One of the many indicators of health in Cowlitz County is the annual County Health Rankings by the Robert Wood Johnson Foundation and the University of Wisconsin. While it should not be considered the only relevant data on the health of the county, it does provide a comparable look with the other 38 counties in the state and counties across the nation. Our latest report is a mixed blessing. Our general Health Outcomes, including length of life and quality of life, has us ranked at 32nd out of 39 counties and in the health factors measure we rank 33rd. The measure for clinical care is a strong 20 and social and economic factors have continued to rise to a current score of 27 out of 39. The physical environment is our best score at 12. The most troubling score is the one for health behaviors: smoking, obesity, physical inactivity, excessive drinking and other behaviors where Cowlitz County ranks dead last, 39th out of 39 Washington counties.
From the perspective of our determinants of health, health behaviors have to be addressed both from the person and by the community. Adult smoking has been reduced by parks in Cowlitz County going tobacco free. At the same time the individual has to take responsibility for their tobacco use. If one aspect of health is both one of prevention and treatment as part of access to healthcare, it is important for the community to know what issues they can collectively impact. Areas where positive change has occurred is in the reduction of the number of pregnancies for women 15 – 17 years of age, sexually transmitted disease, and improved life expectancy. Passage of the Affordable Care Act has resulted in nearly 9,000 individuals with insurance and the ability to seek the care they need. The increased number of insured introduces the challenge of having too few providers. For low income individuals Cowlitz County is a provider shortage area for medical, dental, and behavioral health services. With the increased demand it is unlikely that this factor will improve until there are more trained professionals available for low income individuals in the County.
Many healthcare providers are modifying their approach in dealing with patient needs by addressing the behaviors leading to chronic disease. Kaiser Permanente, for example, questions all patients on tobacco use and physical activity. They, along with PeaceHealth, are utilizing the Cowlitz County Trails Map as a prescriptive instruction to encourage people to be out and more physically active. Lack of physical activity and poor nutrition contribute to an increase in diabetes, strokes, respiratory disease, and cardiovascular diseases. The top 10 mortality rates for the County are higher than for the State and are significantly higher than the State for diabetes. Many of these chronic conditions have led to deaths that could have been mitigated with a more active lifestyle. The 2014 Healthy Youth Survey for Cowlitz County showed that 19% of 12th graders, based on height and weight were considered obese. The story does not get any better as they grow older with 37% of adults being obese and an additional 34% being overweight. It is unusual and troubling to have a population with more people obese than overweight. This rate has continued for many years. Obesity is a more significant problem in Cowlitz County than in Washington State as a whole.
Tobacco use by all ages and genders continues to remain high. 26% of women smoke during their pregnancy compared to less than 10% on average for the state. The Cowlitz County Health and Human Services has looked deeper at the issue and found that Longview is higher than the county average and Kalama and Woodland are below for maternal smoking. Numerous negative outcomes can occur because of maternal smoking including low birth weight babies, premature birth, and respiratory and ear infections in newborns.
A growing concern as a result of new technology is the impact of e-cigarettes. E-cigarettes, or vaping, do not fall under the Indoor Clean Air Act and statewide regulations have not been adopted. There are concerns for use by youth by local organizations such as the Longview Anti-drug Coalition and Cowlitz On The Move. Local government is considering changes in ordinances to prohibit e-cigarettes in public places, particularly parks, but it is a slow process and an area of limited knowledge of health outcomes.
Access to healthcare and improvement with health services are being approached by multiple providers. The Cowlitz Family Health Center and the Drug Abuse Prevention center announced early in 2015 that they were merging, bringing together primary care and treatment for drug and alcohol addiction. They have successfully demonstrated that an integrated approach to healthcare provides the best care for patients by sharing staff at their locations along with Lower Columbia Mental Health. A relatively new community provider is the Cowlitz Tribe with both primary care and behavioral health services for tribal members and others.
In 2014 PeaceHealth St. John Medical Center looked at the results of their Community Needs Assessment and asked themselves what more could they be doing for the health of young children? They brought together a planning team and community partners to consider several approaches. Today they are working on the issue of community health workers or advocates who could help children and their parents connect to needed services and see the value of prevention and treatment and will propose systematic changes in how health care for children is delivered. The community partners are showing a strong collaboration with the eventual program development to happen in late 2015.
The community health worker idea has been modeled after the work by the Healthy Living Collaborative of Southwest Washington that has developed three pilot projects for community health workers in the region, including South Kelso. These workers are given extensive training to know how to navigate through systems, help residents to identify their needs and potential solutions, and to be a voice in the neighborhood for community concerns. The Healthy Living Collaborative is looking to expand the network of community health workers throughout their four county region as both a connector to health services for individuals but also an economic opportunity for the workers.
The health care needs of the senior population are a growing need. All the major providers are planning to staff for increased services fora population that is growing older and living longer and to be responsive to their individual needs. Southwest Washington Area Agency on Aging and Disabilities is offering activities such as a senior fair on available services as well as actively participating in discussions and planning on senior needs including health, housing, transportation, and access to services.
Recently the decision was made to change how behavioral health funding was distributed in the County. Cowlitz County is transitioning out of the Southwest Behavioral Health Regional Support Network to be a member of the Grays Harbor Regional Support Network and in 2016 to be a member of the five county Great Rivers Behavioral Health Organization. The 1/10 of one cent behavioral health tax collected by the County is now paying for new and expanded services to reach the mentally ill children and adults. A number of large grants have been awarded that will increase treatment, particularly for low income individuals, in the coming years. Already there has been support for Drug Court and youth serving projects. Soon there will be services to help the low income or uninsured patients.
From the perspective of social determinants of health, access to healthcare and opportunities to stay healthy can contribute to being successful employees, students, and parents by making the services more accessible and affordable.
One area of ongoing success has been in providing dental care for children and adults in the community. The Access to Babies and Children’s Dentistry Program (ABCD) has helped more than 7,900 children under six years of age to receive their first dental exam and oral health care. Educators and healthcare providers know that a child who has poor teeth and other mouth related issues don’t make good students, miss school and impact their family’s financial resources. The Community Health Partners received a grant and prepared 1,000 oral health kits including toothbrushes, toothpaste, floss, and information on local free and low cost dental services for children and adults. The University Of Washington Dental School continues to provide the quarterly Community Dental Clinics for low income, veterans, and senior citizens each quarter in facilities provided by Kaiser Permanente. Cowlitz Family Health Center continues to provide comprehensive dental services for over 8,000 children and adults. In the fall of 2015 the University of Washington will conduct a series of dental clinics for elementary students and schools with highest numbers of free and reduced lunches. The goal is to test three different formats of information that goes to parents about the oral health needs of their children. Once the best approach is identified the University and others in the community will begin to implement and replicate the work with local schools.
- Become a Statewide Health Insurance Benefit Advisor (SHIBA) volunteer
- Don’t use tobacco products and quit if you are
- Volunteer at youth alcohol- and drug-free events
- Donate to local health projects and drives
- Practice prevention for you and your family
- Support Family Health Center and Cowlitz Free Medical Clinic
- Explore opportunities through three County Health Priorities
- Participate in shared measurement data collection through local agencies
- Encourage collaboration between medical, behavioral health and substance abuse providers
- Support public and private efforts that aid physician recruitment
- Increase behavioral health funding from the state
- Adopt policies for all public property to be tobacco-free
- Implement school based health initiatives
- Maintain funding for school nurses