How your address plays a role in your health, and why Arkansas Blue Cross cares
Did you know your ZIP code can be as important as your genetic code in determining your health?
For 70 years, Arkansas Blue Cross and Blue Shield has focused on what we can do to help our members be healthier. We treat our members as unique individuals and give everyone personalized attention. That will not change.
But, as it has become easier to compile large amounts of data and mapping programs, we have been able to look at different communities within our state and see health trends in large groups of people. This is called population health, the study of people and their health, as influenced by their environment – where they live, eat and work – and their behaviors. It can give us a better understanding of not just how people in a community are healthy or unhealthy, but why they are healthy or unhealthy.
The county-level health landscape
To drill down to the county level, we looked at the County Health Rankings & Roadmaps, which is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The annual County Health Rankings measure health-influencing factors like high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income inequality and teen births. County Health Rankings examines these factors in nearly every county/parish in the United States, along with statistics on the incidence of relevant health/life events in those communities. The result is a local-level snapshot of each county’s health-affecting challenges and virtues.
When we looked at the data, patterns emerged that would be repeated over and over, as each factor was examined. One common theme was that money and health are inextricably connected. In short, the more economically robust a county is, the healthier its population is likely to be – and vice versa. And in many cases, the disparity between the counties at the top and bottom of each category are nothing short of shocking.
Not surprisingly, when it comes to overall health outcomes in the state, the best results are found in Benton County in northwest Arkansas, where business-world giants like Walmart, Tyson and J.B. Hunt have their headquarters. The worst overall health outcomes in the state are found along the Mississippi River Delta of eastern Arkansas. Phillips County, anchored by the Helena/West Helena area, was the hub of the cotton trade in bygone days and a birthing ground for blues artists. Today, the area is struggling with a loss of jobs and resources, which is why Arkansas Blue Cross is working to determine how we can best help in those communities.
Food insecurity in Arkansas … the haves and have nots
Last year, to battle food insecurity and mark our 70th anniversary, Arkansas Blue Cross and Blue Shield packed more than 1.1 million meals in our Fearless Food Fight events in communities throughout the state, far-surpassing the goal of 700,000 meals. We chose food insecurity because poor nutrition is at the root of myriad scientifically linked adverse health outcomes and behaviors, ranging from birth defects and low birth weight … to anemia and asthma … to cancer and heart disease/stroke.
We also chose food insecurity because Arkansas’ food insecurity rate of 18 percent (1 in 6 people) exceeded the national rate of 12 percent (1 in 8 people), which meant that Arkansans had a greater chance of being unsure where their next meal was coming from than the average American.
But that’s the statewide picture. How does food insecurity look within Arkansas – at the county level?
Once again, Benton County had the least food-insecure population of any Arkansas county, with only 12 percent falling into that classification. Calhoun County was the median, matching the state rate at 18 percent. Phillips County ranked as the state’s most food-insecure region, at 33 percent, which is almost triple the national rate and nearly double the state level.
To underscore the severity of the food-insecurity problem in Arkansas, only Benton County posted a rate equal to the national rate of 12 percent. The 74 other counties all were higher than the national rate, and 33 were higher than the overall state rate of 18 percent.
In the category of access to healthy foods, Benton County held at 12 percent but lost top honors to Izard County, in north central Arkansas, which posted the lowest level – 1 percent. Phillips County’s 31 percent of population with limited access to healthy foods was exceeded by Calhoun County, in south Arkansas, at 32.5 percent, and Chicot County, in the southeast corner of the state, at 33.4 percent, placing them 74th and 75th, respectively. In case you were wondering, Saline County ranked 22nd in that category (at 6 percent), and Pulaski came in at 43rd (at 10.4 percent).
Incidentally, the adult obesity rate was lowest in Washington County in northwest Arkansas (at 30 percent) and highest in St. Francis County, again in eastern Arkansas (at a staggering 45 percent). This may seem to be the opposite of food-insecurity, but when people don’t have easy access to healthy foods, they “make do” with overly processed foods that can keep easier over time. These foods have a direct tie to obesity rates.
In the heart-wrenching subcategory of children living in poverty (which is tied closely with food insecurity) Phillips County again was ranked 75th, with a whopping 51 percent. The ranking is ironic since Phillips County’s biggest industry is agriculture and that the county routinely leads Arkansas in soybean production.
