Maybe this isn't Fit City after all

Some surveys and studies have painted our community as Healthy Town, U.S.A. An in-depth, county-by-county health rankings report put out Wednesday isn’t one of them.

El Paso County ranked 29th among the state’s 64 counties — fair to middlin’ — when it comes to health outcomes, and slightly worse when it comes to factors that influence health, according to the report released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The county was dinged for a high rate of premature death, a high chlamydia rate, air pollution, limited healthy food options, and not enough primary care physicians.

“This is a wake-up call for our community,” said El Paso County Health Department medical director Dr. Bernadette Albanese. “This information is important and we need to find resources to look into these issues and start addressing them.”

“You would always like to be top of the list, but we weren’t surprised,” said Kandi Buckland, public health director of the El Paso County Department of Health and Environment.

Buckland said her department hopes to develop a thorough local health-improvement plan in the next year or so. She hopes to use the county rankings report as one starting point as epidemiologists dive deeper into the local data.

“As a health department that has had eight years of continuous funding cuts, it’s really difficult for us to be doing what we should be doing in the area of epidemiology,” Buckland said. “It definitely needs to be done. We definitely want to do it. The community needs to know what is affecting their health.”

In the meantime, the snapshot of El Paso County in the county health rankings is one of mediocrity. Using a formula pulling together 28 health factors, the report evaluated every county in the nation with available data, but the counties are only weighed against those in the same state.

“It’s all about the underlying indicators that you pick,” said Julie Willems Van Dijk, associate scientist at the University of Wisconsin Population Health Institute. “The real challenge was making sure we could get the best available health indicators. And we were limited because some indicators we’d love to use were not available in all counties.”

Albanese predicted debate on which indicators were chosen in the study, but said the institutions behind the report are widely respected.

“These are not inexperienced folks pulling this data together,” Albanese said. “There was a lot of thought put behind this.”

Willems Van Dijk said there’s been pushback on socio-economic factors being part of a health report. In fact, socio-economic factors made up 40 percent of the ranking, health behaviors 30 percent, clinical care 20 percent, and physical environment 10 percent.

“Education and income and social connectedness influence the outcomes, influence the development of chronic disease, and they influence premature death,” she said.

Top counties

Here are the conclusions of the Colorado section of the report “County Health Rankings: Mobilizing Action Toward Community Health”:

Colorado’s 10 highest ranked counties, starting with most healthy, are Douglas, Eagle, Boulder, Pitkin, Broomfield, Elbert, Routt, Larimer, Gunnison and Summit.

The 10 counties in the poorest health, starting with least healthy, are Huerfano, Fremont, Las Animas, Otero, Montezuma, Bent, Pueblo, Alamosa, Prowers and Denver.

El Paso County was in the middle of the heap among Colorado’s 64 counties, at No. 29 in health outcomes and No. 33 in health factors.

Strengths and weaknesses

El Paso County was about average in most of the 28 indicators in the county-by-county health rankings report issued Wednesday. But the numbers were dramatic in the following categories:

Strengths:

1. Hospice use. At 52 percent of chronically ill Medicare patients, hospice use in the county is one of the highest in the state. From the report: “There is wide consensus that hospice services provide superior comprehensive end-of-life care for individuals than care in an institution.”

2. The motor vehicle crash death rate of 13 per 100,000 also is unusually good.

Weaknesses:

1. Rate of premature death is high, which is judged to be any death before age 75.

2. High chlamydia rate, at 444 per every 100,000. This common sexually transmitted disease was chosen as a benchmark to measure unsafe sexual behavior. Buckland said the county had a robust STD tracking and prevention program for many years, but it was slashed a year ago, so this measure figures to get worse.

3. Air pollution. With six days that air quality was unhealthy for sensitive populations due to ozone levels, the county was one of the worst in Colorado. Buckland said air quality is another area that was cut from her department’s budget in January 2009. “It’s an area that we very much would like to provide that level of service again.”

4. Low access to healthy foods. Access to healthy foods was measured as the percent of ZIP codes in a county with a healthy food outlet, defined as a grocery store or produce stand or farmers’ market. Julie Willems Van Dijk, associate scientist at University of Wisconsin Population Health Institute, said the category is important but the formula will probably move away from ZIP codes next year.

5. Primary care provider rate. The average county in Colorado has nearly twice as many primary care providers per capita than El Paso County, which is at 76 providers per 100,000 people. Primary care providers include practicing physicians specializing in general practice medicine, family medicine, internal medicine, pediatrics, and obstetrics/gynecology, and the report deems access to primary care providers “essential so that people can get preventive and primary care, and when needed, referrals to appropriate specialty care.”

Read the report: www.countyhealthrankings.org