Nine of 10 least healthy Missouri counties are in southeastern part of state

Wednesday, March 30, 2011 | 5:21 p.m. CDT

KANSAS CITY — Nine of the 10 unhealthiest portions of Missouri are counties in the rural southeast of the state, according to a study released Wednesday — an area where both cotton crops and meth labs flourish.

The report from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation found that the rate of premature death and teen births in Pemiscot County — the state's least healthy — is twice as high as in Christian County, the state's healthiest. The study also found 45 percent of children in Pemiscot County live in poverty, compared to 14 percent in Christian County.

Lynelle Phillips, a professor of public health at MU, said the rankings are a testament to the "interrelationship between poverty and health." She said rural communities face a host of problems — from a lack of primary care physicians to high rates of people lacking health insurance. People without health care often miss out on potentially life-saving mammograms, blood glucose screenings and flu shots.

"You don't seek health-care providers, and then when you do, your problems may be too far progressed," said Phillips, who helps place graduate students in under-served areas where they can gain real-world experience.

Freestanding St. Louis City is the only community making the state's 10 least-healthy list that isn't in the rural southeast.

Suburban areas near high-paying jobs and health care facilities tended to fare better in the rankings. Many of Missouri's healthiest counties include suburban areas — such as Christian County, near Springfield; Platte and Clay Counties near Kansas City; St. Charles County near St. Louis City and Boone County.

Kerry Noble, chief executive of Pemiscot Memorial Health Systems in the Bootheel town of Hayti, said the ranking came as no surprise to him.

"It should help us to get some attention," Noble said. "We've been trying to tell this story for so long."

Noble said the community has been battling for years the problems of teenage mothers — some as young as 13 — failing to receive prenatal care and then showing up in the emergency room to give birth to premature babies. Many of the teens are the children of single parents themselves, and Noble said they often don't get much guidance at home.

It's not uncommon for women to become grandmothers in their late 20s or early 30s, he said. For the past couple years the county has started sending women who become mothers as teenagers into schools to talk about the challenges they faced as part of an effort to stem the tide of teen births

Meth has also gained a foothold in the area. And diabetes, which is linked to kidney failure, has ravaged the community, too. Noble said it's not uncommon to have people receiving dialysis in their mid-20s and 30s.

Noble said part of the problem is people fail to seek routine medical care, so by the time a medical condition is diagnosed it is advanced and difficult to treat. Even those able to see primary care physicians often have difficulty affording the medicine they are prescribed.

"I think the sad thing is we can't seem to break this pattern," Noble said. "It's ingrained in this culture here."

He said many things the community has tried haven't had much of an effect. The hospital receives no compensation for about 28 percent of the care it provides, up from 12 percent in 2005 when the state lowered how much people could earn and still qualify for Medicaid, the government's health insurance program for the poor.

Pat Remington, associate dean for public health at the University of Wisconsin who directs the County Health Rankings report, said the problems are complex, but there are steps that can help, such as state policies that encourage businesses to invest in poor areas and clean air policies.

"The other issue is these are areas that are hardest hit by the economy," Remington said. "But they are also hard hit by the costs related to poor health, and so it's a vicious cycle. Can you afford to invest in a community health improvement effort? I don't think you can afford not to. The failure of states like Missouri to invest in these communities puts us into these situations we are in now. High costs for conditions that are largely preventable are bankrupting communities."

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