When Dr. Marion Hautea looks out at the waiting room at Thunder Bay Community Health Service in Rogers City, he sees diabetes. He sees hypertension. He sees abscessed teeth and coronary disease.
Mostly, though, he sees jobs.
Jobs that have left Northeast Michigan, burdening the region with the highest unemployment rate in the state. Jobs that remain but pay less today than they once did. Jobs with little or no health insurance.
“A lot of patients don’t come in (until) conditions are intolerable,” Hautea said. “If you want to look at health in a community, look at the health of the economy. Look at the health of education. Here, it’s a downward drift.”
A county-by-county comparison of health by the Robert Wood Johnson Foundation reveals a five-county area where residents are poorer, older and sicker than almost any place else in Michigan. Those counties -- Presque Isle, Montmorency, Alpena, Alcona and Oscoda – also have among the lowest rates of health insurance in the state.
It’s a lethal combination in Northeast Michigan, where residents on average die younger than residents in other parts of the state.
What’s happening in this frayed edge of the Mitten illustrates the viral relationship between health of a community’s residents and the health of the community itself. In communities like Rogers City, Atlanta and Harrisville, where the unemployment rate is nearly double that of the state, the next miracle drug is likely to be a time card.
“It’s not just access to physicians,” Huatea said. “You have to look at each county as an organism.”
NE Michigan: Zone of ‘premature’ death
The five counties in the northeast tip of the Lower Peninsula are all ranked in the bottom quarter of Michigan counties in “premature death” – the number of years lost by dying before age 75. Alcona is dead last among the 82 counties ranked (Keweenaw wasn’t ranked); Oscoda is 79th and Presque Isle 78th.
All five counties are in the bottom quarter in overall health outcomes.
The figures don’t surprise Nancy Spencer, director of clinical operations for Alcona Health Centers, which operates five private, nonprofit clinics for low-income and uninsured residents of Northeast Michigan.
“We see fewer coming in for annual visits,” Spencer said. “We try to encourage preventative care; we explain that maybe they can decrease emergency room visits with preventative care, but they can’t afford it.”
This year, Gov. Rick Snyder asked the Legislature to expand Medicaid eligibility to 133 percent of the federal poverty line (which is $31,322 for a family of four) in his budget message.
But neither the House nor the Senate has approved budget bills to include Medicaid expansion. The administration had calculated that it would provide Medicaid coverage to an additional 500,000 Michigan residents and bring $181 million in federal dollars to Michigan to cover costs for the coming budget year.
A study by the Michigan League for Public Policy found that between 43 percent and 48 percent of the unemployed in the five counties at the northeastern tip of the Lower Peninsula would have health insurance -- if Medicaid was expanded. (See how many unemployed would be covered under Medicaid expansion in your county.)
Worse health is a ripple effect of the economy, Spencer said.
“Many times, they’re coming in with a chronic disease, but they’re not taking their maintenance medications,” Spencer said. “We try to encourage them to take their maintenance meds. But for them, it’s ‘What am I going to do this month? Can I get my high blood pressure pills or feed my family?’”
Four of the counties are in the top six in the state in unemployment. Presque Isle’s unemployment rate in February was 19.7 percent; Montmorency, 18.2 percent; Oscoda, 17.7 percent; Alcona, 17.3 percent. Alpena County has the healthiest job market, with 10.9 percent unemployment, which is still significantly higher than the state unemployment rate of 8.5 percent.
Oscoda has a household median income in the state, at $32,838, just two-thirds of the state median income and is second-worse in the state in health outcomes. By comparison, Leelanau County has a median household income in excess of $55,000, and is ranked tops in the state in health outcomes.
Is a bad economy killing people in Northeast Michigan?
“We’ve had plant closings, plants that had a lot of employees,” Spencer said. “Those residents had to move out of the area to find work or are out of work. A lot of businesses have changed insurance policies, and only cover catastrophic (medical expenses).
“We never turn patients away,” Spencer said. “But it’s tough.”
Curing the health problems of Northeast Michigan will require a long-term plan that goes far beyond high blood pressure medicines and subsidized dental care. It’ll take a change in education.
About one in 10 residents of Oscoda and Montmorency counties over the age of 25 have a bachelor’s degree, compared to the state average of 25 percent. Alcona, Alpena and Presque Isle have about half the percentage of college grads as the state average.
“A lot of people have frustration about it,” Hautea said. “I’m not a politician, I’m just a physician. (But) it starts with the economy (and) providing an adequate education.”
Senior Writer Ron French joined Bridge in 2011 after having won more than 40 national and state journalism awards since he joined the Detroit News in 1995. French has a long track record of uncovering emerging issues and changing the public policy debate through his work. In 2006, he foretold the coming crisis in the auto industry in a special report detailing how worker health-care costs threatened to bankrupt General Motors.