A triangle of health misery

Recently, I blogged about beautiful Humboldt County’s depressing health statistics, the worst in the state.

Since then, I’ve done a little more digging into the state health department’s newest health status profiles to see how California’s other 57 counties are faring. It doesn’t take long to discover that three other California counties are also consistently in the bottom tier, with health statistics almost as alarming as Humboldt’s.

Two other far northern California counties make up, with Humboldt, what appears to be a triangle of health misery.

Only marginally better off than Humboldt is another county with stunning landscapes -- mountain, forest and lake-dominated Shasta. Inland but at the same latitude, with around 177,000 inhabitants, Shasta scores 50th or worse in 10 health indices, including “deaths due to all causes,” where it is, pardon the word use, dead last at 58. It’s at rock bottom in deaths from lower respiratory illness as well, and shows poor rankings in most cancers, stroke, suicide and drug-induced deaths. Overall, it’s yet another pretty place with a less than pretty health picture.

But at least in three categories, Shasta’s numbers offer cause for optimism. It ranks 17th in diabetes deaths, a comparatively high ranking for a relatively poor county (Census figures show the median household income of about $44,000 is well below the state average, and its 16.5 percent poverty rate is well above the state average). Shasta achieves even better results in two other categories, ranking 13th in both deaths from influenza/pneumonia and homicide.

The third point of the troubled health profile triangle is Butte County, about 80 miles north of Sacramento. A scenic county dotted with almond and walnut orchards, it’s slightly larger than Shasta at 220,000 population, and slightly healthier, with 8 health indices in that unenviable bottom sixth, including a 54th ranking in deaths due to all the causes the state includes in its survey. It ranks 53rd in deaths from all cancers, including a 58th place in prostate cancer. It’s 56th in two categories – Alzheimer’s and lower respiratory illness. The latter is particularly interesting. The Center partnered with the Chico Enterprise Record in 2010 to look at the health effects of wood-stove-generated smoke pollution in Butte County. Residents there have for generations heated their homes in winter with wood-burning stoves, and government attempts to impose burning limits have met with fierce opposition. The county’s other notable negative health ranking is its drug-induced deaths, where it ranks 55th.

Butte’s best health numbers can’t match Shasta’s. It ranks 30th among counties in influenza/pneumonia deaths, and 33rd in both diabetes and homicide. That means in all categories there’s not one health statistic that’s in the top half of the state.

Perhaps that shouldn’t be all that surprising. According to the Census, Butte County has a high percentage of seniors, a high poverty rate and low median household income compared to state averages. That mix probably guarantees a population in less than good health.

A last point. There’s a fourth county that suffers from too many bottom-sixth health statistics – the Central Valley’s Kern County. Its profile is quite different than the triangle counties’. It has a relatively large population – 840,000 – and one that is almost half Latino, unlike the mostly white triangle counties. Still, it is similar to Butte in that it suffers low rankings in eight categories, including a 56th slot for deaths due to all causes. It stands out in categories that often define poor populations – diabetes (56th), coronary heart disease (58th) and lower respiratory illness (57th). It’s also high in homicide (55th), Alzheimers (51st) and prostate cancer (50th). Kern’s Census numbers, like Shasta and Butte, reveal a high poverty rate (more than a fifth of the population) and low median household income, both seemingly arrows that point to a population in poor health.

If there are lessons here, the easy one is that natural beauty does not necessarily equate to good health. Another is that good health does not exist in isolation, but in relation to other economic and social factors. The most disturbing health data come from chronically poor rural counties that also struggle with issues of access to care.

In fact, virtually all the counties with low ratios of deaths due to all causes are relatively wealthy, relatively urban, with relatively good access to medical care.

The numbers raise the question: Is California’s rural life doomed to bad health?

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