How to improve

Making Ulster County the healthiest county in New York State has got to be County Executive Mike Hein’s most well-publicized goal in the area of public health. But Hein, who first set the goal in 2009, has never specifically said how long it will take to achieve that worthy goal.

Ulster County Health and Mental Health Commissioner Dr. Carol Smith supports Hein’s goal. It’s the correct goal, she argues. Being number one should be Ulster County’s aspiration.

The nationwide county health rankings first published by the University of Wisconsin’s Population Health Institute four years ago is widely accepted as the standard for comparing county performance. In 2010 Ulster County ranked 33rd of New York’s 62 counties. In 2011 it dropped to 35th. In 2012 it improved to 29th, and this year its rank slid back down to 31st — the statistical middle of the state pack.

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Both at last month’s board of health meeting and at the May 21 meeting for health professionals at Ulster County Community College in Stone Ridge, Smith complained about how this year’s results were skewed by the inclusion of a new category, “drinking water safety,” in which Ulster County was ranked very poorly — probably wrongly, according to her. She also expressed concern about the survey sample size — 500 Ulster County residents had been surveyed.

The ranking system, its research supported financially by the Robert Wood Johnson Foundation, may have its methodological weaknesses, but in the field of American public health it is fast becoming the equivalent of what the Dow Jones Average is on Wall Street — that is, it’s widely followed, and it’s based on the best capsules of comparative data available.

The rankings of surrounding counties suggest the same up-and-down-within-a-narrow-range pattern as Ulster County’s. Neighboring Dutchess County was ranked 11 in health outcomes among the counties in 2010, 13 in 2011, 9 in 2012 and 9 again in 2013. Orange County ranked 21, 19, 20 and 22. Greene County was 59, 60, 52 and 55. Putnam County was ranked 1, 1, 1 and 4 among the counties, and Sullivan County a consistent 61 in all four years. Columbia County was ranked 45 in all years except 2011, when it temporarily moved up to 43.

As can be surmised from these numbers, results vary widely in the mid-Hudson region. What is more important than the rankings derived from the combination of various socio-demographic and medical variables is what they tell us about the pattern of public health care in our counties. What can be most easily improved? Where are structural changes most needed in our fragmented healthcare system? What are the relationships among the institutional players? What investments will yield the highest rate of return in terms of the improvement of overall public health?

The role of the hospitals in the rapidly changing community health systems is one of the big items the state health department is seeking to tackle this year. The county health departments are being required to prepare a four-year community health plan for submission to the state in November.

This is a tough time for people in health care who are comfortable with changing only one thing at a time. Americans are proud of having what we consider to be the best healthcare system in the world. Unfortunately it is by far the most inefficient, fragmented, disorganized and expensive healthcare system in the world as well, leading to our trailing many other nations in terms of outcomes and other results.

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