| Good
health is an important goal for all Cape Cod residents. Are
we achieving it? What can we do now to reach this goal?
The
World Health Organization defines health
as “a state of complete physical, mental, and social well being
and not merely the absence of disease or infirmity.” The
2003 and 2005 Cape Cod Sustainability Indicators Reports adapted
this definition for Cape Codders.
Our
vision incorporates three primary components - access, prevention,
and community responsibility. It encourages a shift in Cape
Cod’s understanding of health and health care from reactive (where
resources are primarily devoted to treating disease) to proactive
(where resources are primarily devoted to preventing disease).
This
proactive approach led the Sustainability Indicators Council Health
Subcommittee to select six key health indicators to measure progress
toward the goal: health insurance, nutrition, oral health
care, adult behavioral health, children and youth behavioral health,
and the index of social health.
Using
these six indicators and understanding how they all relate to one
another can help the community draw upon the Barnstable County Human
Services “Human Condition” and “Monitoring
the Human Condition” research, as well as data from the Massachusetts
Department of Public Health, to help track progress toward a healthier
Cape Cod in 2020.
The
first health indicator is access
to health insurance, which has worsened over the past four years
for both adults and children. This represents a striking
reversal of the health insurance trend from 1999 to 2001.
Progress in this area has been stymied by at least three factors:
- Tightening
of health insurance plan enrollment qualifications;
- Freezing
of the Children’s Health Insurance Plan;
- Erosion
of affordable health insurance plan availability for employers,
resulting in elimination or reduction of coverage for an ever-increasing
percentage of the Cape’s workforce.
Research
by the County’s Department of Human Services shows that from 2001
to 2004 the percent of adults without health insurance rose from
11% to 16.6%; of children from 4.7% to 5.3%.
The
second indicator is nutrition.
In 2005, the “Monitoring the Human Condition” research conducted
by Barnstable County Department of Human Services reported that
17% of Cape Cod households reported not always having enough money
for food, and 11% reported they were not able to afford nutritious
food.
The
third indicator is access to affordable
oral health care, including preventive dental care. This
is measured by the number of Cape Cod dentists offering free care,
which rose from 46 in 2003 to 62 in 2004.
The
fourth indicator is adult
behavioral health, which includes four components: alcohol and
substance abuse, tobacco use, obesity and hypertension. From
2001 to 2004, the percent of Cape Cod households reporting alcohol
and substance abuse rose from 11% to 13%, while adult tobacco use,
which had declined during the 1990’s, has remained steady at 19%.
Reports of obesity in the household rose from 10% to 12%
over the same period while the rate of hypertension improved, showing
a decline from 28% to 26.4%.
The
fifth indicator is children
and youth behavioral health, which includes four components:
children who are sad, discouraged or depressed; children who are
stressed out, nervous or worried; children who use tobacco; and
children who fight with or hurt siblings or other family members.
Each of these indicators suggests improvement from 2001 to
2004, with marked improvement shown in stress levels (42% to 21%)
and fighting (24% to 17%). These indicators continue to be
tracked on annual basis by the County.
The
sixth indicator is a composite, developed by Data Analyst Warren
Smith of Barnstable County Department of Human Services, called
the “Index
of Social Health”. It includes seven components - poverty
rate, unemployment rate, violent crime rate, rate of low birth weight,
infant mortality rate, premature mortality rate and Medicaid enrollment
rate. Although Barnstable County still ranks near the middle
of similar sized counties in the Commonwealth in terms of this Index,
each of these indicators showed a slight worsening from 2001 to
2004.
Taken
together, these six indicators show that Cape Cod is a healthier
place for children than it was four years ago, but that adult health
has declined during the same period. Why?
One
short answer to this question is the substantial gap between what
it costs a family with children to live on Cape Cod and what this
family can earn. Data from the Family Economic Self Sufficiency
project of The Women’s Union
document that for a Mid-Cape family of four (two adults, an infant
and a preschooler) the gap between median income and cost of living
in 2004 was $3,670 - meaning that many families earning median income
or less simply can’t make ends meet. A look at specific measures
of this gap, such as the home affordability gap, show that it is
growing wider each year.
