County’s poverty linked to poor health outcomes

In Clare County, the state’s third poorest county according to federal poverty line criteria, approximately 7,000 people in a county of 30,000 have difficulty affording food.

The federal poverty line is controversial as a guide to measuring true poverty, and in some cases is subject to significant variability. For instance, Isabella County technically has the most people living in poverty. That, however, is skewed by the large number of CMU students who live there.

In Clare, however, the food-related poverty is real. And, the fact that 23.5% of people have difficulty affording food is causing significant health problems, including exacerbating cases of COVID-19.

The county’s obesity rate is 37%, according to countyhealthrankings.org, a webbased database of population-based health metrics put together through a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

That is 10 percentage points higher than the best performing U.S. counties and five percentage points higher than the Michigan average. It’s also getting worse. In 2004, the first year charted on the website, Clare’s obesity rate was 24%.

A good deal of that has to do with the rural make-up of the county, said Yeonsoo Kim, director of the nutrition and dietetics program at Central Michigan University. Seventy percent of the county’s residents qualify as rural.

Rural communities often have fewer options for people to buy food, and what options they have are usually gas stations, convenience stores and small groceries, she said. Those are places that have few fresh vegetables and fruits and lots of processed foods that are high in calories, fat, sodium and sugar.

When people get hungry, she said, they want to eat. And they’ll eat what’s available.

“It’s a typical pattern for rural areas,” she said.

Compounding that is that people with less money also tend to make fewer doctor

visits, either because they can’t directly afford to or because of other barriers like transportation.

Eight percent of people in Clare are uninsured, two percentage points above 6% averages at the state level and nationally. But an even bigger deal is the ratio of people to health care providers.

In Clare, there are 3,070 people per primary care provider, triple both the state and national averages. With 3,840 per dentist, Clare again triples both state and national averages. There are also 990 people per mental health provider, more than double the state ratio of 370:1 and more than triple the national average of 290:1.

The result is a higher incidence of premature death and a lower life expectancy. Clare County’s 10,000 premature

deaths per 100,000 people is nearly double the national average of 5,500 and is higher than the Michigan average of 7,600. County residents also have a life expectancy of 75.1 years, compared to Michigan’s 78 and a national life expectancy of 81.1.

In the immediate term, it also helps explain why Clare’s 14 percent COVID-19 hospitalization rate is higher than other, more prosperous counties.

In addition to chronic health problems associated with more serious bouts of the disease, the difficult availability of fresh fruits and vegetables means people are going without foods that help boost immune systems, Kim said.

Fresh fruits and vegetables contain antioxidants and key vitamins that boost immune systems, which helps reduce the amount of time it takes to fight off an infection.