Clark County working to improve public health

Late last year Springfield was named the least healthy city in Ohio, according to a study by a national financial website. Local health leaders disagree with the study’s findings, saying it’s unclear where the data originated.

But what’s not in dispute — Clark County residents live fewer years than many other Ohioans and community members and leaders want to change that.

After the Springfield News-Sun first reported on the least healthy city ranking, many residents contacted the newspaper and took action, including starting community fitness challenges. The News-Sun will spend the next year digging into this issue, examining many of the reasons behind the health rankings and the community response.

Clark County has improved in some areas and it must continue to make the community a healthier place, said Gabe Jones, epidemiologist with the Clark County Combined Health District.

“We have a lot of areas for improvement in Clark County,” Jones said. “From a health department perspective, even if we were the best county in the state, tied with Delaware County on the county health rankings, we wouldn’t change anything we do. We would still see a lot of room for improvement.”

Many experts say health ultimately comes down to personal choice. Sarah Potter was one of the residents who signed up for the community health challenge. The 34-year-old Springfield woman has two children and decided to make a change for them.

“I want to make sure I’m around to see them grow up,” she said. “Being overweight is not the lifestyle I want to live anymore.”

Where we stand

The health district will present the findings of its 2015 community health assessment on Jan. 29 and will begin collaborating with community health providers to create the 2016 community health improvement plan.

The assessment uses both adult and youth risk behavior surveys, as well as other recent data, including rates of cancer, deaths, births, infectious diseases and hospitalizations, to identify areas of need — and how to improve them — over the next several years.

The improvement plan is designed to be a road map for all health agencies for the coming years, said Chris Cook, chief executive officer of the Rocking Horse Community Health Center.

“It’s not all on the health department,” Cook said. “It’s on all of the community partners — the hospital and us and private practices, all the social service agencies.”

Clark County ranked 74th among Ohio’s 88 counties in the sixth annual County Health Rankings report released last year by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

In 2014, Clark County ranked 70th, its best showing since the survey began. The ranking is based on health outcomes, which measures both length and quality of life.

The county improved, though, on its health factors ranking and climbed to 58th in Ohio — up from its lowest ranking, 70th, in 2013. That measure looks at behavior, clinical care, physical environment, and social and economic factors.

The county ranks worse than the national and state averages in important areas, such as premature death and physical inactivity.

Clark County residents lost more than 8,800 years of potential life before age 75 in 2013, which was an improvement from the past two years, according to the ranking data. That measures all deaths occurring before the age of 75, with each of those deaths contributing to the total number of years of potential life lost.

About 28 percent of Clark County adults ages 20 and older reported no leisure-time physical activity in 2011, the rankings showed, which worse than the Ohio average. According to 2015 health district data, that improved to about 22 percent locally.

The county improved in several areas, including violent crime, air pollution and preventable hospital stays. While the county isn’t the worst in any areas, it ranks in the bottom 20 counties in some.

The health district has access to more recent data, Jones said, allowing it to take a more focused look at the community. Its research shows adult smoking has improved recently compared to the most recent health rankings, down from 28 percent to 20 percent, he said.

“Typically, (the county health rankings) are a little behind,” Jones said. “We still might be one or two more years behind, but it’s still more recent than their data.”

Moving forward

As part of the previous community health assessment, health leaders designated five areas to focus on — improving mental health, preventing substance abuse, preventing obesity, chronic disease, and healthy births and sexuality.

The initiative led to several programs within the community, including the development of a chronic care clinic at Mercy Memorial Hospital in Urbana and another planned at Springfield Regional Medical Center, a Good Behavior Game introduced at local schools and the creation of the Clark County Substance Abuse Prevention and Treatment Coalition.

For the new assessment, the health district will use the same task forces, Jones said, but will also break out into smaller, more focused groups for to look at other areas.

The research data has been broken down to the census tract and neighborhood block level. So in the next few years, the district will focus on areas that have the highest health disparities and where they can have the biggest affect with neighborhoods on board, Jones said.

The focus for the upcoming improvement program will be to set realistic goals, Jones said. By targeting improvements, he said it will make it easier for agencies to manage.