This
comes as no surprise to a family working two full time jobs to stay
on Cape Cod. What the statistics clarify is the significant
threat to health that this gap poses. Faced with hard choices,
families invest first in their children’s health, which pays dividends
- children’s health is improving. But keeping kids healthy
can be at the expense of the rest of the family. In 2005,
“Monitoring the Human Condition” found strong correlations between
overall household health and income. A household reporting
an income below the Barnstable County 2004 median income level is
strongly correlated with not having enough money to pay for doctors
or dentists or prescription medicine, not being able to pay for
or get dental insurance, and the household not always having enough
money for food. A household reporting income below the Barnstable
County 2004 median income level is moderately correlated with a
household not being able to afford nutritious food, with one or
more adult or child member of the household being in fair-to-poor
health and with reports of a lot of depression in the household.
There is also a correlation between a household having an
income below the Barnstable County 2004 median income level and
adults and/or children being without health insurance coverage.
This overview suggests that while each of these six health indicators
could be studied and addressed in isolation, it makes far more sense
to invest in comprehensive strategies to improve access to health
care and prevent health problems before they occur, and to spark
economic development that creates and sustains jobs that pay enough
for a family to support itself - and perhaps even to save for college
or retirement.
Correlations:
What Do These Health Indicators Relate To?
Data
from the 2005 “Monitoring
the Human Condition” research identify correlations
among selected health indicators and the “Household Earnings - Cost
of Living Gap.” A negative correlation means that as income
goes down, incidence goes up. A positive correlation means
that income and incidence rise or decrease in the same direction.
These
health status correlations were derived from examining health data
as related to three basic questions about the household:
- What is the household’s combined
annual income?
- Is the income below the County
Median?
- Is the household “Working Poor?”
The
Household’s Combined Annual Income:
Combined annual household income is strongly correlated with the
household not always having enough money for food and the household
not being able to afford nutritious food. Combined annual
household income is moderately negatively correlated with one or
more members of the household being disabled or chronically ill,
negatively correlated with a lot of depression in the household,
negatively correlated with one or more adult or child member of
the household in fair to poor health and negatively correlated with
reports of a major mental health issue in the household.
Combined annual household income is mildly negatively correlated
with one or more persons in the household being without health insurance
coverage, negatively correlated with not being able to pay for a
mental health counselor and negatively correlated with reports of
substance abuse in the household.
Income
Below the County Median: A
household reporting an income below the Barnstable County 2004 median
income level is strongly positively correlated with not having enough
money to pay for doctors or dentists or prescription medicine, not
being able to pay for or get dental insurance and the household
not always having enough money for food.
A household reporting income below the Barnstable County
2004 median income level is moderately correlated with a household
not being able to afford nutritious food, with one or more adult
or child member of the household being in fair-to-poor health and
with reports of a lot of depression in the household. There
is a mild positive correlation
between a household having an income below the Barnstable County
2004 median income level and adults and/or children being without
health insurance coverage.
Working
Poor: Barnstable County households that have at least
one member working full time and report income less than 200% of
the Federal Poverty Level (“Working Poor”) are significantly more
likely to report having children in the household, to report not
being able to afford nutritious food and to report children and
teens experiencing behavioral or emotional problems than households
with higher incomes. The strongest of these positive correlations
is with the responses, "Not always having enough money for
food," “Not being able to afford nutritious food” and with
the presence of children in the household (i.e. not being childless).
The larger the family, the stronger the positive correlation
that the household is considered to be “working poor.”
Finally, there is a fairly strong positive correlation between
the household being considered "working poor" and the
instance of "Children/teens experiencing behavioral or emotional
problems." There is a moderate correlation between the
household being considered "working poor" and someone
in the household being without health insurance, including adults
without health insurance and children without health insurance -
these are both moderately correlated to the "working poor"
status, although adults without health insurance is more highly
correlated than children without health insurance. Moderately
correlated are the household problems of “Not being able to pay
for mental health counselor” and "A lot of depression in the
household." Alcohol and substance abuse and/or experiencing
an alcohol and drug problem in the household are mildly correlated
with the household being considered "working poor."
Also, there is a mild correlation between children fighting with
or hurting a sibling or adult household member and the household
being considered "working poor."
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