Local Nonprofits, Health Providers Address Shore’s Poor Showing in Health Rankings

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A sign encourages walking in the town of Onancock on Thursday, April 29, 2021. Photo by Carol Vaughn.

By Carol Vaughn and David Martin —
Last week’s front-page article reported that health outcomes for the Shore’s two counties are among the state’s lowest with life expectancy in Accomack at 76.8 years and in Northampton at 76.4 years, compared to the state’s overall average of 79.5 years. But the reality for Black residents of the Shore is even bleaker: five years shorter life expectancy for Black Northampton residents (versus White residents) and 3.8 years shorter life expectancy for Black Accomack residents.
Reacting to this racial reality of lower life expectancies for Black Shore residents, Minister Karen Downing, associate minister of Jerusalem Baptist Church and chapter leader with Virginia Organizing, pointed out that two forces determine life expectancy: genetics and life factors. Genetics might be cast at conception, but life factors can be changed to better people’s lives, improve health outcomes, and increase life expectancy.
Virginia Organizing is working on all those fronts. Founded in 1995 as a nonpartisan statewide grassroots organization, Virginia Organizing is “dedicated to challenging injustice by empowering people in local communities to address issues that affect the quality of their lives,” according to the group’s website.
Downing, a Shore native, became involved in Virginia Organizing in 2016 when the group formed a new chapter on the Shore. She has concentrated on access to health care (organizing for the Medicaid expansion) and fighting against injustices in the education system.
In an interview with the Post, Downing explained that foremost in those life factors that influence health outcomes and life expectancy is economics. “We live in an economic disadvantaged area and two factors that come into play are money to purchase food — and the right kind of healthy food — and money to purchase adequate health care. In households across the Shore, people face that dilemma: do I buy food or do I buy prescriptions? Do I pay for health insurance or do I keep the lights on? This dilemma is especially tough for people who make too much money to qualify for Medicaid but not enough to pay for private insurance and preventive medicine.”
Downing points out that widespread membership in a YMCA can help lower obesity rates and increase life expectancy. The good news is there’s a YMCA in Accomack County and one soon to open in Northampton County. The bad news is that economically stressed families might not be able to join, although they can apply for the Open Doors program, which sets membership rates on a sliding scale.
These economic issues affect health outcomes and life expectancies for poor people of all races, but people of color face special disparities that might help account for their lower life expectancies. Virginia Organizing has done work on how systemic racism affects the health care system and has anecdotal evidence of how White and Black patients are treated differently, for example, at emergency rooms. If two patients — one White, one Black — present with similar symptoms and both self-rate their pain as 7 on the 1 to 10 pain scale, this anecdotal evidence has shown that the Black patient will be given a lower level of care (lower dose of pain medicine) based on two racist assumptions: that African Americans can tolerate pain better than Whites and that African Americans are more susceptible to addiction of pain medication.
These kinds of biases, Downing said, have to be overcome not only in health care but in banking and jobs and other aspects of our lives if racial disparities of all kinds are to be eliminated.
Eastern Shore Healthy Communities tackles obesity
A group called Eastern Shore Healthy Communities was started in 2009, in large part in response to the Shore’s high obesity rates.
The group’s members include representatives from the Shore’s three main health care organizations — Eastern Shore Health District, Riverside, and Eastern Shore Rural Health — among other agencies and organizations.
The coalition has since shifted its focus to include consideration of how childhood and other trauma play a role as root causes leading to health outcomes like obesity. “Over the years research has shown a strong correlation between trauma and overweight,” said Patti Kiger, executive director of Eastern Shore Health Communities, in an email.
Kiger, also an instructor at Eastern Virginia Medical School, noted a 1998 study, the Adverse Childhood Experiences study, began to shed light on the role trauma plays in health.
“We now recognize that trauma happens to children and adults and that the list of traumas is significantly longer than the 10 ACES we’ve come to know through the ACES study. Poverty can be a trauma. Racism is a trauma. Trauma can be systemic and historical,” Kiger said, adding to the list communities’ recent experience of the COVID-19 pandemic.
Research shows more than 70% of people have suffered some form of trauma, which in turn shapes health, behaviors, and even longevity.
ESHC has trained more than 500 people in what it means to be trauma-informed and is offering three free virtual workshops on the topic April 28, May 13, and May 25, from 10 until 11:30 a.m.
