The Community Health Status Indicators Project, run by the U.S. Department of Health and Human Services, seeks "to provide an overview of key health indicators for local communities and to encourage dialogue about actions that can be taken to improve a community’s health."
What's especially helpful about the project is that it allows people examine health information on a county-by-county basis and then compare that data to similar counties across the United States. For a better understanding of Prince George's County, where the University of Maryland-College Park is located, we talked with Research Associate Professor Carolyn C. Voorhees of the Department of Public and Community Health.
Healthy Turtle: Does anything in this data surprise you?
Dr. Carolyn C. Voorhees: I'm not surprised but alarmed by the extremely high CHD/CVD (coronary heart disease and cardiovascular disease, which includes stroke) disease death rate in
Medicines, though are expensive and have to be taken daily for many years--many people skip their meds if they can't afford them at end of month, putting them at high risk of heart attack and stroke AND death from CVD.
Access to care issues especially factor in when people experience heart attacks; there are many known effective treatments, but not everyone has access equally depending on where they are located and insurance status. The outcome (death, disability, etc.) in many cases depends on how quickly they are seen by emergency medical professionals, and fast access to "clot busting" drugs and advanced cardiac treatment. The availability of these measures varies across the country--sometimes they are available in the EMT vehicle, sometimes patients must wait until they reach the hospital--all of which factors into the outcome.
HT: By far, the most prevalent risk factor for premature death in PG County is a lack of fruits and vegetables. Why would this be a risk factor for premature death (more so than obesity or smoking), and is this common across the nation?
Dr. Voorhees: A lack of fruits and vegetables serves as a surrogate for a poor diet in general and is closely tied to CVD risk and certain types of cancers. Several studies around the country (Detroit area and one to come out soon from our colleagues at Johns Hopkins, who looked at Baltimore City and County) show that lower income areas also lack affordable access to healthy foods across the board over and above fruits/vegetables. We've found in our studies of neighborhood environment that urban youth and adults have many barriers to physical activity as well.
As you can see, many of these factors are interrelated and so often are a function of socioeconomic and racial/ethnic disparities in access to care and related "healthy" resources such as healthy food and opportunities for physical activity.
HT: 15% of residents in PG County are uninsured. How much does this impact the high infant mortality rates?
Dr. Voorhees: Many of the uninsured are women and children, and uninsured pregnant women get little to no prenatal care. In many cases, those same women present in labor in Emergency rooms, which isn't the best place for optimal birth outcomes and care for the mother. Additionally, many women who are substance abusers that become pregnant may not realize they are pregnant until well into the first trimester, when drugs and alcohol have major impacts on fetal development.
There's a misconception that all uninsured are low income earners or are unemployed, but many are employed but as contractors or hourly wage earners with no benefits (like a lot of students!). As our current system is structured where your employer is the main way people get insurance, many of the unemployed, self-employed, and underemployed slip though the cracks, impacting many health outcomes.
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Carolyn C. Voorhees, PhD, MS, is a Research Associate Professor in the Department of Public and Community Health. She has served as a fellow at the NIH and has a background in background in CVD prevention, womens and minority health and health policy.
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