons, Dr. Frankovich emphasizes that the individual rankings are less important than looking at the specific data that was collected and whether it accurately reflects what we already know about our communities.

“One problem when developing a report of this kind is that in order to measure all counties by the same standards, large national databases are used and it can be tricky using this information to evaluate small, rural populations, “said Dr. Frankovich. “In fact, data is not available at all on some measures for smaller counties, making accurate ranking difficult.”

Dr. Frankovich also notes that some of the measurements chosen to review are selected because they are easily found for counties across the nation, not necessarily because they are the best measures of a particular problem.

For example, the study measures morbidity (how sick a person or community is), according to how people responded to a telephone survey when asked whether they were healthy or not and how many days in the last 30 they felt unwell-either physically or mentally.

“Perhaps we would get better information by looking at how many people in our community have been diagnosed with diabetes, heart disease, cancer or other chronic diseases – but that information is harder to get to in a standardized way, across the country,” Dr. Frankovich said.

“That being said, it will be helpful to look at the data to see what it tells us about each community’s strengths and challenges,” Dr. Frankovich said.

Dickinson County overall ranking remained fairly stable compared to the previous year’s results.

Health Outcomes were unchanged at 29th in the state and Health Factors were 12th (10th last year).

This year’s report suggests that Dickinson County’s strengths lie in areas such as number of primary care physicians, dentists, preventable hospital stays, health screening, high school graduation rates, unemployment and number of low birth weight babies delivered.

Dickinson County’s challenges were seen in areas such as smoking, excessive alcohol use, limited access to healthy food and high percentage of fast food restaurants.

This year a measure of drinking water safety was also included for the first time but was reported as “the percentage of population exposed to water exceeding a violation limit during the past year.”

Unfortunately, this is not a particularly helpful measure to use when comparing counties across the state, since rural areas often have only one or two population centers where nearly all residents are served by the same water source.

One water issue on one day in Iron Mountain, for example, would impact a high percentage of the county population whereas the same would not be true in an urban area served by multiple water supplies.

In 2013 the reported percentage was 50 for Dickinson County and 1 percent for the state overall. This is a perfect example of needing to evaluate the numbers with a local lens.

Iron County’s ranking for Health Outcomes (morbidity and mortality) fell from 39th to 50th this year and Health Factors moved from 18th to 23rd.

Most of the decline in Iron County Outcomes appears to be related to higher mortality in the past year. This may simply reflect the statistical problem of a small number of events having a large impact when they occur within a small population-rather than an actual upward trend in mortality.

Iron County ranked better than the state overall in areas such as delivery of low birth weight babies, number of STD’s, preventable hospital stays, high school graduation rates, unemployment and percentage of fast food restaurants.

Iron County Challenges were seen in areas such as motor vehicle death rates, uninsured residents, fewer primary care physicians and dentists, and more children in poverty.

Reliable data were not available in this report on alcohol use rates for Iron County. Iron County has the same measurement issues as Dickinson County when ranked on drinking water safety, which came in at 50 percent.

Dr. Frankovich said that issues of tobacco use, obesity, physical inactivity and alcohol use continue to be problems across local counties, and the state as a whole.

They contribute enormously to the preventable chronic disease burden that will have an impact on our local population for years to come. Dr. Frankovich said one of the purposes of the rankings is to draw people’s attention and motivate them to change.

“Not only can individuals change their own behavior they can also help to change the community they live in by supporting things like the development of great places to be active (like safe bike lanes, parks and trails) and increasing access to good, fresh foods, through farmer’s markets and community gardens,” Dr. Frankovich said.

While the results of the report shouldn’t be taken at face value, some of the information can be useful when looked at in the context of what else is known about the health of the county.

As noted by Dr. Frankovich, “this is one more tool to be used when assessing the health of our community.”