April 13, 2014

Many answers, many questions in county health rankings

Calhoun and Orangeburg counties offer stark health contrasts despite sharing a hospital, and Edgefield County busts the rural county stereotype when it comes to health.

Calhoun and Orangeburg counties offer stark health contrasts despite sharing a hospital, and Edgefield County busts the rural county stereotype when it comes to health.

Those findings from the annual County Health Rankings from the Robert Wood Johnson Foundation drive home one point: When it comes to community health, social determinants such as income and education can be as important as medical facilities and physicians.

Tony Keck, director of the S.C. Department of Health and Human Services, believes the County Health Rankings are important not for county bragging rights but for the discussions they engender. “They encourage you to bring people together and ask questions,” Keck said.

Among the questions from this year’s rankings:

•  Why does Calhoun rank much higher than neighboring Orangeburg in health outcomes, which measure length and quality of life, and in health factors, which rank behavior, clinical care and economic factors?
•  Why is lightly populated, rural Edgefield ranked No. 4 in health outcomes? Edgefield is the only county among the bottom third in population to rank in the top 10 in health outcomes.

Calhoun, Orangeburg starkly contrast

The hospital in Orangeburg changed its name years ago to the Regional Medical Center of Orangeburg and Calhoun Counties in part to make its name more inclusive of Calhoun County residents.

In terms of the hospital, the counties are joined at the hip, yet their rankings in many health categories vary remarkably. Calhoun ranks much better than Orangeburg in terms of premature deaths, adult smoking, alcohol-related driving deaths, sexually transmitted infections, high school graduation rate and unemployment. One of the few statistics in Orangeburg’s favor is that it has more than three times as many primary care physicians per capita.

Calhoun ranks 11th and Orangeburg 37th among 46 counties in health factors, and Calhoun is 25th compared to Orangeburg’s 40th in health outcomes.

“Answering why the data is so different between these geographical areas — for example, why is there such a difference in alcohol-impaired driving deaths? — would take more investigation into the communities themselves,” said Megan Weis, associate director of the South Carolina Institute of Medicine and Public Health. “And that is precisely the type of discussion we hope the rankings inspire so that communities are able to identify where action may be taken to improve health.”

Keck believes most of the differences are connected to education and economics. The high school graduation rate is 88 percent in Calhoun and 71 percent in Orangeburg. The unemployment rate is 10.7 percent in Calhoun and 13.6 percent in Orangeburg. Better education leads to better jobs leads to better health outcomes.

Keck cited a study in the journal Health Affairs that found “the only things statistically related to mortality were income, education and cigarette smoking,” he said.

The Regional Medical Center long ago noticed the differences between the three counties (including Bamberg) in its primary service area, according to CEO Thomas Dandridge. And while the hospital doesn’t play favorites among counties, its aim to improve the health of all residents can lead to more attention paid to problems more common in Orangeburg.

Diabetes rates, for instance, are highest among African-Americans, and Orangeburg has a higher percentage of African-Americans than Calhoun. However, residents from either county should benefit from the hospital’s special diabetes-related programs.

One surgeon at the hospital, for instance, routinely spends an entire day doing maintenance on dialysis ports in diabetes patients who have worsened to kidney failure, Dandridge said.

Edgefield on the rise

The bulk of Edgefield’s health outcomes improvement from 2010-14 is related to a decline in premature death, Weis said. Put simply, fewer people in the county are dying young and more people are making it to age 75.

Why? There’s no one answer, but it might relate to Edgefield becoming more of a bedroom community for Aiken and Augusta workers or to more upper income retirees moving to the county, Keck said.

The high Edgefield ranking didn’t stun Keck. As part of an effort to funnel more Medicaid funds for primary care physicians in areas with the highest need, Keck’s agency recently ranked counties using its own index. Edgefield ranked as the healthiest of the counties studied.

Edgefield has improved in the rankings each of the past three years. The county is much better than the state average in terms of premature death, sexually transmitted diseases, teen births and violent crime. But the county is well below the state average in physicians per capita and access to exercise opportunities.

Keck said when his agency drilled down a little deeper, it found the percent of people in the county with college education has been on the rise – possibly a by-product of wealthy retirees moving to the area.

But Will Williams, CEO of the Economic Development Partnership of Aiken and Edgefield Counties, said he hasn’t noticed a major influx of retirees to Edgefield. In fact, the percent of households with someone age 65-or-older in Edgefield (27.7) is only slightly above the state average (25.7).

Looking for answers, Williams pointed to a different positive health statistic: Edgefield didn’t have a traffic fatality in 2013. But the latest County Health Rankings are based on 2008-12 traffic data, and Edgefield ranked below the state average for alcohol-related traffic deaths in that period.

Weis dug deep through statistics and talked with other experts, yet they couldn’t come up with a good reason why Edgefield is outperforming other rural counties. “ ‘I don’t know’ is not my favored response,” she said.

Maybe good health and long life is just endemic to Edgefield. After all, the county’s most famous native son, Strom Thurmond, lived to be 100.

County health rankings

The rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute can be found online.

Richland County: Ranks ninth among 46 counties in health outcomes and seventh in health factors.

Lexington County: Ranks third in both health outcomes and health factors.

Details: www.countyhealthrankings.org

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