We’ve all heard that old saying that, “When they say it’s not about money, it’s about money.”
But it was interesting to note that recently Dr. Linda McGhee, a family practice physician from Fayetteville, applied that aphorism to disparities in health outcomes among Arkansans.
At a meeting in Springdale organized by the Arkansas Minority Health Commission, McGhee reviewed county-by-county health statistics, starting with median incomes by county and race. Not surprisingly, Benton and Washington counties ranked first and second, respectively, in health outcome rankings by the Robert Wood Johnson Foundation. Also no surprise, at the other end of the scale are the primarily impoverished Mississippi River Delta counties, with Phillips County ranking dead last, 75th out of 75 counties.
Craighead County came in at number 14, with its neighbor to the south, Poinsett, ranked 67th and northern neighbor Greene, at 37th.
If one were to draw a roughly diagonal line from northeast to southwest across a map of Arkansas, the counties between the line and the Mississippi River encompassing many counties in the Delta generally have the lowest health outcomes in Arkansas. In the Robert Wood Johnson Foundation report, health outcomes are measured by length of life and quality of life. The foundation also computes a by county ranking of health factors. Rankings in health factors represent what influences the health of a county. They are an estimate of the future health of counties as compared to other counties within a state that include health behaviors, clinical care, social and economic factors and physical environment. Health behaviors measured include smoking, obesity, excessive drinking, STDs and teen births, among others.
Benton’s median household income is more than double that of Phillips County. Both Benton and Craighead counties have lower unemployment rates, higher percentages of residents who have attended college and a lower percentage of children in poverty than Phillips.
McGhee urged her audience in Springdale not to judge people too harshly about their unhealthy behaviors, the Arkansas Democrat-Gazette reported. She said in essence that it’s one thing to tell people they should change their unhealthy behaviors, but it’s another thing to be able to afford a healthy lifestyle. For example she said, when a person can feed his family cheaper at a fast-food outlet than by buying food at a grocery store and preparing it, fast food often is the more attractive choice.
In this country generally and in the South in particular, there also is a cultural factor at work, one maybe not easily measured scientifically, but which also may prove difficult to defeat.
We’re served a heaping plate of food when we’re children, told to eat it all and be grateful, even if that means suppressing the gag reflex. An empty plate is a “happy plate,” we’re told. Well, guess to whom we pass on that unhealthy behavior? If you guessed our children and grandchildren, go to the head of the class (and be sure to take your bag of chips with you).
Visitors to the United States from overseas often remark about the overlarge portions they are served in restaurants and homes. If they’re visiting this part of the world, they often say everything they’re served is fried. OK, I’ll plead guilty to that one. When we say we’re going out to eat fish, that generally means catfish – fried, not grilled. If I want to eat “healthy,” I’ll skip the hushpuppies.
I recall a fund-raiser breakfast for a political candidate some years ago at which the candidate made waves by asking the small-town restaurant for cantaloupe instead of sausage and biscuits. The restaurant had to send someone to a grocery store for the melon, as you might expect. Later in the week, the candidate was advised by a staffer that a cookout in an adjoining county was strictly a “red meat and whiskey event” and not to ruffle sponsors’ feathers by asking for healthier options.
Those attending the Springdale meeting heard that there are a number of efforts underway to help Arkansans improve their health, for example, an initiative to provide more fruits and vegetables statewide through the Healthy Active Arkansas program. The Arkansas Coalition for Obesity also has funding for community gardens and for improving access to healthy foods statewide. Public and private healthcare providers have a myriad of health-improvement outreach initiatives that include not only ways to choose better foods more cheaply but also how to become more physically fit without an expensive gym membership.
The commission is expected to begin bringing information and services directly to Arkansans by putting in service this month a mobile health unit that will travel to the state providing health screenings and information, following up with patients who have abnormal screening results that need attention.
I would encourage you go to the Robert Wood Johnson Foundation’s web site http://www.countyhealthrankings.org and take a look at your county’s health outcomes and health factors. There you’ll find – illustrated by color maps and lots of charts and statistics – evidence of what Dr. McGhee is telling us: It’s about the money.