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