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Original article URL: http://bridgemi.com/2013/04/living-on-right-side-of-county-line-means-more-life-better-health/

Quality of life

Living on right side of county line means more life, better health

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(Bridge illustration/A.J. Jones)

Zack Conley and Mike Sannan live on opposite sides of Rawsonville Road, a noisy strip of pavement separating Wayne and Washtenaw counties.

Both men have access to some of the best hospitals in the state. Yet Sannan is almost twice as likely to be in poor or fair health. As a Wayne County resident, he is, on average, more likely to suffer from diabetes, have mental health issues and have a child die as an infant.

If his life is representative of Wayne County men, Sannan will die six years earlier than Washtenaw’s Conley.

How can residents of neighboring counties, both with world-class medial facilities, live in two vastly different states of health?

There are clues in a recently released study by the Robert Wood Johnson Foundation.

That study found striking health disparities across Michigan’s 83 counties, and highlights the sometimes tenuous correlation between health and health care.

Among the findings:

-Gladwin County has the highest percentage of smoking adults (31 percent); the lowest rate of smokers is in Ottawa County (11 percent)

-Saginaw County has the highest rate of obesity (40 percent), but even in the skinniest counties (Ottawa and Washtenaw), a quarter of adults are considered obese.

-Lake County has the highest teen birth rate, at 64 births per 1,000 females ages 15-19; that’s more than four times the teen birth rate in Livingston and Washtenaw counties (13 per 1,000).

One border, two worlds on health
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Nowhere are the state’s health disparities more stark than the neighboring counties of Wayne and Washtenaw in Southeast Michigan. Of the 82 Michigan counties ranked (Keweenaw wasn’t included), Wayne finished dead last in health outcomes – an amalgamation of how sick residents are and when they die.

Despite being the home to five of the state’s top-10-ranked hospitals, Wayne County ranks last in health outcomes such as poor physical and mental health, low birth rate and premature death.

By contrast, Washtenaw, with the state’s top-ranked medical facility (University of Michigan Hospitals and Health Centers), is ranked fifth. (Leelanau County is tops in health outcomes.)

MORE COVERAGE: See the top 20 counties for health outcomes.

The health gap is best summed up in one piece of data: The average Wayne County resident dies at a younger age than residents of any other county in the state. (Michigan life expectancy for women and men.)

Washtenaw men live an entire U.S. Senate term – six years — longer than Wayne men; the average Washtenaw woman lives 2.7 years longer than her counterpart to the east.

To put the difference in a global perspective, Washtenaw’s male life expectancy of 78.4 is about the same as Switzerland’s; Wayne’s male life expectancy of 72.4 is the equivalent of Syria’s.

Washtenaw resident Zack Conley, sitting across the table from a Wayne County friend in a Rawsonville Road coffee shop, was shocked at the difference.

“We have some of the best hospitals in the country,” Conley said. “If you can’t get fixed here, you can’t get fixed anywhere.”

Medical care, health results aren’t same thing

But doctors and hospitals play a surprisingly minor role in the overall health of residents, said Marianne Udow-Phillips, director of the Center for Healthcare Research and Transformation at the University of Michigan.

“Both Wayne and Washtenaw have superb health-care organizations, but that’s really misleading,” Udow-Phillips said. “There are some very core issues that have a bigger impact on health status than medical care treatment — poverty, education, clean water, clean air.”

Of the 82 ranked counties, Wayne County finished dead last in health factors, with Washtenaw first. Health factors included in the study range from smoking, drinking and sexually transmitted disease to education, crime and the prevalence of fast food restaurants.

MORE COVERAGE: See how your county ranks on health factors.

“Some of these (health factors) are behavioral,” said physician and third-generation Detroiter Nat Pernick. “Even though people in adjacent communities live nearby, they have different habits. Smoking, drinking, exercise, weight — these are all major contributors to disease. Even when people have similar diseases, their health behavior may be different. Are you getting vaccinated? Making regular visits to the doctor and making follow-up visits?

“Health care isn’t simple,” Pernick said, “and a lot of people don’t do it well.”

Wayne County resident Mike Sannan is 80 pounds overweight. He lights a cigarette as he talks about health care. “I know I should stop,” Sannan said. “I work 12-14 hours. There is stress.”

Wayne residents have a higher rate of obesity than their neighbors to the west; almost twice as many smoke and report being in fair or poor health. The teen birth rate in Wayne is more than triple that of Washtenaw. Wayne children are more likely to be born with low-birth weight (10.6 percent to 7.8 percent); they’re more likely to grow up in poverty and in single-parent homes; and, as teens, they have less access to recreational facilities and more access to fast food restaurants. Finally, as adults, they are less likely to graduate from college and more likely to be unemployed.

