by Mary Rupert
A multi-year study of Wyandotte County health has found that there is a significant difference in the level of health care depending on where residents live.
The Community Health Council of Wyandotte County and the REACH Healthcare Foundation commissioned the study, which was conducted by the Kirwan Institute of Ohio State University. Other support came from the Wyandotte Health Foundation and Kansas Health Foundation.
For several years, Wyandotte County has ranked either at the bottom or near the bottom of counties in the state of Kansas on the Robert Wood Johnson’s annual survey of health. According to the CHC, the Kirwan study addresses the “why” of being at the bottom of the health rankings. The Kirwan study says there is probably a link between social factors such as poverty and race, and the low health rankings.
For example, the study stated life expectancy was 20 years less in some eastern Kansas City, Kan., neighborhoods, and the infant mortality rate was 11.6 infant deaths per 1,000 live births in predominantly black neighborhoods, about twice that of other neighborhoods.
Neighborhoods with limited incomes also had poor health outcomes, the Kirwan study found. These neighborhoods also had higher use of hospital emergency rooms and had more patients who had to return to the hospital after being released from it, according to the study.
‘Health outcomes don’t just happen by accident’
The Kirwan study delved into the history of Wyandotte County to discover that there were past policies that discriminated in housing in certain neighborhoods. Some neighborhoods were redlined through federal loan programs such as the Home Owners’ Loan Corp. in the Depression era, through racial criteria that was used in making the ratings for neighborhoods, according to the study. The study stated that it used documents from that era that specifically redlined neighborhoods according to race.
Loans were not approved in the redlined areas. The resulting disinvestment in certain neighborhoods then resulted in poor housing stock there, according to the study. Older housing stock posed some health risks, such as exposure to lead, and the potential for mold problems and infestations, according to the study.
Some of the older housing was located near heavy industry, and the study stated that two of the tracts close to industries had the highest cancer death rates in Wyandotte County.
Today, there are still extremely low rates of mortgage originations east of I-635, as compared to the rest of the county, according to the study.
“For me, the most important revelation is that health outcomes don’t just happen by accident, they are the product of design, whether of policy design, or design of the built environment,” Jerry Jones, executive director of the Community Health Council of Wyandotte County, said. “They don’t happen by accident. Seeing how there are certain parts of the county, especially east of I-635, where we see both inordinately high rates of heart disease and cancer, we look at the history of the neighborhood, and see that these same neighborhoods were the same ones that were redlined nearly 80 years ago.
“We believe that there is at minimum a correlation between the policies of the past and the health outcomes that we are currently seeing in Wyandotte County,” Jones said.
He said they would like to see further investigation on what are the actual causes, such as what in the built environment and policy environment can be said with certainty are the root causes of the health challenges Wyandotte County is now facing.
“Once we understand that, it will be easier for us to develop strategies to improve health in the county,” Jones said.
‘The poorer the neighborhood, the worse the health outcomes‘
The study stated while personal lifestyle choices affect about one-fourth of a person’s health outcomes, and medical clinics affect one-fifth of the total influence over health outcomes, that more than one-half of a person’s health outcome stems from factors over which they have no control, including influences in the social and built environment.
The project started in 2014. The study used data from the University of Kansas Hospital and Children’s Mercy Hospital, Jones said. It covered the years 2011 through 2013. Even though the data is a little dated, the outcomes currently in these areas appear to be consistent with the data, he said. The study also used data from the Unified Government Health Department.
The original intent of the project was to understand where the people came from who were relying on the emergency department for their primary care, he said. The data showed both children and adults from certain neighborhoods in eastern Kansas City, Kan., were using the emergency rooms more than other neighborhoods, he said. The study was an effort to find out why these neighborhoods were going to the emergency rooms, and that is when they began looking at social and economic factors.
“What we see across the board is the poorer the neighborhood, the worse the health outcomes are,” he said. “That is not exclusive to Wyandotte County. That seems to be consistent across metropolitan areas in the United States.”
In 1934, after the national housing act was signed, there were 239 communities that were surveyed for economic vitality, almost all in metropolitan areas, he said. Areas with African-Americans or immigrants tended to be rated much lower, which was a signal to Realtors and bankers not to lend money and to steer people away from the areas, he said.
Almost 80 years later, almost all of these neighborhoods in metropolitan areas are dealing with the same situations as Kansas City, Kan., he said.
“We do not see the work we’re undertaking now as being different from the work being undertaken in Flint, Mich.,” Jones said. “What we feel like we’re up against is a mindset that people of color, people who are challenged economically, people who are poor don’t deserve the same access to healthy and safe environments in the same way that others are, and we are here to contest that notion.
