I’m going to show you three maps. The maps show the distribution of some serious health problems in the Midwest. What you will see is that rural central and northern Michigan is in trouble. In fact we look like some of the sickest parts of North America. What you will also see is that even though the maps represent different public health problems, the distribution is the same in each case. This provides evidence about what those forces causing our public health crisis might be.
I do not understand why, but Minnesota and Wisconsin, which I think of as being similar to us, fare much better. But look at big cluster of mortality centered on Kentucky and West Virginia; our heart disease death rates are like theirs.
Opioid overdoses have recently shot up in some rural areas, especially in Kentucky and West Virginia, and also in northern Michigan. Opioid use has been identified as a risk factor in the spread of HIV in rural areas. Again, Minnesota and Wisconsin seem to be spared. New York is spared also, because of policies ensuring access to drugs that aid in recovery from addiction.
These problems—chronic disease, drug abuse and suicide—are part of a cluster of health problems befalling low-income, rural communities in some parts of North America that are so severe, they are actually causing measurable increases in the overall mortality rate. For background on that look here and here.
The chart shows the heart disease death rate; the blue line is for Montcalm. For years heart disease death rates had been trending down locally just like everywhere else in North America due to reductions in smoking and improvements health care, but in the past few years the trend locally has reversed.
There are many factors that are contributing to rising mortality rates. Some of these factors, like stagnating rural economies, involve complex public policy and political issues. Other factors, like the pushing of opioids by pharmaceutical companies, are specific and narrow. But low-income, rural communities seem especially vulnerable and are being hit harder than other areas. In my next two blog posts I want to explore why they are so vulnerable.