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By Michael Broadway & John Broadway via Rural Insights
MARQUETTE – Each year the University of Wisconsin publishes a report assessing health outcomes and access to health care resources in counties throughout the nation. And while issues including the Covid-19 pandemic, suicide, drug overdoses and road accident deaths have driven health outcomes down across the county, Iron County has been hit particularly hard even compared to its Upper Peninsula counterparts.
For the study, the health of each county is ranked within each state — from the healthiest to the least healthy — using a model that summarizes the overall health outcomes of each county, and the factors that contribute to health.
There are two health outcome categories: length of life and quality of life (using self-reported measures such as poor physical and mental health days). Factors that contribute to health include individual behaviors, access to care, an area’s physical environment, and general social and economic conditions.
Deaths from drug overdoses in 2021 exceeded 106,000, a significant jump from 70,000 in 2019; road accident deaths also increased during the same period, from 39,000 to 43,000; and suicides went up slightly from 47,511 to 48,183. It is against this backdrop of deteriorating health conditions at the national level that provides the impetus for an examination of overall health in the U.P.
Most U.P. counties’ rankings fell, which means that their overall health deteriorated relative to other Michigan counties. (See Table
1) The largest drops are associated with Iron, Baraga, Delta and Gogebic counties, while Marquette and Dickinson experienced the smallest declines; two counties that were in the top 10 in 2011 (Alger and Houghton) fell out by 2023.
Ontonagon showed the biggest improvement, with its ranking increasing from 79 to 56. In Michigan, the top five counties for health outcomes in 2011 were, in rank order: Ottawa, Leelanau, Livingston, Washtenaw and Alger. Leelanau, Ottawa and Livingston remained in the top five in 2023 and were joined by Clinton and Oakland counties (Washtenaw dropped to 6).
The relative stability in ranks among the healthiest counties is in marked contrast to most U.P. counties. The distinguishing feature of these counties ranked healthier is that they are either popular retirement destinations (Leelanau, Ottawa) or among the state’s wealthiest (Livingston and Oakland) in the Detroit metro area.
Given the drop in U.P. health outcome rankings, it is not surprising that the conditions affecting health experienced a similar fall, with the average rank dropping from 38 in 2011 to 44 in 2023. (See Table 2) Eight of 14 counties experienced a decline in rankings with the largest occurring in Iron County. Five counties recorded improved rankings, most notably Chippewa and Luce.
At the state level in 2011, the top five highest ranked counties in order were Washtenaw, Livingston, Ottawa, Oakland and Grand Traverse. There was only one change in 2023, with Grand Traverse being replaced by Clinton County. A comparison of factors contributing to health outcomes found that in 2023 several U.P. counties are among the highest in the state for persons without health insurance. Food insecurity in the U.P. is also above the state average, as well as adult obesity, smoking rates, alcohol impaired driving deaths and levels of physical inactivity.
The fall in most U.P. counties’ health rankings is either the result of other counties improving their outcomes or a worsening of U.P outcomes. Regardless of the cause, health outcomes have deteriorated in the region.
Covid-19 produced an increase in deaths. For example, Iron County’s 2021 death rate from the virus was five times higher than in Leelanau County. Fatal injury rates increased across the board between 2011 and 2021, but doubled in Baraga, Gogebic, and Luce counties. Finally, death rates from heart disease increased in all counties except for Gogebic, Houghton, Iron and Ontonagon.
Life expectancy is also used as an indicator of a population’s overall health. For nearly 120 years this number increased steadily in the U.S. to reach 79 years by 2019, but in 2020 it dropped to 77 and just over 76 in 2021.
The statistic is an average that varies by gender, race, geography and socioeconomic status. For example, life expectancy for women is higher (79.1 years) than for men (73.2), while for American Indian and Alaska Native populations life expectancy is 65, which is 11 years below the figure for white Americans.
Those with the shortest life expectancies tend to experience the most poverty and food insecurity, while having less or no access to healthcare. Epidemiologists attribute much of the recent decline in life expectancy to increased deaths from Covid-19, drug overdoses, accidental injuries, heart and liver disease and suicide.
In the UW-Madison study, individual behaviors include tobacco use, obesity, diet and exercise, and drug and alcohol use that influence health outcomes.Access to care indicators include the numbers of uninsured persons, primary care physicians and mental health providers. Each county’s general socioeconomic condition is profiled using census data that focuses on poverty, unemployment and education levels.
The physical environment for each county is measured using air and water quality statistics and housing quality indicators. The data for specific measures are derived primarily from three sources: the National Center for Health Statistics, Center for Disease Control and Prevention Behavioral Risk Surveillance System, and US Census Bureau.
Further details on individual measures and the methodology behind the rankings are available at countyhealthrankings.org.
Editor’s Note: Rural Insights is a nonprofit online publishing outlet focused specifically on issues affecting the U.P. and its residents. To learn more or to sign up for its newsletter, visit https://ruralinsights.org/.