County health rankings fuel improvement efforts in Sangamon County

April 01-- Apr. 1--Rosie Jackson has no doubt that the visitors to her home on Springfield's north end who have faithfully driven her to doctor's appointments and physical-therapy sessions have helped maintain and even improve her health the past few years.

"They are there when I need them," said Jackson, 65, a native of Mississippi who grew up in Chicago Heights and moved to Springfield's Enos Park neighborhood 10 years ago. "I put my heart in their hands."

Jackson, a retired nursing-home dietary aide and former smoker who deals with high blood pressure, Type 2 diabetes, spine and lung problems and several other ailments, is one of 1,200 people who have been served by community health workers employed through the nationally recognized Enos Park Access to Care Collaborative.

The free program, funded the past three years with a total of $500,000 from HSHS St. John's Hospital and Memorial Medical Center, focused on the neighborhood bounded roughly by North Grand Avenue on the north, Carpenter Street on the south, 10th Street on the east and Second Street on the west.

Funding for the program was renewed for three more years under a new name -- Access to Health -- since it was expanded in November to include the nearby Pillsbury Mills neighborhood.

The Sangamon County Community Health Needs Assessment, which led to the Enos Park program's creation and spawned other initiatives, was itself fueled by what many community leaders considered alarming local statistics.

What struck local officials in the nationwide County Health Rankings & Roadmaps reports was the disparity between the county's stellar rankings for "clinical care" and its mediocre rankings for "health outcomes."

The fact that the disparity continued in updated rankings in the recently released 2019 report -- despite positive results reported by the Enos Park project and related small-scale efforts -- frustrated but didn't surprise Springfield public-health advocates.

They said the numbers underscore the daunting task ahead of them.

"This is a long-term commitment," said Tracey Smith, director of population health and community outreach for Southern Illinois University School of Medicine's Department of Family and Community Medicine. "It's not something we expect to see overnight."

Because of its relatively high number of doctors per capita, Sangamon County, a regional hub for medical care and home to SIU School of Medicine, typically ranks first, second or third among the state's 102 counties for clinical care. The county again ranked first in the 2019 report.

But for the health outcomes ranking, which is based on national measures of premature death, mental health, physical health and low birthweight, Sangamon County has been listed between 62nd in 2011 and 81st in 2014 among Illinois counties the past eight years. The county ranked 78th in this year's report.

Poverty and other economic factors often play a role in the health outcomes rankings, health experts say. Health problems in the population, as well as economic struggles, often are entrenched.

"When people have chronic diseases, you don't turn that around really quickly," Smith told The State Journal-Register last week.

Sometimes, progress can take the form of preventing overall health from becoming worse, she said.

The Enos Park project's three-year impact statement listed positive results for patients that included improved employment rates, better nutrition, reduced homelessness and fewer police calls, hospitalizations and unnecessary emergency-room visits.

But Smith pointed out that the project served 1 percent of Springfield's population of almost 115,000 people and less than 1 percent of Sangamon County's 196,500 population.

SIU, which administers Access to Health, is looking into ways of "scaling up" the program to serve more people in the county, she said. Such a feat will take money and personnel, and the impact statement noted that there are "very limited opportunities" to bill Illinois' Medicaid program or private insurance companies for the no-charge services provided by community health workers to their low-income clients.

The state of Illinois' budgetary constraints only add to the difficulty of supporting a major expansion, Smith said.

She and her colleagues aren't alone in facing challenges to make big differences in their communities.

Not a single U.S. county with a population the size of Sangamon County or larger has been able to significantly improve its health outcomes ranking in the nine years the nationwide report has been produced, according to Joe Hinton, a researcher with County Health Rankings.

"We've definitely seen some changes" in the individual statistics that influence the rankings, he said.

But it may take expanded efforts and decades of work before innovative programs such as the one in Enos Park, which have made a difference in individual lives, make big changes throughout communities, Hinton said.

Public-health activists are aware of this reality, he said.

The not-for-profit County Health Rankings group is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Kimberly Luz, director of community outreach for the central Illinois division of Hospital Sisters Health System, said the rankings are "one piece of the puzzle" to improve overall health. But the rankings may not accurately indicate progress in the short term because of a lag of several years in the data used to compile the rankings reports, she said.

The Enos Park and Access to Health projects are teaching health-care providers how to better influence patients' quality of life outside of a doctor's office or hospital, she said. Those improvements are ongoing and may not take years to have a positive impact, she said.

Despite the lack of rapid change, the rankings are a valuable tool "to alert the community and make people think about what we should do," said Dr. David Steward, a retired SIU internist who is a member of Springfield's Community Health Roundtable.

The rankings helped the roundtable gain attention a year ago for its report calling on the community to do more to address elevated lead levels in children and higher-than-average asthma rates, said Sheila Boozer, director of teaching and learning for Springfield School District 186.

Disparities highlighted in the rankings have become part of the debate among Springfield's mayoral and aldermanic candidates as Tuesday's municipal election approaches, Steward said.

A recent series in Governing Magazine titled, "Segregated in the Heartland," helped to focus the candidates' attention on the bigger issue of racial and economic inequities in downstate Illinois communities.

"It's tough to make a difference," Steward said.

But because Springfield isn't a major metropolitan community, he said local leaders have an opportunity to make major improvements in health and the quality of life if the issue can remain elevated in the public's consciousness.

Rosie Jackson, the north end resident who is single and lives in a house with her rent subsidized through the federal Section 8 program, said she doesn't like the crime she sees in her neighborhood but feels safe with her two pit bull dogs, Sexy and Ninno.

And Jackson said she feels cared for by SIU's community health workers in the Access to Care program.

"SIU is a great big help," she said.

Jackson's daughter, Charisse Jackson, 47, a manager at Springfield's Hy-Vee supermarket, said she doesn't always have time to transport her mother to medical care, and her mother doesn't drive.

Charisse Jackson said SIU's workers have been "a total blessing."

Contact Dean Olsen: [email protected], 788-1543, twitter.com/DeanOlsenSJR.

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Illinois 2019 health rankings for "health outcomes"

Counties Ranking among 102 counties

Sangamon 78

Menard 30

Cass 53

Christian 54

Logan 66

Macoupin 75

Morgan 67

Montgomery 48

Cook 52

DuPage 2

Kane 6

Lake 9

Will 12

Champaign 34

Macon 85

McLean 22

Peoria 90

St. Clair 94

Winnebago 89

Source: County Health Rankings & Roadmaps

Available online at bit.ly/countyrankings2019

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