photo by: Mackenzie Clark

Some of Douglas County's best and worst categories in the 2018 County Health Rankings.

Douglas County has fallen from the seventh healthiest county in Kansas last year to 23rd in 2018.

This is the first time since the annual County Health Rankings and Roadmap report was first published nine years ago that the county has not been included in the top 10. However, an expert with the Kansas Health Institute said it’s still impressive to be in the top quartile.

“I think that overall, Douglas County is still in good shape,” said Dr. Gianfranco Pezzino, senior fellow and strategy team leader with KHI. “I think most measures and indicators are going the right direction. There are a few areas of concern. … I wouldn’t put too much weight just on that change in ranking alone.”

photo by: Contributed Photo

Dr. Gianfranco Pezzino, senior fellow and strategy team leader with the Kansas Health Institute

Pezzino is concerned, however, about racial inequity.

New this year, the report shows racial and ethnic disparities for a few select categories — “that information is quite difficult to obtain,” Pezzino said.

For instance, the teen birth rate of 10 per 1,000 girls and women between ages 15 to 19 is significantly lower than the statewide average of 30 — however, the numbers for black and Hispanic teens in Douglas County are 26 and 18, respectively, and just 8 for white teens.

Also, the county’s percentage of children living in poverty has gradually declined each year from 17 percent in 2014 to 12 percent this year, and is now better than the statewide average of 14 percent. Broken down by race, though, the numbers show 27 percent of black children, 30 percent of Hispanic children and 11 percent of white children live in poverty in Douglas County.

“There are pockets of poverty and underprivileged populations, including sometimes maybe even the (University of Kansas) students,” Pezzino said. “They need to be taken care of. They need to be addressed. These are populations that remain vulnerable. If they live in poverty and adopt unhealthy behaviors, that can affect their entire community and not just their own personal health.”

Chris Tilden, community health director with the Lawrence-Douglas County Health Department, said the department has looked closely at these disparities but has had difficulty because of sample sizes.

“That’s not to say that they don’t exist, but we’re a relatively small county, we have relatively small populations of racial and ethnic minorities, so we’ve got pretty limited data on local disparities,” he said.

photo by: Contributed Photo

Chris Tilden

LDCHD has, however, identified inequity in economic categories, many of which came up as concerns in last year’s Community Health Assessment. Those issues, echoed in the latest report, include issues such as safe and affordable housing and income inequality.

Severe housing problems have stayed fairly flat between 20 and 22 percent for the past five years in Douglas County. The latest report indicates housing with at least 1 of 4 problems: overcrowding, high housing costs, or lack of kitchen or plumbing facilities. This year’s 21 percent is 7 percent worse than the statewide average of 14 percent.

Also, the county has the second highest income inequality, or the ratio of household income at the 80th percentile to that at the 20th percentile, in the state. It is 5.2 for Douglas County and 4.4 statewide.

“As you look at this report and note that we really do not compare favorably with other communities around the country on things like safe and affordable housing, income inequality,” Tilden said. “I think we’ve targeted the issues that we know have been a challenge in Douglas County and have brought many, many partners to the table to try to address them in coming years.”

Quality of life factors also look worse for Douglas County this year — it fell to 68th from 28th last year. That measure includes the percentage reporting fair or poor health (13); the number of poor physical health days (3.4) and poor mental health days (3.6) in a 30-day period; and percentage of low birth weights (6.5).

The number of poor mental health days is heavily weighted — 10 percent — in the rankings, and Douglas County’s is the seventh worst statewide, based on responses to the Behavioral Risk Factor Surveillance System. The same weight is applied to poor physical health days, and Douglas County falls in the worst 20 in that category as well. The statewide averages are 3.3 and 3.1, respectively.

“It would even be dangerous, in most cases, I think, to say that these (latest numbers) represent a trend,” Tilden said. “… We’d love to be seeing downward trends for all of these numbers, and what we’ve seen over time is, again, they’re hard numbers to move, and they’ve been pretty constant over time but not improving, and that’s certainly something, at the end of the day, that concerns us.”

Another notable factor in the report is a continuous upward trend in sexually transmitted infections and alcohol-related behaviors. As the Journal-World has reported, both Douglas County and the University of Kansas campus have seen increased rates of STIs this year.

Pezzino said that’s somewhat to be expected in a college town, “but I think taking that for granted probably would be the wrong attitude. I think it’s still something that needs to be addressed,” he said.

The percentage of adults reporting binge drinking or excessive drinking was 22 percent, compared to the statewide average of 17 percent. The percentage of driving deaths involving alcohol had been trending downward, from 33 percent in 2014 to 24 percent last year, but that number rose to 30 percent in the most recent report.

Overall, Tilden said this report each year gives the health department an opportunity to highlight challenging issues and face them in coming years.

“We’re now working on the next five-year community health plan, and that plan will address disparities, with a real focus on disparities and health equity, doing that through the lens of behavioral health, safe and affordable housing, poverty and jobs as well as nutrition and physical activity,” Tilden said.

The annual report comes from the Robert Wood Johnson Foundation and the University of Wisconsin Public Health Institute. The Kansas report ranks 103 counties, and it can be found at countyhealthrankings.org.