“We believe that by asking the tough questions, we can really begin to get the answers we need to come up with solutions,” Jones said. “Our premise is that it doesn’t matter what your skin tone is, it doesn’t matter if you are poor, it doesn’t matter if you don’t have the same level of education, we are just as entitled to live in a healthy and safe home and healthy and safe environment as anyone else. Our work in Wyandotte is to ensure that everyone has that.
“We know that’s going to take a level of courage and collaboration that is unprecedented here,” Jones said. “But we are showing that as a county through Healthy Communities Wyandotte and other collaborative efforts, we are willing to come together to improve health, and we see this as just the next step in that evolution of partnership in improving health in Wyandotte County.”
‘A series of red flags’
Because the homes in these areas in eastern Kansas City, Kan., were mostly built before 1978, it is appropriate to question how many of the homes were not tested for lead, he said. About 49 percent of the homes in Wyandotte County were built before 1978, and the Environmental Protection Agency has identified a few areas in the county they would consider “environmental justice” zones, Jones said. Many older homes had lead-based paint.
While at this time, there is no proof that there is a cause-and-effect between being located next to an industrial area and poor health, there seems to be a connection between the nearness to industries and bad health outcomes, he said.
“This report doesn’t prove there’s a causation, this report reveals there is a series of red flags and a series of questions we need to begin to ask about what might be causing these health outcomes and why are they so disparate from other parts of the county and other parts of the state,” Jones said.
The question now is how to use policy to rebuild neighborhoods, he said. The housing policies of the 1930s and 1940s, according to the study, were very racialized and used to disinvest communities, he said.
“We now see those opportunities with policy to rebuild and empower communities, especially communities of color in Wyandotte County,” Jones said.
The Kirwan study stated that the inequitable health of today did not occur overnight, and that solutions will require a long-term view, plus a commitment that is beyond elections and institutional turnover.
One of the conclusions of the study stated, “Policies have long-term, residual and sometimes unforeseen impacts. Consideration of past policy choices can inform thoughtful design of present-day solutions.”
Other questions raised by the study
Providence Medical Center at 89th and Parallel Parkway in Kansas City, Kan., did not participate in the study, probably because it was in a transition of a change of ownership at the time, Jones said. Questions may remain about whether people who live in the area surrounding that hospital also are using the emergency room for primary care purposes. Jones said he expected that Providence would participate in any future studies.
He said although that information is not contained in the study, they’re interested in the answer of whether people also are using the Providence emergency room for primary care. Also, Shawnee Mission Medical Center has estimated that a fourth of its patients are coming from Wyandotte County, Jones said, and that hospital is not covered by the study.
The report has made them think of all the questions that they haven’t asked before, Jones said.
“We feel more than anything else that this report should spur a heightened sense of curiosity about why things are the way they are, and our hope is that we begin to take a strategic approach to how we respond to the health challenges we face,” Jones said. “If we start asking better questions, we will likely get more clear answers to help us figure out where we go from here.”
Challenges of the future
There are some challenges to be faced in improving health in Wyandotte County, Jones said.
“It will take a sense of curiosity, collaboration and some political and economic courage to really begin to undo what we believe has been done to certain neighborhoods in the past 70 to 80 years through redlining and other housing policies of the past,” Jones said.
The central part of Kansas City, Kan., also could be facing the same challenges in the future as the more eastern parts of the community.
A challenge is that as communities age, insuring that people are able to live in a healthy and safe environment regardless of age or income, he said. While almost 40 percent of the people living in these areas of concern in Kansas City, Kan., are children, it is also important to assist those who are seniors or approaching advanced age. If their homes were built after 1978, they may not have a lead issue, but they could have an accessibility issue, he added.
“It’s going to take a multi-generational lens in order to ensure all of us have a healthy and safe environment to live in,” he said.
Jones said he is hopeful the CHC Community Action Board will begin to identify some solutions in response to this study. There is community interest currently in working on abating lead from the 50 percent of homes in Wyandotte County that may be affected, he said.
There may be an effort for a policy to test all homes for lead, he said. Exposure to lead could affect chemistry and brain development in children, particularly in younger children, he said. Usually lead is found in paint in older homes.
“With so many children living in the older homes, we would like to see a policy that enables every parent to have their child tested for lead,” he said. “There’s not currently any state or local program that mandates testing, and we’d like to see that changed on the local level. That would be a great start.”
“Our thought is if we can reduce the amount of exposure to lead, we’ve added to that child’s capacity to develop their brain at the normal rate, and to achieve in the same way that any other child who has not been exposed to lead can achieve,” he said.
He’s not sure whether there is also a need to test the air and the ground in the residential areas located near industries. If the community is concerned about it, he would like a commitment that everyone is living in a healthy and safe environment, and that the community would respond by testing appropriately for other contaminants.
