6/2/2009

Rural counties radiate health

The study, along with an interactive web application, is available at www.khi.org

By DUANE SCHRAG

Salina Journal

The good news is that Saline County has great health care facilities.

The bad news is that it needs those health care facilities more than most Kansas counties.

A study released Monday by the Kansas Health Institute ranks Kansas counties by their health index. Saline County comes in 63rd, solidly in the middle of the state. Rural counties tended to score well: Gove and Sheridan counties were the top two, and half the counties in the top quartile were in the Salina Journal readership area, in north-central and northwest Kansas.

Urban areas -- with the notable exception of Johnson County, which scored third -- tended to fare less well. Wyandotte County was 105th; Sedgwick County was 85th. The bottom quartile was otherwise dominated by southeast Kansas counties.

"I hope this can act as a stimulus to generate some conversation," said Dr. Gianfranco Pezzino, a senior analyst in KHI's public health unit and the study's lead author.

Saline County scored somewhat better than the state average on the incidence of sexually transmitted disease (317 cases per 100,000 compared to the state average of 364), but worse than the state average on violent crime (338 per 100,000 compared to 223), smoking during pregnancy (23 percent compared to 15) and high school non-graduation rate (15 percent compared to 11).

Dr. Robert St. Peter, president and CEO of the health institute, said a central purpose of the study is to underscore "linkages about places we live and the things that we do, and how they affect how healthy we are as a people."

Health care reform has emerged as a major national issue but the discussion nearly always focuses on issues relating to the cost and delivery of health care. A wealth of research shows that health outcomes -- wellness, if you will -- has little to do with the quality of available care and nearly everything to do with genetics, lifestyle and socioeconomic factors.

The study created the health index from two components: health outcomes and health determinants.

Outcomes were measured using three, equally weighted factors: mortality (expressed as the years of potential life lost due to premature death), general health status and the incidence of low birth weight babies.

Determinants were measured using four factors that were measured using a total of 28 indicators: health behaviors (tobacco use, diet and exercise, alcohol use and high-risk behaviors) and socioeconomic factors (education, income and social support) each accounted for 40 percent of the health determinants component. The remaining 20 percent was derived from health care (access to care and quality of preventive and outpatient care) and physical environment (air quality, water quality and built environment).

Pezzino said the relative rankings of two counties in the Kansas City area -- Johnson, at third, and Wyandotte, 105th -- underscore the role socioeconomic factors play in health:

nIn Johnson County the high school non-graduation rate is half the state average; in Wyandotte County, it is twice the state average.

nChildren in Johnson County are in poverty at one-third the state rate; in Wyandotte County, they are in poverty at twice the state rate.

nTeen births occur at half the state rate in Johnson County; they occur at one and a half times the state rate in Wyandotte County.

"When you have those kinds of indicators, it's not surprising Wyandotte ranks at the bottom and Johnson ranks at the top," Pezzino said.

n Reporter Duane Schrag can be reached at 822-1422 or by e-mail at dschrag@salina.com.

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