In data published recently in the journal PLoS ONE, a county-by-county look at hypertension, treatment and control found “wide disparities” among counties, especially within a state such as Georgia, said Dr. Ali Mokdad, the head of the Institute for Health Metrics and Evaluation’s U.S. County Performance team at the University of Washington. In 2009, for example, there was nearly a 20 percent difference in men’s hypertension rates between the best counties, such as Forsyth (32 percent) and Columbia (34 percent), and the worst, such as Hancock (51.8 percent) and Taliaferro (51.4 percent). Many of the worst counties also showed greater increases in rates from 2001 compared with the best counties, the report found.
“There are people falling behind,” Mokdad said. The same holds true for women, who actually have higher rates than men, though this is not well known even by women themselves, Mokdad said.
“They don’t see heart disease as being their No. 1 killer,” he said.
Women do well with mammograms and pay attention to breast cancer, which is good, Mokdad said.
“But at the same time they are not doing equally so when it comes to other risk factors, blood pressure and cholesterol,” he said. “The system has to do a better job educating women, and women have to also understand that they have the same risk factors when it comes to cardiovascular disease as men.”
The disparity among counties also shows up in the 2013 Power Ratings of Georgia counties put out by Partner Up! for Public Health. The rating combines health outcomes reported by county annually from the University of Wisconsin with economic rankings by county from the Georgia Department of Community Affairs. In that listing, Columbia County is fourth (seventh best in health but second in economic strength); Lincoln County was tied for 87th; Richmond County was 108th; McDuffie was 109th; Screven County was 131st; Jefferson County was 142nd; Burke was 147th; Warren was 149th; and Taliaferro was next to last at 157th because two counties in south Georgia tied for dead last.
As with the hypertension numbers, there is a stark difference in health measures between the top counties and the bottom counties in Georgia, said Charles Hayslett, who is managing the Partner Up! campaign.
“It’s like two different planets,” he said. “It could not be more striking.”
Earlier this year, Hayslett compared the top counties north of Atlanta with some of the lowest in southwest Georgia, near the Alabama line, in a piece headlined “From Minnesota to Mississippi.
“If you look at their health metrics,” Hayslett said, “you couldn’t believe they are from the same state.”
And the same is true for many of the rural counties surrounding the Augusta area.
“In some respects, the numbers are just as bad and maybe even a little worse. And it’s more of a mystery in some respects,” Hayslett said. “Particularly because of the presence of the medical college, I guess I’m surprised that there hasn’t been a more beneficial influence in that part of the state.”
But there is a simpler explanation for the difference between Columbia County and its neighbors.
“To a huge degree that’s economics,” Hayslett said. “And you’ll find that Columbia County pattern all over the state” in bedroom communities next to urban areas. And it is not just the income of the county’s residents but the marketplace it provides.
“In Atlanta and in Augusta, we’ve got pretty good health care markets,” Hayslett said. “We’ve got lots of people who are covered through private employers or Medicare or Medicaid or work for the state in the case of actually both of those communities. That supports a lot of doctors and hospitals and other providers. But you get 20, 30, 40 miles outside of Augusta and you really don’t have the conditions necessary to create or sustain a health care market.”
Even those with health insurance in those areas have to travel to use it in the larger markets, he said. The Affordable Care Act, with tax credit subsidies up to 400 percent of the federal poverty level, will provide the potential for coverage for tens of thousands in the Augusta area, according to a recent report. But that might not change things, Hayslett said.
“Theoretically at least, that should help. But even the folks who will then have access to it and buy it, they still have the supply problem,” he said. “If they are out in Burke County or Jenkins County or wherever outside Augusta, they still have the problem with a lack of physicians and a lack of providers.”
The difference in conditions means starkly different realities based on where someone lives in Georgia.
“The truth of the matter is I think there are probably four or five Georgias at this point,” Hayslett said. “I think it has really become that much more stratified, and the problems are becoming that much more intractable.”
There was some good news, however, in the hypertension report: In even in the worst performing counties in Georgia the rate of treatment was above the national average, Mokdad said.
“This was a surprise for us,” he said. “The fact that people in the Southeast, where usually traditionally blood pressure is high, are doing much better in treating and following that, controlling blood pressure.
“For us this is an encouraging story. The medical system, the society, is heading in the right direction. Slower but heading in the right direction.”
Staff Writer Sandy Hodson contributed to this report