Critical condition: Indicators show health declining in Reno County

April 30--Reno County's ongoing economic struggles are causing more than money troubles. They also affect residents' health.

That's according to recently released county-level health rankings compiled by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The study identifies challenges to physical and mental well-being for residents across the nation.

The 2018 report showed Reno County ranking worse than state averages on 20 of the 34 health outcomes measured, with the overall quality of life in the county ranking 80th overall out of 103 counties in the state. Two Kansas counties that don't keep the necessary statistics -- Stanton and Wallace -- are not included in the report.

Officials agree that many of these issues beg for a community response.

"These rankings make it clear that where you live influences how well and how long you live," said Reno County Health Department Director Nick Baldetti in releasing the statistics. "We are not surprised by these numbers, as we anticipated some movement with the economic challenges we are experiencing in our county."

This year's report marks a steady decline in overall health:

* Overall Health Outcomes: the county fell from a ranking of 64th last year to 77th overall in health outcomes. In 2010, the county was ranked 55th.

* Health Behaviors: Reno County was ranked 81st this year in both health behaviors and physical environment

* Social and Economic factors: the county slipped to 82nd in the state for these factors.

The only reason the county wasn't in the bottom 20 percent of counties in the state overall was due to a relatively high ranking -- 14th -- for local clinical care offerings. That's for the ninth largest county in the state.

Reno County did improve over last year in a couple of areas and ranked better than the state average for some outcomes as well.

"I think these issues are worth bringing to light and having conversations about," Baldetti said. "The macro-message we're trying to interlace with a lot of conversations already happening in the community about economic development and poverty is that these aren't separate issues. They're all interrelated."

"... These rankings indicate a strong call to action to address poverty issues in Reno County," Baldetti continued. "This would include employment, transportation, neighborhoods, education, access to food, and the strength of the community."

The experts, however, also offered some caveats in interpreting the data.

First, the county's rankings are based in part on what is happening elsewhere. If another county improves in some area while Reno County improves less or stays the same, that too pushes the county down in the rankings.

Also, the latest data for many categories is from 2014, 2015 and 2016, with some classes relying on multiple years of data that are even older. So, health areas that communities have made attempts to address in recent years might not show up in the numbers yet.

It is sometimes that same lag in data, Baldetti said, that may prevent a county from recognizing ramifications of decisions until years down the road.

Children in poverty

It's important when looking at the data to look at longer-term trends, said Gianfranco Pezzino, a physician and team leader for public health services systems at the Kansas Health Institute in Topeka.

"You have to look beyond annually, at five years or more," Pezzino said. "The first thing that jumps out is, looking at the trends, it doesn't look good for Reno County. It's not just this year or last, but there's a long trend that needs attention by policymakers and the community."

Besides the overall trend, some of the things that struck Pezzino in reviewing the data were some of the county's social and economic measures.

"The level of children in poverty and the number of single-family households is not what you typically see," he said.

According to 2016 U.S. Census estimates, 18 percent of Reno County children were living in poverty last year, compared to 17 percent the year before. This is higher than the state average of 14 percent.

Those figures are down, however, from the county's highs of 20 and 21 percent, in 2013 and 2014, respectively.

"That's odd in that many other counties have improved," Pezzino said. "The economy has improved, but that number is pretty high. You'd expect it to improve a little more."

Even more disturbing, he said, was the racial breakdown of those in poverty.

While the latest data indicates 18 percent of white children in Reno County are living in poverty, the same as the county average, the number of Hispanics in the category was 27 percent, and the number of blacks, a full 39 percent.

"That's pretty alarming," Pezzino said. "You probably have some problems with pockets of poverty in the county that to some extent affect the whole population across the county, but certainly seem to affect disproportionally minority populations. All these things act together as a deterrent to a healthy community."

The report for 2016 had a similar breakdown for Hispanics but did not list a poverty rate for blacks. Before 2016, there were no racial classifications listed at all.

