So Many Hospitals, But Where’s the Health?

Those of us who are from Greater Cleveland know the pride with which Clevelanders talk about our local hospital system. People come from all over the world to be treated for chronic conditions at The Cleveland Clinic. MetroHealth’s Level 1 Trauma Center was Cuyahoga County’s only Level 1 Trauma Center, until this past December, when University Hospitals opened their own. UH Rainbow Babies and Children’s Hospital provides excellent healthcare for our region’s young people. All of these hospitals and doctors make Cuyahoga County a leader in the state for clinical care, but the data show that we’re not actually a very healthy county. So what’s the problem?

Newly released data from County Health Rankings place Cuyahoga County fifth out of 88 counties for clinical care (3 out of the 4 counties that rank higher- Delaware, Warren, and Putnam- also have the 3 lowest poverty rates in the state). But Cuyahoga’s high rank for clinical care does not translate to high rankings for other measures. For instance, we only rank 64th for overall health outcomes, and when it comes to social and economic factors we rank 79th- in the bottom 10 percent for the state. What this tells us is that despite the high concentration of doctors and mental health providers in the county, the county’s overall health is hindered by a variety of other social determinants.

Social Determinants of Health

According to the World Health Organization, social determinants of health “are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” This is an acknowledgement that having healthcare is not enough for people to be healthy; poor health outcomes, such as high rates of infant mortality and lead poisoning, teen births, and deaths from drug overdose, are rooted in systems of poverty and isolation.

According to the County Health Rankings, Cuyahoga County performs worse than the state average on nearly every social and economic indicator, including unemployment, child poverty, income inequality, and violent crime. In this year’s rankings, some new additional measures were added, which look at how counties rank with respect to frequent physical and mental distress, drug overdose deaths, and residential segregation.

When it comes to these social determinants of health, Cuyahoga County has a long way to go. We are the 6th most segregated county in the state (between black and white residents, not counting 12 counties where the black population was too small to calculate a segregation index). This means that black residents are disproportionately impacted by poor health outcomes including “infant and adult mortality, and a wide variety of reproductive, infectious, and chronic diseases” (County Health Rankings). Out of every 1,000 babies born in this county, eight do not live to see their first birthday. Over 100,000 households in this county – vastly more than any other county in the state- have “severe housing problems” such as lacking complete kitchen or plumbing facilities, or being severely overcrowded or severely cost-burdened. We have the second highest rate of Chlamydia incidence in the state, with over 10,000 newly diagnosed cases in 2013, indicating a higher overall rate of sexually transmitted infections. We have over 11,000 teen births per year in Cuyahoga County. The list goes on.

All of this data points to the fact that even in communities where there are adequate doctors and hospitals, other factors determine how healthy people in the community are. While preventive care, emergency treatment, and chronic disease management from healthcare providers is important, access to safe, affordable housing, living-wage employment, reliable transportation, healthy food, and parks and recreation are also essential for people to live healthy lives. If Cuyahoga County is to prioritize the health and wellbeing of all of its residents, the provider network and local policymakers must consider these social determinants in order to address the true root of our health problems.