“It doesn’t make sense to focus on the county as a whole whenever 20 percent of the population is contributing to 80 percent of the problem,” Jones said.

Ways to improve

At first glance, Springfield resident Diana Cuy Castellanos — a registered dietitian and assistant professor at the University of Dayton — was surprised by the city’s health statistics. But when looking at other factors, including lack of access to healthy foods and crime rates, she said it made more sense.

Several programs can be put into place to improve health locally, but she said it must be done holistically. It can be difficult for educational programs to make a difference if the environment doesn’t support the program, she said.

“It’s not just in the home, it’s also in the schools, it’s also within our own family culture,” Cuy Castellanos said. “It’s an environmental, cultural, I think, shift as a society we have to make.”

While lunch programs are federally mandated, Cuy Castellanos said schools should go above and beyond to target children’s health.

She’s a big supporter of programs that allow people with food stamps to receive double bucks when purchasing healthy foods, similar to a recent initiative at the Springfield Farmer’s Market. In Michigan, the program has been extended to grocery stores.

“It’s been very successful in terms of increasing fruit and vegetable consumption, especially in low-income populations,” she said.

Businesses, schools and nonprofit organizations can work together to increase access to fitness areas, including providing incentives to people who join a fitness club, Cuy Castellanos said.

Several programs currently in place, such as Springfield Promise Grows community garden, are a step in the right direction to providing healthy food to city residents, she said.

Mental health key

This year the Rocking Horse Center will continue to focus on behavioral health services, a field that includes mental health and substance abuse treatment. There’s a nationwide shortage of those services, Cook said.

Until you change a person’s view about their mental health, he said, it’s difficult for them to become healthier.

“You’re not going to have the best medical health outcome without addressing the behavioral health side of things, too,” Cook said. “It’s touching everything people come through the door with.”

The community health center at 651 S. Limestone St. is examining several behavioral health integration models, which will allow therapists and medical offices to work together. If a doctor or nurse practitioner believes a patient needs behavioral health services, the therapist can provide a brief intervention for possible treatment in the future.

Rocking Horse has also considered different techniques used by health facilities in other cities and hopes to roll out its program later this year. The health center also will merge its mental health records into its medical records system, Cook said.

The center also plans to hire a care coordinator for its family care practice to target families who need specialized care, Cook said. The coordinator will follow up with families to make sure they’re getting the help they need, he said.

‘Commitment to change’

After last month’s least healthy city report, two downtown fitness centers decided to work together on a fitness challenge with the Springfield Peace Center. As part of the challenge, competitors offered discounts for classes at both the Fitness Cellar and Springfield Health and Fitness Center.

At the first weigh-in last week, 33 residents signed up to compete in the challenge, including Potter. She recently won a trial health challenge held by the Springfield Peace Center over the summer.

Potter’s weight loss has also helped other family members get back into shape. Both her mother and uncle are participating in the challenge.

“With them seeing what I can do, it motivated them to do this one,” she said.

Potter used apps on her phone, such as MyFitnessPal, to track diet and exercise. She also made sure she exercised every day.

“I changed my whole lifestyle,” Potter said.

She was surprised by the turnout for the challenge and hopes to support the group members throughout the process.

“I’m really glad so many people are making that commitment to change,” Potter said.

‘He saved my life’

When Dr. Mohammad Ullah told her to it was time to lose weight, Springfield resident Cheryl Mosco followed through when it mattered most.

“He saved my life,” said Mosco, 52, who had a check-up at the Rocking Horse Center last week. “He literally saved my life.”

Mosco recently lost 100 pounds after Ullah told her to get into better shape, which she said was difficult.

“I try to stay healthy, but I have asthma and (chronic obstructive pulmonary disease),” Mosco said, “so it’s hard to stay healthy. That’s why I come to these guys so they keep me healthy.”

While Mosco smoked for a few years in her 20s, the asthma came out of nowhere, she said. She also uses inhalers and takes breathing treatments for her condition.

Soda is Mosco’s biggest nutritional challenge, she said. She hopes to lose another 30 pounds this year.

Mosco was surprised by Springfield’s health ranking, even with the drug problems in the city. The key her to lose weight was simple, she said.

“Eat right and exercise,” Mosco said.

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