Region struggles with sick economy, sick families

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.)

MORE COVERAGE: Mapping NE Michigan’s insurance gap

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.

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Jeff Salisbury
Tue, 04/30/2013 - 9:57am
And you were doing so well on this piece Ron until.. "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." --- having more people in that region possess a college degree wouldn't lower anyone's blood pressure or reduce their risk of diabetes or tooth decay. Good grief.
Ron French
Tue, 04/30/2013 - 12:47pm
Oddly enough, Jeff, increased education DOES decrease risk of diabetes and tooth decay, and many other health problems. The more education you have, the more likely you are to be employed, and employed in a job that has health (and dental) insurance; A family with dental insurance is much more likely to have biannual teeth cleanings and checkups than a family for which the cost of the cleanings come out of their pockets. Higher education and higher income usually also leads to better eating habits, which can reduce the risk of diabetes; and once you have diabetes, you're much more likely to continue to take medications to control the illness if you have health insurance to pay for those medications. So, yes, education impacts health. Thanks for reading.
Tue, 04/30/2013 - 4:47pm
"increased education DOES decrease risk of diabetes and tooth decay, and many other health problems" Once again Ron you have confused correlation with causation! I know it makes for a nifty article but it's flat out wrong. You ignore other overlying factors that may explain both lack of education and lack of attention to one's health along with a host of other factors. I bet there's a correlation with time spent watching TV or a single parent with both lack of education attainment and poor health or smoking or obesity. What do you want to do with those?
Nan Higgins
Tue, 04/30/2013 - 5:01pm
You are correct Matt. Many young gals go the college route and don't return. The ones that remain are having out of wedlock children and the cycle keeps going on and on and contributes to the poverty levels. I think if you look at the numbers the population of below the poverty line is high and correlates to one parent families and the rest are retirees.
Jim Carty
Tue, 04/30/2013 - 2:39pm
Ron, Excellent piece. Any theories as to why Northeast Michigan is so disproportionately suffering in these areas compared to, say, Northwest Michigan?
Nan Higgins
Tue, 04/30/2013 - 3:47pm
I am one of those who left 10 yrs ago due to a job transfer. Many children go on to college and never return because there are so few well paying jobs. I love the region because my family lives there and I love the lakes and hopefully will be able to retire there but most jobs available are low paying and provide no health insurance or are seasonal jobs. It has been that way for years - this is nothing new to the area. So it is an ongoing problem not something that just happened. But the bigger problem is coming. Many employers have gone to the catostrophic health plans because traditional health plans have gone up 25-50%. And they are going to be going up again when Obamacare really starts to kick in. Our lawmakers are to blame for this and if anyone thinks that insurance is going to be affordable to anyone to pay out of pocket better do their homework. This health care law is a disaster!!!
Tue, 04/30/2013 - 5:28pm
Another interesting angle would be to ask why and how people stay so long in areas with such dismal economic conditions and poor future prospects? There's nothing wrong with leaving areas of low opportunity, we've been doing it for millions of years, what are we doing to these people by not encouraging it?