Scioto County Takes Action on County Health Rankings

Dec 11, 2012, 10:52 AM

The County Health Rankings & Roadmaps show how every county in the United States ranks on critical measures that impact health, in comparison to all the counties in a state. The program helps communities create solutions that make it easier for people to be healthy in their own communities, focusing on specific factors that affect health, such as education and income.

Now headed into its fourth year, the Rankings are spurring communities to action. In Scioto County, Ohio, which was ranked last among all 88 Ohio counties last year, the Rankings motivated community leaders to convene two recent meetings. One held last spring gathered stakeholders at the table to set the agenda for helping to improve the county’s health. And a summit held this fall brought engaged county partners together with leaders from counties in both Ohio and Kentucky who shared ideas and initiatives that are already working to help improve health and lives.

NewPublicHealth spoke with two conveners of the summit, Ed Hughes, CEO of Compass Community Health, a local mental health and substance abuse provider, and Ohio State Representative Terry Johnson.

NewPublicHealth: What did the 2012 County Health Rankings reveal for your region?

Ed Hughes: We slipped this year from 87 to 88—last place. So, it became a rallying point for us as a community to be able to actually see those numbers, and to understand what the rates for the measures mean. We probably knew about a lot of it, but didn’t have the information available in a comprehensive way, like the number of people who smoke in our region, the number of folks who are struggling with obesity and the percentage of children who do not have their immunizations. We were surprised that we were one of the most struggling counties in the country.

Terry Johnson: We knew there was a lot of smoking and obesity, but to have those numbers so graphically illustrate the problem was really an impetus for us. When we decided to have our first health conference, it was a county affair, and we invited the state health commissioner to join us. In our area there is good medicine being practiced, but no coordinated effort to improve the health of the community. So our thought process was to bring folks together and challenge them to do things differently than we’ve done in the past. We had the initial summit, and then we realized that our problems aren’t just county-wide. If we try to address them on a single county basis, then we’re really addressing them in a vacuum—we needed to bring in our contiguous counties, including counties from urban Kentucky.

That spurred us on to our recent regional health summit, and the health director, Dr. Theodore E. Wymyslo, came back again and we had a pretty great experience. Our idea was to figure out ways to communicate and collaborate based upon the County Health Rankings numbers. We have a great deal in common and a great deal at stake together.

NPH: Who attended the summit?

Ed Hughes: We made sure that we had a representative from three counties in Kentucky and the four counties in southern Ohio that we asked to collaborate with us. The goal was to target people in the health field or in the community service field that have actually created or initiated programs that have helped their community. It was important for us in our summit to highlight people that were actually making a difference in their community and bring them here to teach us how we could do the same. The speaker from Greenup County, Kentucky told the summit that they have added bike pathways and walkways to any road project that they were doing in their community.

Terry Johnson: Our target for the summit attendees was a holistic group, so we see everybody in the community as potential solvers of our problems. We wound up with a lot of doctors and nurses and administrators, but we got important conversations started and we’re hoping to do it again and next time add teachers, superintendents of schools, clergy, law enforcement, judges, and so on. We’re looking at ways to broaden the participation. We did pick up some great information from General Electric, which has a big presence in a nearby county. They’ve got a huge employee health initiative and that’s a very poor county that benefits greatly from their private organization doing good things over there.

NPH: What were the takeaways from the summit?

Ed Hughes: As the day wore on, people learned more about the interrelatedness of health problems—how much poor childhood nutrition contributed to early age smoking; how drug and alcohol addiction essentially creates a barrier for the treatment of any health problem. We had people there that were putting dollar amounts on the barriers that this was creating.

The government folks were able to talk about a variety of pathways that we might be able to pursue funding for, or even technical support, but it would require us to become organized as a community. It would require us to be able to better vocalize what it is that we’re trying to solve. And I think that we’re still trying to understand the complexity and the interrelationships that exist out there if we’re going to solve the problem. I know for me, one of the things I was hearing most from other participants was sentences that began with “I did not realize” and “I did not know.”

One of the other themes that ran through the whole conference was that we have some very large health systems in our region—hospitals and public health departments—but we have a real disconnect in terms of people’s ability to access those services. For example, we don’t have what is traditionally looked at as a high homeless problem, but over 40 percent of the people that come to our agency for drug and alcohol treatment report that they’re living with a relative, and it may be different relatives the next week and the week after. So, the ability to access services without having stable housing is an issue. The absence of public transportation is an issue. So while we have services, a large part of our citizenry does not have access to them. If you don’t have transportation, an appointment at a primary care doctor doesn’t do you much good. You’re going to go to the doctor when you’re brother-in-law gets off work and can take you, which is going to be in the evening. And we have no evening primary care services in our region—not just in one county, but in our region.

NPH: What were some of the other initiatives presented?

Ed Hughes: The Greenup County Department of Health has been working on these issues for about four or five years. They had the same type of numbers that we had in comparison to the rest of their state, and they have had a marked improvement. They were able to share with us the direction that you have to go once you pick the low-hanging fruit.

Another key thing was trying to link electronic healthcare records, so that for example we would be able to keep track of a child who is behind on immunizations regardless of where they lived or where they were engaging services.

The schools are asking if there is a way that primary care services and immunizations could be moved to the school, to essentially decentralize some of these basic health care services.

This commentary originally appeared on the RWJF New Public Health blog.