Cuyahoga County Health Rankings: 3 Startling Numbers Explained

In Cuyahoga County, a zip code kills.

Or at least that’s what the 2016 County Health Rankings seem to indicate. Cuyahoga ranked 64th of Ohio’s 88 counties, and the numbers indicate structural issues in the region.

A recent study by the Economic Innovation Group (EIG) found that Cleveland is the second most economically distressed city in the nation, behind only Camden, NJ which has 314,820 less residents. But it’s especially severe in the inner cities.

"Of the 585 counties we looked at (in the nation), Cuyahoga County was the 18th most unequal," said EIG Co-Founder Steve Glickman, according to Cleveland.com. "That means that Cleveland is doing a lot worse than the suburbs of Cleveland."

“What we like to say basically is ‘place matters,’” said Terry Allan, the health commissioner of the Cuyahoga County Board of Health. “It affects your health, your wealth and it'll tell us how long you'll live and it shouldn't be that way.”

Allan assisted Patch in giving some of the numbers context, and also what the Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga) plans to do about some of the inefficiencies.

Food Environment Index: 6.6 out of 10

Though not as stark as other numbers, Cuyahoga still ranks near the bottom of Ohio, which itself lags behind with a 6.9 rating.

The number measures reasonable access to healthy foods, namely proximity to grocery stores. Cuyahoga's low food index compared nationally and to the state indicates limited access to healthy foods. Instead, populations are located near cheap fast food chains and convenience stores.

Allen refers to these spots as food deserts, meaning people simply aren’t given reasonable access to healthy food options. According to HIP-Cuyahoga, about 50% of all Cleveland residents live in a food desert compared to 25% for Cuyahoga County as a whole. In the city, about 60% are people of color in these food deserts. The County Health Rankings relate obesity and premature death to food deserts.

HIP-Cuyahoga hopes to recruit store owners in the area who will meet certain standards for certification. Allen wants to improve diet at an earlier age by bringing greenhouse fruits into the school system and hopes to continue to see the proliferation of community gardens in Greater Cleveland.

“We’re trying to think about first of all, what do we do for the youngest of our children,” Allen said. “Change the trajectory of the future and tying it into the school system.”

Income Inequality: 5.6

A ratio of household income at the 80th percentile to income at the 20th percentile, Cuyahoga county is noticeably unequal in terms of wealth.

According to the study, "Income inequality within U.S. communities can have broad health impacts, including increased risk of mortality, poor health and increase cardiovascular disease risks."

Allen noted that the financial problems and unemployment in Cuyahoga County, “can serve as a social stress.” HIP-Cuyahoga believed such stress leads to high-blood pressure.

“All those compounding disadvantages cause a lot of stress,” Allen said. "If you gotta take three buses to work and you got kids in daycare and you gotta put food on the table.”

Allan also pointed to the low high school graduation number at 76%. Under Governor John Kasich, money has funneled out of traditional public schools and into charter schools, which have infamously misused funds.

A person’s level of education can illustrate their health – particularly in regards to self-worth and employment options – and Cuyahoga is further below Ohio and the nation.

“Less than a high school diploma means you're going to have poorer health,” Allen said.

Ohio itself has one of the nation’s most pronounced gaps in high-performing and low-performing test scores, according to a 2015 White House Report.

In general, HIP-Cuyahoga hopes to work with clinics in the area to help residents better control their stress. And luckily, Cuyahoga is ranked fifth in the state for its ratio of health physicians to the population; 880:1 in Cuyahoga compared to 1,040:1 nationally and 1,300:1 in Ohio.

But wealth inequality is linked to a larger problem emblematic of the county.

Segregation Index: 72

Cuyahoga County is one of Ohio’s most-racially segregated counties.The index number can be interpreted as a percentage of either black or white residents who would have to move in order to match the larger area.

Much of the health issues related to location derive from the discriminatory practice of “redlining,” according to Allen.

The Home Owners’ Loan Corporation in 1933 created residential security maps, or redlining maps. These maps were used as guides to award white investors the best neighborhoods while leaving the worst for black and immigrant families. People of color were denied home loans, so they were forced to settle in the least desirable locations of a city, where they were also denied mortgage insurance or credit. The practice ended in 1951, but as illustrated by the segregation index, its effects are still felt today.

Being located in these redlined areas – where the schools have low-graduation rates, the grocery stores are further away, the employment options are bare – helps explain the high-amount of premature deaths: 7,900 in Cuyahoga County. The Ohio number itself is high at 7,500, but seems even more stark when compared to the nation’s 5,200 number.

“If you're poor and African-American, then you're more likely to have chronic disease and less likely to make it to your first birthday,” Allan said.

According to HIP-Cuyahoga, as many as three times more African-American babies die than white babies. And depending on your zip code, you may be looking at a 20-year difference in life expectancy. HIP-Cuyahoga’s plan is to chip away at institutional racism through awareness and better community relations.

Allan recognizes the extensiveness of the problem, as it was created over many decades of discriminatory practices. “It's not something we're going to unwind overnight,” Allan said. “I do have a sense that things are beginning to change for the better… people are beginning to identify the drivers and levers for change.”