Paying for poverty?

Jim Unruh, a facilitator with Circles of Hope, assists young families and those in poverty with stabilizing their households. He believes the answer to improving many of the issues lies in better wages.

"Everything from obesity to smoking to single-parenting is in response to something bigger. Everyone has a different story, but if you do a broad sweeping look, the same thing for all is wages in our community being lower than the communities around us," Unruh said.

"Not having stability in income triggers a whole lot of instability in health, in mental health and physical health, and in how we relate to one another," he said. "When wages are low there is more anxiety in the household, which leads to more breaks in relationships. Often moms are stuck with the leftovers of a crumbling world; they're left to deal with the children and putting all the pieces back together."

A "living wage" for a single person working in Reno County, Unruh said, is between $10 and $14 per hour. For a family of one adult with a child, that jumps to almost $24 per hour. The calculation, developed by MIT, takes into account local costs for housing, food, healthcare, childcare, transportation and taxes.

"If you don't pay upfront to address core issues, you pay on the backside," he said. "We need more school counselors because kids are acting out in school because their home life isn't stable. We need more people building correctional facilities because they act out and land in prison; there is more drug addiction because people don't feel good about themselves and are using coping skills through drugs."

Employment disparity?

"There's not a lot of employment opportunity for blacks," said Darrell Pope, president of the Hutchinson Chapter of the NAACP. "And if you're not gainfully employed, you can't get health services and the nutrition you need to stay healthy."

Pope believes there are jobs, but also significant "cronyism" by employers.

"The ones I look at are tax-supported -- city, state and county jobs -- those sort of things," he said. "I see very little diversity in jobs that have to do with government."

He's sent people he knew were qualified to apply for posted job openings at both the city and county, Pope said, and they were advised after applying that the jobs had already been filled.

"The reality is, if you're not in the circle, you'll not get the information," he said. "Another area that is deficient, if they're really serious about trying to take care of a lack of diversity, is to go outside and do some recruiting. To me, it's an excuse. I think they hire people that look like them and they feel comfortable interacting with."

Hutchinson City Manager John Deardoff challenged Pope's complaint, saying the city has actively recruited minority candidates, particularly for the police department, going as far as sending a representative to a black university to hire.

"I can only speak for our organization, but a lot of our issues are getting minority candidates to apply for jobs," Deardoff said. "We've had conversations with the NAACP about helping with recruitment and not seen a lot of results. We continue to work hard. I think there's always more we can do to increase the number of minority candidates or applicants that walk through the door."

Hutchinson sociology professor Hence Parson said he believes that a large segment of that population is working poor, and that for many blacks in Hutchinson, and across the nation, it is generational poverty.

"Some folks work 40 hours a week, every day of the week, but the income is so low they're still impoverished," he said.

Single parents

Coupled with the high rate of children in poverty, Pezzino noted, was the high percentage of children in single-parent households.

"They are often related," he said. "You are more likely to find children in poverty if there is just one parent in the household, because of the ability to produce income."

For Reno County, there were 4,667 single-parent households in 2017, or 32 percent of all households. That is up from 29 percent of households in the county in 2016, and above last year's state average of 29 percent.

"That's probably something to focus attention on," Pezzino said.

There is a wide variety of reasons for single-parent households in Hutchinson and Reno County, said Kristine Mayberry, lead family educator at Early Head Start. Those include teen parents, young unwed mothers, separated or divorced couples -- whether due to incompatibility or domestic violence -- drug abuse and families with a spouse in jail or prison.

A 2015 study by the Department of Children and Families on Kansas child and family wellbeing showed Reno County ranked 92nd in the state at that time both for its high number of single-parent households and its high ratio of divorce.

"I think a lot of parents that are here are because of a situation where the significant other, boyfriend or girlfriend, just isn't there," Mayberry said. "We do have a lot of single dads."