MORE COVERAGE: The Wayne-Washtenaw gap

“For us as doctors, it’s not a matter of just writing a prescription,” Pernick said. “If you’re not with poor people a lot, you forget how difficult things can be. Most of us are privileged. Even if we have bad circumstances, we have the belief and knowledge that it doesn’t have to be that way and a support system. But what if everyone you know is in bad circumstances?”

Jan Hudson, senior policy analyst with the Michigan League for Public Policy, sees another factor in the Wayne-Washtenaw health gap, one that has implications across the state.

According to the study, 18 percent of Wayne County residents have no health insurance, while the uninsured rate in Washtenaw (11 percent) is the third-lowest in the state. (Livingston County is first.)

“The fact that emergency rooms are available for the uninsured doesn’t mean that being uninsured isn’t bad for your health,” Hudson said. “If you go in to the hospital with symptoms of a heart attack, they will treat you immediately for that, and then tell you to contact a cardiologist. If you call and say you have Blue Cross or Aetna, I’m sure they’ll take you right in. But the uninsured don’t have access to those great cardiologists and great cancer experts.”

Improving the health of Wayne County residents has less to do with cardiologists than with jobs, says Udow-Phillips.

“This is about changing economic opportunity,” Udow-Phillips said. “Health is about poverty. And the best way to get people out of poverty is education.

“If we invest in early childhood education, health issues (will improve)” eventually, she said, because education is positively correlated with better jobs and better health.

“This is a long-term issue,” Udow-Phillips said. “It’s not going to be solved by hiring more doctors.”

Senior Writer Ron French joined Bridge in 2011 after having won more than 40 national and state journalism awards since he joined the Detroit News in 1995. French has a long track record of uncovering emerging issues and changing the public policy debate through his work. In 2006, he foretold the coming crisis in the auto industry in a special report detailing how worker health-care costs threatened to bankrupt General Motors.

7 comments from Bridge readers.Add mine!

  1. Charles Richards

    It would have been extremely helpful if the health outcomes for all 83 counties had been made available, instead of just the top twenty. It would have made for interesting comparisons between outcomes and factors.

  2. Forrest

    Interesting data, not much evidence of cause. The data does make one better understand that health care or doctor care has little to do with good health. Yes, once sick or stricken with disease a good thing, but life style has most to do with good health. Now, are the people adapting poor health habits lazy, ignorant, uneducated, suffering from peer pressure, have heritage that serves their health habits poorly, we know little of, as the “science” will not go their. Instead the PC undertaking will only investigate matters that could be controlled by government resources. This is sad and will lead to false hoods and ignorance upon taboo limits. Science should not have such limits. We have correlations, but that info is mostly useless i.e. poor people have a better chance to die early therefore give the poor money and they have longer lifespans and disease free. But, we know some of the healthiest people on planet are the poorest. Some with little health care. Also, motivated citizens will succeed with good healthy habits, good education, and probably a good income within a total vacuum of such government services trying to accomplish said. Were barking up the wrong tree as some would say……We should be studying what motives people vs what depresses people. Providing to much easy money or IOWs proving to much temptation a bad thing as it is immoral or at least the act of begging for charity will develop bad personality traits i.e. less self worth. Rewarding and celebrating success a good thing for motivate populace. Dissuading victim hood mentalities good. Freedom is good to allow citizens more control. Some of the most depressed people in the world have tyrants and other systems of governance that take opportunities away from private citizen control abdicating to elites upon central control. Like the closer one gets to D.C. the more benevolent one becomes. Personalty I think this has more to do with mental health such as despair and depression. But, again, money has little to do with such state of mind energy. Our modern state controlled lifestyle and accepted practices or priorities are horrible caustic. We could do so much to propel the country to pursuit of happiness, yet we seemed to be locked within poor solutions and priorities. Government should be utilized to harmonize this pursuit and do so upon the smallest footprint possible.

  3. Duane

    If health is about (Nat Pernick) “Smoking, drinking, exercise, weight — these are all major contributors to disease”, is personal health individual choice?

    If health is about (Udow-Phillips) “There are some very core issues that have a bigger impact on health status than medical care treatment — poverty, education, clean water, clean air…”, are people forced into poor health?

    Is it choice (Nat Pernick) or is situation (Udow-Phillips)?

    If smoking, drinking, eating are habit driven, then are they a choice? If it is choice and habit why aren’t we talking about how and why those who don’t have those habits are avoiding them and developing ways to help those with the poor health habits to change?