Jones said there is also a need for access to employment opportunities, and they are interested in having conversations with employers about a multi-generational approach to training adults for new jobs coming here, and preparing school-age youth for potential employment opportunities.
The study points the community to the northeast and southeast parts of Kansas City, Kan., he said, to start asking questions.
“Our goal is to eliminate as many of the possibilities to these causes as possible so that we can begin to focus on what might actually be the root causes,” Jones said. Community leaders, health professionals, business leaders and residents should not only ask the questions, but work together to find solutions, he said.
“We’re all in it together,” he said.
Efforts being made to improve health
Jones said there is a lot of uncertainty about the future, and a concern that gains that have been made in enrolling people in Wyandotte County for health insurance could be reversed under a new administration. Right now, Wyandotte County leads the state in reducing the number of uninsured, he said.
Before the Affordable Care Act, the uninsured rate in Wyandotte County was 26 percent and it’s now down to 14 percent, he said. He’s hoping it’s not repealed, but if it is repealed and replaced, he hopes that residents here will be able to maintain their health coverage.
Also, he said there are thousands here who are not eligible for the ACA program and would benefit from expanded KanCare.
“Regardless of what happens with the Affordable Care Act, what may or may not happen with the expansion of KanCare, all of us who are working to improve health and the quality of life in Wyandotte County have a responsibility to reimagine and possibly redesign our systems to prepare for the fact that these things may change, the Affordable Care Act may be repealed, we may not see an expansion of KanCare. That does not relieve us of our social responsibility.”
It will cause more work for the local community to figure out how every resident has access to care, but changes on the federal and state level do not absolve the community of its responsibility to figure it out, with or without those policies, Jones said.
Initial reaction to study
State Rep. Louis Ruiz, D-31st Dist., at a public Unified Government Commission meeting on Thursday mentioned the study and asked what Wyandotte County is doing to improve health.
At the meeting, the Unified Government placed KanCare expansion as its top state legislative priority this year.
State Rep. Kathy Wolfe Moore, D-36th Dist., said for a moment after the November presidential election there was a stutter-step on the issue of the federal health care programs, but with the Kansas Hospital Association working on the issue and the election of more moderates in the Kansas Legislature, it’s now full speed ahead.
“It’s a critical issue for our community because the expansion of Medicaid could cut the number of uninsured in Wyandotte County in half,” Mayor Mark Holland said at the meeting.
The UG has been working on improving health in the community for several years. When the Robert Wood Johnson findings first came out ranking Wyandotte County at the bottom in the state, the UG Commission decided to funnel a half-million dollars in casino charitable contributions each year to health programs originated by local agencies and groups. That effort gets local groups and residents to initiate health programs.
The mayor mentioned that seven task forces are currently working in different health care areas, including an active infant mortality task force that is doing a case-by-case study, looking at what can be done with prenatal and postnatal care to address it. The group has received more than $8 million in grants, he said.
One grant for $2 million is being used on health care workers from the Community Health Council going door-to-door in the community to help people who have signed up with the Affordable Care Act to learn how to use their health insurance and get medical checkups, Mayor Holland said. Some of the newly insured persons have little experience with health care.
Despite all their work, much remains to be done.
“We just enrolled a third of the people who didn’t have health insurance,” Mayor Holland said at the Thursday meeting. “We’re still last in the state.”
The top two correlates for poor health in Wyandotte County are unemployment and children in poverty, he said. Affordable workplace housing is important, he said. But soon after a person in public housing gets a job, that person typically may move somewhere else, he added.
Mayor Holland said Rep. Stan Frownfelter, D-37th Dist., has been working for a few years on an abandoned housing bill that would get blighted properties into the hands of a not-for-profit agency before the properties have to be torn down. The goal is for the not-for-profit to rehab the properties into quality housing.
However, this bill was opposed in the Kansas Legislature last year by some minority legislators, who pointed out that it could be primarily minority property owners, some without the money to fix up the properties, who would lose their property under its provisions. The bill did not include provisions to compensate the property owners in the blighted area for taking the property. The bill passed last year, but was vetoed by the governor, who cited protection of the property rights, especially of those who are less advantaged.
Wyandotte County also has ramped up other efforts to address blighted housing conditions this past year, through efforts in several UG departments.
Wyandotte County has continued at the bottom of the state’s health rankings, with nearby Johnson County at the top. Mayor Holland said Wyandotte County needs data to compare itself to other urban areas in the country, and not to suburban areas, so that Wyandotte County can mark its progress. He said Wyandotte County is making progress, but it is not showing up in the health rankings because of the delay in the studies reporting the data.
“There’s a ton of work going on countywide to make this a better place to live,” Mayor Holland said.