Staying employed

Mayberry and Unruh both acknowledge it's difficult for employers to deal with young employees who have different attitudes about work, or employees who are "not work ready."

"They jump from job to job to job because they're not recognized for their efforts or for whatever reason," she said. "Jobs are replaceable in some people's mind, and they don't push through when things get hard."

But Mayberry believes "if they (employers) have the time and money an effort to put forth, instead of firing them for doing something wrong, teach them," and it will reduce the revolving door.

Unruh believes if wages were higher, those employees would make an effort to retain their jobs.

"The question would be 'why would a person who is struggling to live give their best effort if they're not getting a living wage?" he said. "If your life is not stable you're not able to focus for eight hours a day. A lot of chaos goes on in their lives and it's hard to stay focused, or they are responding to the chaos and put things in their bodies to help cope and then they can't perform their jobs."

How to accomplish such a goal, Unruh said, "we need to have a community conversation about."

"It seems to me if we're investing resources reacting to the problems, we need to invest resources to stop the cycle from happening," he said.

Other numbers not factored directly in the county health rankings, but of interest to what is happening in the community, Baldetti said, include that 58 percent of children qualify for free or reduced lunch, and the county's median household income is $46,208, more than 15 percent below the state's $54,828.

State aid

Despite the lingering poverty rates and growing number of single-family households, state assistance to individuals and families in Reno County is in decline.

Data from the Kansas Department of Families and Children shows

* Temporary Assistance for Needy Families program and SNAP food assistance payments were down in the county more than $284,000 combined, or 3 percent, from 2016 to 2017

* The SNAP program served 230 fewer people in the county in 2017

* Payment for child care assistance grew by nearly $22,000 -- for one additional family

* LIEAP energy assistance, which helps pay heating and cooling bills, was cut by more than $101,000

* Comparing 2017 with 2014, when children in poverty were estimated at 19 percent in the county, food assistance is down more than $1.4 million, or some 1,100 recipients.

The changes are likely due to policy and legislative changes on who may qualify for assistance and for how long. The state in the interim also imposed restrictions permanently cutting off illicit drug users from the aid.

Local expenditures under the WIC (Women, Infants and Children) program are also down, both from last year and 2014.

Thirteen more clients received WIC payments in 2017, compared to 2016, but the $1.1 million spent at local stores was down more than $26,400.

Prison question

Among the 100 families in her Early Head Start program at any given time, Mayberry estimated perhaps 5 percent are single-family households due to imprisonment.

A pair of studies by the National Institute of Justice and the Ella Baker Center for Human Rights both found those left at home when a family member is incarcerated, particularly children, face significant social and economic challenges, many that carry into adulthood.

The NIJ study noted the rate of parenthood for those in prison or jail is about the same as the general population, with 50 to 75 percent reporting having a minor child.

The average daily population of prisons in Hutchinson since July -- though they draw inmates from throughout the state, and many families don't move here -- was 1,870 inmates. The Reno County jail this week housed 190 people.

For families of someone arrested, besides the challenges from the loss of a wage earner and caregiver, are the high costs of legal expenses, bond, fines, fees and restitution. Then there are costs of merely maintaining contact with an incarcerated family member, which the Baker Center study found led 34 percent of families into debt just to pay for phone calls and visits.

The study also pointed out that more than half of those entering the criminal justice system are already living at or below the poverty line, with at least 80 percent of incarcerated individuals claiming indigence.

"There's quite a stigma in this town of drugs and prison and poverty," Mayberry said. "But our community has the capacity to help change this. If you look at the past four to 10 years, we've improved in terms of what we're providing and getting out there. It's slow, but it's improving."

"It's hard for policymakers and decision-makers by way of investing," Baldetti said. "They hope to see a return on investment rather quickly. This is health work. It's longstanding work that takes a longstanding commitment toward intervention and a commitment to those in need to play out for many years to be able to measure an impact and outcome."

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