    Haven’t we known for decades lifestyle choices can create poor health. I wonder about how people can create good personal habits and good health.

    Much like the Federal government, Mr. French only wants to talk about failures and ignore the how’s/why’s of successes. Mr. French seems more interested being unhealthy rather than in how people can become healthier.

  4. gary Kujat

    The topic of health care hits a raw nerve with me. What justifications do health provivers have for their charges? Why do some of them jack up the bill if they know the insurance company is going to pay the bill? Do doctors order more test than neccessary to help cover the cost of their medial malpractice insurance? Do they over look test than may harm their finincial status? Do the forms patients sign during pre admission conform to state and federal laws? Do the forms explain where patients can file a complaint, suggestions, or comments? What agency or department would review, at the request of the patient, treatments and medications given?
    Patients should have the rights to review and include comments in their medical records before anyone else has access to them

  5. Forrest

    Agree, that good health has little to do with doctor care. Don’t agree with the following except that it is a correlation. “This is about changing economic opportunity,” Udow-Phillips said. “Health is about poverty. And the best way to get people out of poverty is education.“This is about changing economic opportunity,” Udow-Phillips said. “Health is about poverty. And the best way to get people out of poverty is education.

    Don’t forget education is a student accomplishment. Meaning once student is motivated, mission accomplished. So, what motivates people to exceed or accomplish? Free money? Free education? Expensive union teachers? Expensive schools? Compassionate talk? No and no! Mankind is basically a greedy lot whom work selfishly to better themselves. To make themselves more admired, wealthier, or to make themselves more rewarded in afterlife. I grew up next to Indian reservation and had young friends from the area. Sad to watch how easy lifestyle or livelihood corrupted their spirit and propelled them to downfall and depression. Better to starve a while and pull your own wagon and regain human spirit and self worth. We should, as a society, enable or better yet maximize ability to earn a living. Some ideas…..adapt cooperative part time job experience upon our 7th to 16th grade education system. Let students achieve from get go by earning income from education. Students should achieve more freedoms upon academic success. Meaning more independent hours to pursue interests if keeping grade point up upon standardize testing. Those whom require less formal expensive education should be rewarded with monetary payments. Formal Public Education should be the punishment for poor achievement. It performs much that way currently.

    1. Duane

      Lee,

      What you say about the individual makes sense. I might frame it a bit differently, rather than greed it maybe more about a sense of accomplishment and how we score it. I would also see it more a short-term and long-term focus. Does the individual have confidence to be willing to invest themselves for the long-term or so they focus on what they can enjoy in the short-term. It also has to do with the habits they develop and maintain. Do the invest in creating habits that can benefit in the long-term and reinforce those habits with short-term scoring or do they fall into habits that are reinforced by short-term satifactions.

      It is about the individual and what they are willing to do. It is also how those around them, the people and the reinforcements that turn to. As an example do teacher set goals for them and give them the goals and coaching to create the habits it takes to achieve those goals or do the teacher/the system focus on what gives them short-term recognition. Do the systems the politicians create feed the short-term wants/needs and discourage the long-term benefits (does the system reward or at least encourage the people who invest for the future or do they cause those people subsidize the ones who only look to their immediate wants)?

      Does is the medical care system designed to fix immeidate problems or does it invest in providing the tools and support for people to change for long-term health?

  6. Lee

    Agree, that good health has little to do with doctor care. Don’t agree with the following except that it is a correlation. “This is about changing economic opportunity,” Udow-Phillips said. “Health is about poverty. And the best way to get people out of poverty is education.“This is about changing economic opportunity,” Udow-Phillips said. “Health is about poverty. And the best way to get people out of poverty is education.

    Don’t forget education is a student accomplishment. Meaning once student is motivated, mission accomplished. So, what motivates people to exceed or accomplish? Free money? Free education? Expensive union teachers? Expensive schools? Compassionate talk? No and no! Mankind is basically a greedy lot whom work selfishly to better themselves. To make themselves more admired, wealthier, or to make themselves more rewarded in afterlife. I grew up next to Indian reservation and had young friends from the area. Sad to watch how easy lifestyle or livelihood corrupted their spirit and propelled them to downfall and depression. Better to starve a while and pull your own wagon and regain human spirit and self worth. We should, as a society, enable or better yet maximize ability to earn a living. Some ideas…..adapt cooperative part time job experience upon our 7th to 16th grade education system. Let students achieve from get go by earning income from education. Students should achieve more freedoms upon academic success. Meaning more independent hours to pursue interests if keeping grade point up upon standardize testing. Those whom require less formal expensive education should be rewarded with monetary payments. Formal Public Education should be the punishment for poor achievement. It performs much that way currently.

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