Checking Up on Forsyth County's HEALTH: Poverty rate influences 20th-place rankings

Dr. Tim Monroe, the health director for Forsyth County, said he is asked frequently why the community lags behind other urban areas in North Carolina regarding overall quality of health.

After all, with two of the state's largest hospitals here, there's no shortage of access.

A national health-care study released yesterday offers an answer from an analytical perspective. By providing a standardized measuring stick for every county in the country, it helps explain why Forsyth's predicament is more related to socioeconomic reasons than to lack of care.

The study, done by the Population Health Institute of the University of Wisconsin, ranked each county within its state by measuring the residents' health and they lifespan. The study did not make a state-by-state comparison.

The data were collected primarily in 2005 to 2008, which means that it doesn't reflect the surge in the jobless rate and the ranks of the underemployed in the past 18 months, nor did it take into account those without health insurance or who are temporarily relying on COBRA.

The study focused on two major categories: health outcomes, which represent mortality and morbidity; and health factors, which represent behavior, clinical care, socioeconomic conditions and physical environment.

Forsyth was ranked 20th in the state in both categories, and ranked fifth among urban counties behind Wake, Mecklenburg, Guilford and Durham.

"All the individual studies involving infant mortality, sexually-transmitted diseases, teenage pregnancy and tobacco use are all manifestations of the bigger phenomenon reported in this study," Monroe said.

"It's clear that having two major hospitals here is a benefit, as represented in the study," he said. Forsyth was ranked seventh for clinical care, including second among the top five urban counties.

"However, clinical care and new medical technology alone can't fix the socioeconomic conditions that weigh on Forsyth," Monroe said. "Health status, for the most part, still can be determined by where someone lives and their socioeconomic resources."

For example, the N.C. Budget and Tax Center has reported that Forsyth had the lowest median household income -- and the highest percentage of residents living in poverty -- of the state's five largest urban counties for 2008 and 2009.

"The single strongest cause of poor health in any population is poverty, and the harmful and stressful conditions associated with life in poverty," Monroe said.

The Wisconsin researchers agreed, putting the most emphasis on social and economic factors in ranking counties by their health factors, followed by behavior, clinical care and physical environment. Regarding health outcomes, premature mortality and morbidity were weighted equally.

In the category of health outcomes, researchers used four measurements: the rate of people dying before age 75; the percentage of people who report being in fair or poor health; the numbers of days people report being in poor physical and poor mental health; and rate of infants with low birth-weight.

Included among the measurements for health factors were rates of adult smoking, adult obesity, binge drinking, teenage pregnancy, the number of uninsured adults, availability of primary-care providers, preventable hospital stays, rates of high-school graduation, number of children in poverty, rates of violent crime, access to healthy foods, air-pollution levels and liquor-store density.

The study found that Watauga was the healthiest overall county in Northwest North Carolina. It was ranked eighth in health outcomes and 16th in health factors.

"There are big differences in health among North Carolina counties," said Dr. Jeff Engel, the state's health director. "Poorer communities have poorer health. Education, jobs, availability of healthy foods, access to high-quality affordable health care, individual behavior … all these things have a big effect on people's health."

Monroe said he hopes that the study's rankings serve as a "call to action for communities to work together to develop programs and policies that address the multiple influences on health."

The study can be accessed at www.countyhealthrankings.org.

It was paid for by the Robert Wood Johnson Foundation.

rcraver@wsjournal.com


727-7376

Health-survey rankings

Watauga County had the highest rankings among North Carolina's counties in the two main health categories measured in a study by the University of Wisconsin:

County Health outcomes Heath factors

Alamance 26th 28th

Alleghany 74th 48th

Ashe 29th 37th

Davidson 41st 58th

Davie 37th 23rd

Forsyth 20th 20th

Guilford 10th 17th

Randolph 13th 41st

Rockingham 71st 85th

Stokes 53rd 53rd

Surry 48th 60th

Watauga 8th 16th

Wilkes 64th 62nd

Yadkin 42nd 30th

Source: Population Health Institute, University of Wisconsin