Breaking the ZIP code’s barriers
Lori Graham, a supervising medical social worker for Arkansas Blue Cross, acknowledges that people in counties where healthy resources are scarcer might be tempted to give up. “It’s easy for people who are facing an environment like this to become so overwhelmed they don’t know where to turn or what to do,” she said.
Graham and her fellow social workers routinely help members address unhealthy environments. “The important thing to remember is that each individual, no matter where they live, has the capacity to take charge of his/her own health and develop strategies to overcome the challenges that may be inherent in their environment,” Graham said. “Knowing what those challenges are is the first step to creating a healthier life.”
Graham and her colleague Jonathan Howland regularly look at Phillips County and other counties with a powerful tool they use in their daily work: the Community Health Management (CHM) Hub® medical geographic information system, a proprietary tool of the Blue Cross Blue Shield InstituteSM. The CHM Hub helps them problem-solve and identify resources that can help members meet basic needs. The CHM Hub allows social workers to examine a specified geographic area (at a much more granular level than the County Health Rankings & Roadmaps) and overlay it with health information, socio-economic data, community resources, etc., which allows them to simultaneously assess risks, identify concerns and pinpoint possible solutions.
A closer look with the CHM Hub showed that the Helena/West Helena area has only a few grocery stores and that several on the list actually were convenience stores that may have few healthy options (like fresh produce, etc.).
In such an instance, Howland noted, the social worker might focus on directing a food-insecure or obese member to shop primarily at stores that have healthier alternatives. In some cases, this reveals barriers that must be overcome.
Identify and address
“Transportation is a big thing, sometimes,” Howland added. “If the only store with a produce department is in West Helena, and you live in Helena and have no car, you might be more likely to get your food from the dollar store around the corner.” Other times, finding a way for the member to get assistance with prescription costs can make the difference. “Way too many people in areas like Phillips County are facing tough decisions – like deciding whether to pay for their medicine or food for their kids.”
Sometimes, the problem may be a deficit of training or information. “We might have to look at helping the member acquire some cooking skills,” Graham observed. “It’s not uncommon for people in disadvantaged areas to gravitate toward fast food and other prepared foods, and before long, you have a generation that does not know how to prepare food for themselves, which usually would be better for their health and more economical.” Other times, social workers may help connect members with assistance programs (public and private). The problem, though, is that economically depressed areas frequently have many fewer nonprofits to help people who need that type of help.
The issue is more economics than geography, Howland said. “There are areas of Little Rock that look very similar to Phillips County,” he noted. “If you look at 72204, it looks a lot like Helena/West Helena in terms of access to healthy foods, etc. That area has lots of convenience stores and liquor stores that carry some food but very few real grocery stores. A major difference, though, would be that a large metropolitan area like Little Rock is going to have more community resources that people in that ZIP code can turn to for help.”
Healthier communities start with YOU
Graham and Howland agreed that residents of less healthy counties can take charge of their own health and break the cycles that may have contributed to their current rankings. Here are a few of their common-sense suggestions:
- Have a health-promotion and disease-prevention mindset (avoid unhealthy foods and habits, seek healthy options and go to the doctor at least once a year for a checkup).
- If you don’t have enough food, investigate all options (aid agencies, vegetable gardening, etc.)
- Take exercise where you can find it. (Walking, jogging, situps, pushups, etc. do not require money).
Howland and Graham also agree that the best hope unhealthy communities have is their collective will.
“People in these areas often can feel so isolated that it can be easy to fall into poor emotional health,” Graham said. “My recommendation to prevent this is for them to get active in the community and help others.”
“Each community – and each person – has the power to make life better in their own hometown,” Howland said. “Find grants. Start nonprofits. Attract new business and industry. Lobby for government help. Start a community garden. Grassroots change is lasting change and it makes communities stronger in the long run.”
If you’d like to know more about the County Health Rankings & Roadmaps or the Robert Wood Johnson Foundation, visit: https://www.rwjf.org/en/how-we-work/grants-explorer/featured-programs/county-health-ranking-roadmap.html. Or to get the latest comparative life-expectancy data for your specific address, visit: https://www.rwjf.org/en/blog/2018/09/new-data-provides-deeper-understanding-of-life-expectancy-gaps.html.