Wednesday, March 25, 2015

Two Kansas counties, two vastly different health outcomes

Heartland Health Monitor

KANSAS CITY, KAN. ----- When it comes to standard measures of health, Kansas is a laggard. Whether we’re talking about obesity rates, incidence of diabetes, acute or chronic diseases, or childhood mortality, the Sunflower State typically ranks in the bottom half of state health rankings – and in recent years it’s been sinking even lower.

That’s bad enough. But there are vast disparities within the state itself. Averages only give a rough-and-ready sense of the state’s overall health picture; dig deeper – down to the county level – and you’ll find that some counties actually perform quite well while others perform poorly.

Nowhere is that more apparent than in two counties that sit cheek by jowl, both in metropolitan Kansas City: Johnson and Wyandotte counties.

State-by-state county health rankings released Wednesday by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute rate Wyandotte County 94th in health outcomes out of 101 counties in the state (four counties weren’t ranked). Johnson County weighed in at No. 2, behind Riley County.

And Wyandotte fared even worse in the rankings’ “health factors” – behaviors such as diet and exercise, tobacco use, sexual activity, and alcohol and drug use, as well as access to and quality of health care, social and economic factors, and the physical environment. The county finished dead last among the 101 ranked counties. Johnson County was ranked No. 1.

The two counties’ relative rankings have remained essentially unchanged over the years: Johnson at or near the top, Wyandotte – along with the state’s southeastern counties – at or near the bottom.

How to account for the health chasm dividing counties that adjoin one another?

Wealth matters

Start with the fact that Johnson is the most affluent county in the state, with a median household income of $73,733, according to the 2010 Census. (In fact, out of 3,143 counties in the entire country, Johnson is the 81st richest.)

Wyandotte, on the other hand, is the eighth poorest of Kansas’ 105 counties. Its median household income of $38,503 is about half that of Johnson County.

Those wealth disparities go a long way toward explaining the counties’ health disparities. An immense body of research shows that social determinants – including economic factors – have a much greater impact on health than medical interventions.

“The percent of children living in poverty in Wyandotte County is five times higher than in Johnson County,” said Robert F. St. Peter, a physician and president and CEO of the Kansas Health Institute in Topeka. “If you have children growing up in poverty, we know that that’s correlated to lifelong challenges related to maintaining good health status, healthy behaviors, good educational achievement and good employment opportunities down the road.”

There are any number of reasons why greater wealth correlates with better health. Wealthier people might be better educated and thus better informed about health. It’s possible socioeconomic status is itself a cause of health. And wealthier people tend to have better access to health care. The bottom line: Richer people have higher life expectancies and lower morbidity than poorer people.

Wyandotte County “has a sizable vulnerable population,” said William P. Moore, vice president of program and evaluation at The REACH Healthcare Foundation, which works to improve health access and quality on both sides of the state line.

By that he means that, compared with Johnson County, Wyandotte County has more people living in poverty, more homeless youth (it’s eight times as high in Wyandotte County as in Johnson County), more disabled people who have greater difficulty accessing care, and fewer residents who have completed high school.

Generational poverty

The poverty figures are especially striking. Fully a quarter of Wyandotte County’s population lives in poverty, compared with only 6.5 percent in Johnson County.

“Poverty and educational outcomes are very much associated with poor health,” said Wesley McKain, supervisor of Healthy Communities Wyandotte, an initiative launched in response to the 2009 county health rankings, the first year they came out and which listed Wyandotte County as having the worst health in the state.

“In order for our health factors to improve, there’s going to have to be jobs that Wyandotte County residents can get that will pay more than poverty wages,” McKain said. “And we’re going to have to improve our educational attainment.”

And while there are pockets of poverty in Johnson County, “what you have in Wyandotte County compared with Johnson County is generational poverty, generations of families in the community that have lived in poverty,” Moore said. “You don’t have that, in large numbers at least, in Johnson County.”

Communities Creating Opportunity, a faith-based group in Kansas City, has been working to identify medical “hot spots” in the greater Kansas City area – the ZIP codes with the highest concentrations of chronically ill and medically underserved residents based on emergency room use. And not surprisingly, preliminary results on the Kansas side show that the hottest spots coincide with some of Wyandotte County’s most economically distressed areas.

“What are the factors that lead individuals to frequently utilize the emergency room?” asked Seft Hunter, chief operating officer of Communities Creating Opportunity. “They tend to be minorities, they tend to be low income, they tend to have high rates of unemployment, they tend to have multiple chronic diseases that aren’t necessarily being adequately managed, they tend to be uninsured, they tend to have challenges with access to transportation. And it’s a confluence of all these things coming together in these communities in Wyandotte County.”
Mortality and morbidity

The new county health rankings dovetail with mortality and morbidity indicators for Wyandotte and Johnson counties compiled by the Centers for Disease Control and Prevention. The rankings’ health outcomes map neatly onto the CDC’s figures showing deaths attributable to various diseases and the relative incidence of diseases in the two counties.

In nearly every category, the discrepancies are striking. In fact, one of the few categories in which Wyandotte County outperforms Johnson County is Alzheimer’s disease/dementia. The reason for that: Wyandotte County residents have shorter life spans than Johnson County residents, and the biggest known risk factor for Alzheimer’s and dementia is increasing age.

“It’s hard for people to be healthy if they don’t have the education and resources and the wherewithal to take care of themselves and follow directions and do the kinds of things that we all know are healthy for ourselves,” said St. Peter, of the Kansas Health Institute. “It’s hard for people that don’t have jobs and economic resources and transportation, good child care – it’s hard for them to do that.”

Of course, even drilling down to the county level is somewhat misleading, because the county averages are just that – averages – and don’t account for the different population subgroups within each county.                                                           

“For some population groups, when you look at African Americans, when you look at Hispanics, the figures aren’t the same,” said Hunter, of Communities Creating Opportunities. “The figures for African Americans and some Hispanics in Johnson County are actually quite similar to what you’d see in the bottom six sickest counties in Kansas.

“Just looking at Johnson County in the aggregate, you may say, ‘They don’t need access to transportation, they don’t need to worry about issues related to health care access,’” Hunter said. “But they absolutely do for some of these populations, pockets and communities of individuals whose demographics actually rival some of the counties with the worst outcomes.”

That said, the overall health gap between Johnson and Wyandotte counties remains large – although initiatives such as Healthy Communities Wyandotte and the Healthy Campus project promoted by Mark Holland, mayor and CEO of the Unified Government of Wyandotte County and Kansas City, Kan., are helping to narrow the gap, however incrementally.

“I am optimistic because I do see things that are happening in Wyandotte County that are encouraging,” said McKain, of Healthy Communities Wyandotte. “We are not at the bottom anymore, which is fairly significant when you’ve been at the bottom for the last four or five years.”

St. Peter said that in the long run, allocating resources to additional medical care may prove to be less important in improving overall health than investments in the community that “will help people help themselves be healthier.”

“I think that it’s those sorts of long-term policy, social kinds of conversations and discussions we hope come out of the county health rankings,” he said.

Editor’s note: The Kansas Health Institute is the parent organization of the editorially independent KHI News Service.

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