Residents in the tri-county area have some of the best health outcomes in the state. And some of the worst.
The results of a nationwide, county-by-county study released Wednesday show a wide gap between neighboring counties in the Upstate of South Carolina. York County reported the third-best health outcomes in South Carolina, while its nearest neighbors ranked decidedly lower.
Lancaster County ranks 21st in health outcomes out of 46 counties across the state, while Chester County came in 34th.
Those disparities are re-created across the United States in statistics collected by the County Health Rankings and Roadmaps program of the Robert Wood Johnson Foundation. The study shows distinct splits between contiguous counties based on income, environment, social factors and lifestyle.
“We know that where you live matters,” said Attica Scott, a community coach with the County Health program. “Your ZIP code tells us more about your health than any other indicator.”
In any state, more prosperous areas see better health outcomes. The only South Carolina counties that exceeded York County’s health outcomes were coastal, suburban enclaves Beaufort and Dorchester counties.
York ranks second in terms of “quality of life” based on the length of time residents report dealing with health issues, and ranks highly in terms of healthy behavior like nonsmoking, obesity rates and physical activity.
Chester and Lancaster, on the other hand, report higher levels of obesity – 39 percent and 33 percent, respectively, versus 32 percent statewide and 29 percent in York. Only 44 percent of Chester County residents and 55 percent in Lancaster have “adequate access to locations of physical activity,” the study finds, compared to 79 percent of residents in York County.
One factor that can affect a patient’s outcomes is whether they even have access to a doctor. While York County has one primary-care physician for every 2,240 residents, and Lancaster one per 2,010, Chester County residents only have one for every 3,260.
The Chester Regional Medical Center has worked to counteract that absence by establishing “access points” in the county’s three main population centers, Chester, Great Falls and Richburg, said medical center CEO Page Vaughan.
“Some of our residents are not privileged to be able to take a car to a tricked-out operator in Charlotte,” Vaughan said. “If the question is, ‘can you get an appointment when you need one?,’ the answer is yes.”
Rural health centers often face challenges reaching people in need, he says, citing the recent closure of Bamberg County’s only hospital. State officials often don’t treat rural counties as a priority, he said.
“When the state did not expand Medicaid, that had a big impact on a lot of people,” Vaughan said. “That would have covered something like 250,000 to 300,000 people (statewide).”
Vaughan said his office and others in the county have tried to correct for patients whose “lifestyle doesn’t help with their genetics,” noting the YMCA in Chester has a $60,000 fund to pay for membership for people who otherwise couldn’t afford one.
But Scott said a community’s economic opportunity, social support networks, and the presence of clean air and water – or the lack of all those factors – can have a bigger impact on an your health.
“Individual behavior counts for a smaller percentage of the total,” she said. “It’s a challenge to be fit if you’re breathing unhealthy air. If I live in an area that has a high rate of violent crime, that can affect me regardless of what I do. You can only do so much as an individual.”
Part of her job as a community coach is to create “action plans” for areas to do what they can to improve health factors. In Louisville, Ky., where Scott is based, her team runs a program for children of incarcerated children – an at-risk group for unhealthy behavior – and has worked with other rural, Appalachian counties to create greater connectivity networks – and opportunities for physical activity – by adding sidewalks.
Vaughan sees lessons in those plans for Chester County.
“There are places here you could get all the exercise you need cheaply. You could shop at the farmer’s market and eat well,” he said. “The trick is to get people to change their behavior.”