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Data shows link between environmental factors and health outcomes

Kate Kingery, deputy director for community transitions at the UW Health Population Institute, draws a direct connection between environmental factors and health outcomes.

“Where we live, work, learn and play matters to our health, and our county-level data really shows us that,” Kingery said as part of a discussion yesterday in Madison put on by UnitedHealthcare.

She used two Wisconsin counties -- Adams and Kewaunee -- as examples to highlight the various factors at play.

Adams County, located in the middle of the state, has about 20,000 residents. The county’s premature death rate -- one measure of population health -- is higher than both the national and state rates, and it’s continuing to rise.

“This represents about 404 deaths before the age of 75 in 2014,” Kingery said.

Kewaunee County in eastern Wisconsin also has about 20,000 residents. Its premature death rate is lower than the state rate and national average, and seems to be declining, Kingery says.

“This represents 181 deaths before the age of 75,” she said. “So these are pretty dramatic trends that we’re seeing across these two counties… What matters is when we start to look at the factors that are contributing to the overall health and well-being of these populations.”

Increases in rates of premature death are correlated to increases in child poverty and income inequality, she said.

Adams County has a slightly older and more diverse population, and is considered to be completely rural. Kewaunee County has a slightly younger population and only 72 percent of the county is considered rural.

“If you look at some of our national trends, we’ve also seen that premature death rates are rising in rural counties,” Kingery said.

Kingery is part of the institute’s County Health Rankings & Roadmaps, a collaboration with the Robert Wood Johnson Foundation. By their measure, Kewaunee ranks near the top of the list of Wisconsin counties for overall health outcomes while Adams falls near the bottom. Only Ozaukee County is ranked higher than Kewaunee, and Adams is in the bottom three just above Milwaukee and Menominee Counties.

“When we look at the premature death, or years of potential life lost, it’s more than twice as many for Adams County than Kewaunee County,” Kingery said.

Many Adams County residents say they don’t have access to exercise opportunities like lighted pathways, bike trails and safe streets, Kingery said. And Adams County has only one primary care physician, so people are having to leave the county to get their primary health care.

“But we don’t know where they’re going, and we don’t know what that means for the consistency and accuracy of the care,” she said, adding that Adams has only two dental providers. “So their access to care in Adams County is very different than what it is in Kewaunee County.”

She said Adams has a higher number of preventable hospital stays, noting that this stems from problems with access to providers.

Rates of college participation are also higher in Adams in Kewaunee, though high school graduation rates are similar for the two. Unemployment is higher in Adams than in Kewaunee, and so is the number of children in poverty and children in single-parent households.

“We are certainly seeing around severe housing problems, higher rates in Adams County and then longer commutes to work as well,” she said. “We know driving alone in the car, spending more time in the car has a negative impact on health.”

Adams County also has the highest rate of disconnected youth -- young people not engaged with schooling or work -- in the state. Median household income is also lower in Adams County, and 75 percent of children there are eligible for free or reduced fee school lunch, compared to only 26 percent in Kewaunee County.

“Reading proficiency was one that really stuck out for me too,” Kingery added. “Fourth grade reading proficiency in Adams County is calculated at 27 percent, and it’s calculated at 66 percent for Kewaunee County -- these are not great numbers for young people.”

Kingery also used data to highlight ongoing efforts that are working to improve health. These examples include mental health benefits legislation, more public spaces for physical activity, paid family leave and telemedicine.

“We have research that support these different kinds of strategies and practices,” she said.

--By Alex Moe


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