The Health of Clinton County

by Colin Read, October 12, 2009

Counties that are primarily rural face health care challenges not found in large urban areas. Clinton County is more fortunate than most because of its leading edge health maintenance programs and its access to a very high quality regional hospital located in the City of Plattsburgh. Nonetheless, health issues remain a county-wide focus.

Demographics, geography, and economics are inextricably linked to health outcomes. The demographic component is obvious.  An aging population imposes greater pressures on health care delivery, both in the maintenance of health, and in prolonging life.  Those aged 65 years or older in Clinton County represent 13.5% of the population, which is in line with the overall rate of 13.4% for the entire State of New York.

Data published by USA Today on October 18 in 2006 showed health care costs for the last six months of life total $35,838 in New York City. They estimate that 27% of Medicare’s annual budget goes to patients in their final year of life. With life expectancy in the United States at 77 years, most of the elderly will fall under Medicare for a dozen years.  The first ten of those years will cost less than the last two years.

Clinton County does not have as many children under the age of 18 when compared to the state as a whole. Statewide, 22.6% of the population was under 18 in 2008, as reported by the U.S. Census Bureau Quick Facts, while only 18.4% of the Clinton County population was under 18. We see also that 68.2% of the Clinton County population is in the working age population of 18 to 64, as compared with 64% for the state as a whole. This working age cohort typically does not have access to the same government subsidized or provided health insurance as do needy children or the elderly.

Geography is also an important factor. The following table summarizes the data:

County Health Indicator Profiles (2003-2007)

Source: New York State Department of Health

The rate of injury and of hospitalization is significantly higher in large urban centers for most ailments. The rural regions of New York rely more on out-patient, clinics and general practitioners, and hospice care. The urban population in New York also has a higher pregnancy rate and live birth rate.

The rural New York population is exposed to fewer drug-related illnesses, stomach disorders, pediatric asthma, AIDS, sexually transmitted diseases, tuberculosis, and homicides than its New York City counterpart. However, rural areas are more prone to pertussis, Lyme disease, cirrhosis of the liver, suicide, motor vehicle and unintentional injuries, and lung cancer. Upstate New York also had 847 deaths per 100,000, which is 12% higher than the NYS average of 758 in 2007.

The local economy is an important determinant of health care affordability and access. The median household income in New York is $53,448 in 2007. Clinton County had a lower median income of $45,462 in 2007, up from $38,772 in 2003. Over that same period, the percent in poverty rose from 12.7% in 2003 to 13.2% in 2007, as compared with 9.8% for the Upstate New York as a whole.

Higher household income is usually associated with better access to insurance and health care. However, the Clinton County demographic that is strong in the 18-64 cohort also tends to impose greater strains on preventative health care because this cohort does not have the universal access to health insurance as do their young and aged counterparts.

A comparatively high level of poverty can mean two things. A greater incidence of poverty creates affordability and health care issues as households forego health insurance so they may pay the rent. As a consequence, a greater number of individuals may delay treatment to the point that it becomes more chronic and requires greater intervention. This intervention may even require hospitalization, imposing a greater cost on regional hospitals that are legally bound to stabilize any patients regardless of their financial status.

On the other hand, higher poverty also leads to a higher incidence of Medicaid coverage. The following table shows that while Upstate New York has a lower level of Medicaid enrollment than the state as a whole, Clinton County is significantly higher than the Upstate average:

Number of Medicaid Enrollees by Category of Eligibility by Social Service

Source: New York State Dept. of Health (2007 & 2008 Data)

With this higher level of Medicaid coverage typically comes better access to health care.

Overall, Clinton County is doing a good job with health care delivery. Its regional hospital, Clinton Valley Physicians Hospital, is a very strong rural hospital. It also offers innovative programs, such as a network of advanced preventative and out-patient services provided in conjunction with, and at the offices of, local general practitioners. The Clinton County Health Department, in conjunction with CVPH, other health departments, and other agencies, runs a number of programs that promote healthful living, provides early and regular treatment for obesity and diabetes, and offers food relief and better eating programs from a variety of outlets in Clinton County. Some of these models are now receiving national attention. The rural character provides a level of cooperation and innovation that benefits health care delivery.

While Clinton County is challenged by its rural character, a relatively high level of poverty and social assistance, and the various problems remoteness induces, the County is doing well in providing the level of support this region requires.

 

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