The Argus Leader
February 17, 2010
by John Walker
http://www.argusleader.com/article/20100217/NEWS/2170335
Wealth can be a sign of health, but habits and social behavior might be better clues to personal well-being for South Dakotans.
A study released today finds Brookings County the healthiest spot in South Dakota and Shannon County the place with the poorest overall health.
The rest of the rankings show that access to hospitals is helpful but not most important in gauging a community's health.
The study, "The County Health Rankings," is from the University of Wisconsin and the Robert Wood Johnson Foundation in Maryland. Researchers ranked nearly every county in the United States, using data on issues such as life expectancy, smoking, obesity, crime, graduation rates, unemployment and child poverty. The listings are at www.countyhealthrankings.org.
Julie Willems Van Dijk, associate scientist with the University of Wisconsin Population Health Institute in Madison, said the work points to some surprising conclusions.
"We know many times people think health is a product of how much health care you receive," she said. "While access is very important, a number of factors weigh more heavily than access and quality of care - such as behaviors, socioeconomics and physical environment."
The report ranks several of South Dakota's poorest counties near the bottom for health, including some with Native American reservations.
Healthy living, though, does not always follow the money. Lincoln County, the state's wealthiest with $64,000 median household income, did rank near the top in the new rankings, trailing only Brookings.
But Custer County, at more than $48,000, ranks sixth in median household income but is in the bottom 10 on the health scale.
And Minnehaha County, a regional health care hub and fourth richest with $49,967 per household, couldn't crack the top 10 for healthy living. It finished at No. 11, in part because it ranked No. 44 in a subcategory for physical environment measuring such factors as air pollution and density of liquor stores and fast food chains.
The study covers 57 of the 66 counties, leaving nine unranked because of a lack of enough data.
South Dakota, culturally and geographically, has some disadvantages. The air is cleaner but the smoking rate is higher. Obesity is more common. Open spaces mean South Dakotans drive or ride almost everywhere, rather than walk or bike.
South Dakota also faces what every state faces, a conspiracy of habits blending technology with convenience and inactivity.
"Clearly what we're seeing is a sudden awareness that what has happened the last 10 to 20 years has put people at greater risk," Willems Van Dijk said. "Soda and junk food are cheap. Entertainment comes from sitting instead of going out to play."
Colleen Winter, with the Department of Health in Pierre, said the state pushes initiatives to encourage exercise, good eating and preventive measures such as screenings for disease. The state runs a tobacco quit-line at 866-737-8487. It promotes outdoor recreation, and it supplied Pine Ridge Reservation with a mobile medical unit to give health care access to people without vehicles.
Those all are signs of progress, but poor habits persist.
"We have those resources out there, but behavior changes are tough," said Winter, who is division director for health and medical services.
The rankings indicate acute problems on reservations.
"Unfortunately, that's not a surprise," Winter said. "Native Americans do experience shorter lives, higher health risks, poverty, isolation and a lack of transportation to get health services."
Julie Garreau, executive director of the Cheyenne River Youth Project in Eagle Butte, said it was no surprise that Dewey County, home of her agency, is among the least healthy.
Her agency runs the Main Youth Center for children age 4 to 12 and the Cokata Wiconi Teen Center. They host numerous activities for children, raise vegetables in a two-acre garden and promote a well-rounded family services program, she said.
But an unhealthy diet is cheaper, which embeds poor eating as a way of life.
"Buying food that's high-fat and high-starch makes the budget go further. Families work hard, but they learn habits early and that's what they pass on," said Garreau, a member of the Cheyenne River Sioux Tribe.
John Mengenhausen, CEO for Horizon Health Care in Howard, oversees 11 clinics and four dental sites in central and southeastern South Dakota, including reservations.
"We try to provide good basic primary care and preventive medicine to a population that truly needs it and educate people on how to take better care of themselves," he said.
His clinics aim to give people a sense of a medical home for preventive care and education that they would use instead of hospital emergency rooms.
The full population faces challenges with hypertension, diabetes, a love for fast food and the inactivity that corresponds to a technical world, he said.
"It's more a lifestyle, a culture of people. Our hope is it will turn around."
Reach reporter Jon Walker at 331-2206 or 800-530-6397.
