Health: From the Voices of the Vulnerable

New Community Survey Shows How Poverty Impacts Health in the North Country

Are you curious about your blood pressure? There are devices for that and they’re popping up everywhere, even in local grocery stores. Do you need to assess your risk for developing type 2 diabetes? There is a simple test for that here. Want to investigate the burden of chronic disease in our region? There is a website for that, too.

In our community, we have unprecedented access to a growing variety of personal health data and community health indicators. But suppose you wanted to investigate patients’ attitudes, behaviors, and experiences with health care? For that you must go directly to the patient, which is exactly what we did.

We called community residents on their cell-phones and landlines, and asked them questions about their personal health, lifestyles and socio-economic status. In the end, we talked to 1,800 men and women of the tri-county region from all age groups, income categories and educational backgrounds. From our group of 1,800 respondents, we found more than 230 individuals who live in very fragile economic conditions. This group spoke on behalf of those of us who live in poverty and are most in need of our support.

vulnerableCensus estimates inform us that the most recent 10-year poverty estimates for each of our three counties — 15 percent of the population in Jefferson; 13 percent in Lewis; 18 percent in St. Lawrence — are the highest they’ve been since the early ‘60s and ‘70s. This vulnerable and growing population typically suffers a disproportionate burden of poor health outcomes, low access to health care and insufficient social supports. To alleviate these burdens and develop an equitable health care system, we need a greater understanding of the scope of social and economic factors impacting their health.

Our 2016 Community Health Survey allowed us to explore these social and economic health determinants while confirming the county-level estimates of individuals impacted by poverty. The survey revealed that individuals with limited resources are 67 percent more likely to visit an emergency department and have a 27 percent higher rate of hospitalization than the general population.

Though there are numerous potential explanations for these higher emergency department visits and hospitalizations, the survey data established that these individuals are sicker than the general population. In fact, more than half of Medicaid enrollees reported a diagnosis of at least one of the following chronic conditions: diabetes, prediabetes, high blood pressure, heart disease, chronic obstructive pulmonary disease (COPD), or obesity — while just 38 percent of non-Medicaid enrollees report having one of these illnesses.

In addition to battling the challenges of finding the appropriate level of health care, 43 percent of Medicaid enrollees expressed that they do not always understand the instructions they receive during a clinical appointment. Significantly fewer non-Medicaid enrollees — 31 percent — expressed similar challenges. Health literacy, or the ability to obtain, process, and understand health information to make informed health decisions, affects all economic classes but disproportionately affects impoverished members of our community. Low health literacy is associated with increased risk of mortality, poor overall health and lower rates of preventive screening and immunizations.

Arguably the most startling statistic from the survey indicates that only 29 percent of Medicaid enrollees have five or more close friendships, while 41 percent of non-enrollees enjoy the benefit of large social networks. In other words, more than 70 percent of the individuals living in poverty within our community do so while experiencing low levels of social engagement and isolation. Notably, high levels of positive social engagement are associated with improved physical health and mental well-being.

Documenting the voices of the vulnerable is only half of the battle. Our extensive network of partners — including community coalitions, local health departments, community health centers, hospitals and social services agencies — will leverage these findings to tackle these challenges. These stories will continue to motivate action by all sectors of our community. The data underscore our duty to support our vulnerable brothers and sisters.

To learn more about poverty and health in our community and how you can take control of your own health visit the North Country Health Compass at www.ncnyhealthcompass.org.


Ian Grant is the population health program manager for Fort Drum Regional Health Planning Organization, Watertown. Note: This column also appeared in NNY Business Magazine.

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