By MARGARET THOMPSON
Trumbull County ranks 71st out of Ohio's 88 counties in overall health, according the findings of a national program. That's down from 66th last year.
Kent State University at Trumbull student Courtney Milner of Garrettsville works out on an elliptical machine at the Kent Fitness Center.
Mahoning County ranks 75th, the same as last year.
Neighboring counties fared better: Geauga, first; Portage, 20th; Stark, 39th; Columbiana, 50th; and Ashtabula, 60th. The unhealthiest county in the rankings is Scioto.
The rankings are based on a combination of various county statistics - from the prevalence of excessive drinking to the availability of clinics and the volume of violent crimes. These and other factors are analyzed to determine the quality of life and mortality rates within each county.
Representatives from the University of Wisconsin and the Robert Wood Johnson Foundation, the two organizations heading the County Health Rankings and Roadmaps program, announced the findings last week.
While most of the findings wavered slightly since last year's, Trumbull County has dropped significantly in its overall health rank, with an estimated 8.47 out of every 100 people dying prematurely - before the age of 75 - and 18 percent of the population living with poor or fair health.
Mahoning residents report 14 percent living with poor to fair health, and 8.73 of every 100 people dying prematurely.
Health behaviors determine 30 percent of the rank. While Mahoning ranks 27 out of the 88 counties in this category, Trumbull ranks 63rd as a result of several factors.
For example, 30 percent of Trumbull County is obese. This is in line with the state average, though higher than the national benchmark of 25 percent.
"I don't know about Trumbull County," said Dr. Yun Xia, of Mill Creek Health Center, "but in the whole nation, obesity is increasing."
Xia said she believes it is due to the constant use of cars and consumption of fast food.
"Most important is diet. If you do both, it is good, but diet is more important than exercise," Xia said.
For example, eating a small bag of potato chips may have 200 to 300 calories, which would take an hour of running to burn off. Portion control is also important, she said.
"I was listening to the radio and they said you gain weight one pound at a time, and so you can prevent it one pound at a time," Xia said.
Other unhealthy behaviors in the county include excessive drinking, physical inactivity and the transmission of STDs. With 332 reports of chlamydia per of 100,000 people, sexually transmitted infections in the county are far above the national benchmark of 92. Also in the county, there are 38 pregnancies for every 1,000 teenage females, ages 15 to 19. This is much higher than a national benchmark of 21.
Clinical care determines 20 percent of a county's rank. Among Ohio's 88, Trumbull ranks 44 in clinical care, while Mahoning is at 15 percent.
Fifteen percent of the Trumbull population is uninsured, and the ratio of dentists and primary care physicians is steep compared to the national benchmark. Mahoning, by comparison, ranks 14th in the state with a ratio comparable to the national average.
In addition, there are 88 "preventable hospital stays" per every 1,000 Medicare enrollees in Trumbull. These are hospitalizations for ambulatory-care sensitive conditions.
Lauren Manusakis, clinical dietitian at St. Elizabeth Health Center, said these preventable stays can happen when a patient uses the emergency room of a hospital as their primary care doctor.
"Most people don't want to pay for preventive care," Manusakis said. "Their priorities have shifted."
In her line of work, Manusakis said, visiting a dietitian for weight issues, blood pressure problems and high cholesterol could help prevent a heart attack.
"Controlling your weight can help prevent a lot," Manusakis said.
Social & economic factors
Social and economic factors determine 40 percent of the county's rank. While Remington said 20 percent of children live in poverty nationwide, the Trumbull and Mahoning statistics are even more bleak at 29 and 30 percent respectively. Ohio as a whole sits at 24 percent.
Tim Schaffner, director of Trumbull County Children Services, said numerous factors feed into child poverty rates.
"When you see the economy get bad, and an increase in drinking and drugging, and more unemployment," Schaffner said. "Unfortunately it gets worse."
Likewise, Schaffner said, that adverse childhood experiences cycle back into the other factors like unemployment, which is up to 9.6 percent in the county, compared to a national five percent.
Schaffner heads a subcommittee of the Family and Children First Council that brings together professionals and locals from all areas in the county who deal with children.
"We decided to create a trauma-informed community of care," Schaffner said.
For example, the council works to inform teachers that adverse childhood experiences have a direct correlation with chronic illness. Schaffner said the local schools become a safety net for reporting any trauma they may suspect is taking place in the children's home lives.
High school graduation rates are remarkably high in Trumbull County at 89 percent compared to state-wide 78 percent.
Physical environment determines the last 10 percent of the ranking.
In the Trumbull County, there are 11 recreational facilities for every 100,000 people. In Mahoning, its 12.
The national benchmark is 16 facilities for every 100,000 people.
On the other hand, Trumbull County has a notable number of fast food restaurants at 54 percent, and Mahoning, 51 percent, compared to the national bench mark of 27 percent.
Other elements of the physical environment include a daily pollution average of 14.2 fine particulate matter in micrograms per cubic meter (PM2.5). The national benchmark is 8.8.
"Mahoning and Trumbull are meeting national air quality standards," said Tara Cioffi, administrator of the Mahoning-Trumbull Air Pollution Agency.
Cioffi said the two counties are monitored daily and have been declining in pollution. She attributes this to changes in industry in the area, as well as to a decline in population.
Cioffi said there are better pollution control standards in place by the EPA to ensure clear air.
"It definitely can effect your health," Cioffi said, "but it varies person to person based on sensitivities."
Patrick Remington, associate dean for public health at the University of Wisconsin School of Medicine, said, "Counties and communities are using the rankings to identify problems and work together."
The nationwide rankings began four years ago, growing out of an initiative at the University of Wisconsin. According to Remington, they have sparked changes across the nation.
Remington listed examples such as rebuilding schools in Baltimore and numerous efforts in New Orleans.
"It's all of our responsibilities to make our community healthier," Remington said.
During the conference, Karen B. DeSalvo, New Orleans health commissioner, spoke on how the county rankings inspired her city to make "systematic and durable changes" to increase their health ratings. After the city was destroyed in 2005 by Hurricane Katrina, leaders realized the need to rebuild it as a healthy city, she said.
"Health is more than getting someone to the doctor," DeSalvo said.
Since then, her city has made significant improvements to their primary care clinics and has enrolled 85 percent of their students in charter schools, she said. It also made strides in promoting healthy behaviors and increasing their accessibility to biking.
"We used partnerships of the public and private sectors," DeSalvo said. ''We brought the best of everybody to the table to leverage our resources."
The majority of the time, Trumbull County falls either with or below the state average in the 25 specific health factors that the research addresses.
There are four areas where Trumbull performs better than the state average: high school high graduation rates, the number of sexually transmitted infections, mammography screenings and violent crimes. However even in this, Ohio never reaches the 90th percentile of the nation for any of the factors. (Ohio is ranked 35 in the nation, according to the United Health Foundation.)
The program groups the 25 factors into four categories: health behaviors, clinical care, physical environment and social and economic factors to determine the quality of life and mortality rates within each county. Each category is then weighted to derive the overall ranking.