Email kigerpg@evms.edu to reserve a place in all three and receive the URL. Participants can join one or all three. The presentations also will be posted online afterward. Go to http://www.eshealthycommunities.org/ for information.
“Over my 12 years with Eastern Shore Healthy Communities, local response to improving our local health and well-being by health, business, faith, educational, and social organizations has been significant and energizing,” Kiger said, adding, “This community is willing to look at its issues and address them.”
She noted seven communities have built health and well-being into their designs by offering walking trails to encourage residents to get out and walk — “and residents are using these trails in increasing number.”
Leading Shore organizations “have responded with great energy and involvement in resolving obesity and the transition to addressing well-being, including trauma,” she said, adding, “It is gratifying to support these individuals and organizations. We need to recognize and fully appreciate this response. We’ve moved from the bottom of the list of obese counties and that is a significant accomplishment even though we remain in the bottom quartile. The move towards well-being is a multiple-generations-long quest and we can’t take our eye off the vision.”
The annual county health rankings “gives us a means of accountability,” she said.
It is encouraging that more residents now have health insurance due to Medicaid expansion, Kiger said.
Like Downing, Kiger cites poverty as a challenge. A recent report found half of Shore residents live below a survival-level budget, even though they are employed. “They work — sometimes multiple jobs — but they can’t get ahead. We need to focus on poverty. We need to heighten our expectations for education so our children are prepared to earn a living wage, and for employers to pay higher wages. … We need our economic development leaders to envision and work towards only living wage or higher-wage jobs in our area,” Kiger said, predicting health outcomes will improve as the standard of living improves.
Eastern Shore Rural Health,
Riverside, health department
address rankings
The Eastern Shore Health District has many programs — including WIC and the Nurse Family Partnership, among others — available to the public which, directly or indirectly, help fight the obesity epidemic.  In addition, both health departments offer counseling on STD prevention and help with screening and treatment of STDs, according to Jonathan Richardson, chief operating officer.
Riverside Shore Memorial Hospital has a full-time nutritionist and diabetes educators on staff and offers Healthy U classes to the public, focused on healthy weight and nutrition.
Additionally, the hospital campus has a walking route and offers employees a discount for YMCA membership.
Matt Clay, ESRH chief executive officer, said the Shore has benefited from both Medicaid expansion and the federal health insurance marketplace.
ESRH has a team of certified application counselors who can help residents understand insurance options and complete enrollment applications.
Last year, 84% of Rural Health patients were insured with either private insurance, Medicare, or Medicaid, compared to only 76% in 2015.
Additionally, ESRH last year provided over $2 million in services on a sliding payment scale to uninsured and underinsured patients eligible for discounted rates based on income and family size.
“No one is turned away from Rural Health due to inability to pay,” Clay said.
Dental providers
Dr. Scott Wolpin, ESRH chief dental officer, commented on the report showing a positive trend in dental providers, saying:
“The Eastern Shore Rural Health System, Inc., dental program is becoming the provider of choice for many Eastern Shore residents’ oral health needs. This is in response to the recent retirement of several private dentist offices on the Shore. Just over the last 18 months, the Rural Health Dental Program has welcomed an average of 150 to 200 new patients each month and has recruited three full-time dentists plus a dental hygienist. In an effort to meet the Eastern Shore’s oral health needs, as well as continue to serve as the safety net provider for vulnerable populations in the region, Rural Health elected to keep its Franktown Community Health Center Dental office open after opening the new Eastville Community Health Center. The Franktown center medical team moved to the Eastville center one year ago. The Eastville center has eight dental treatment rooms including one for individuals with special health care needs.”
Sexually transmitted infections
Commenting on the upward trend in STIs, Dr. Tom Hollandsworth, ESRH chief medical officer, said:
“Eastern Shore Rural Health System, Inc. medical providers offer routine screening for sexually transmissible infections as part of preventive well care. Testing is offered for patients with STI symptoms. Counseling about safer practices is given and reinforced. Note, Rural Health is participating in a Sexuality Education Curriculum for teens presented by the Eastern Shore Healthy Communities Better Birth Outcomes Workgroup at The Women’s Club of Accomack County July 20 to August 5. Course details will be announced soon.”
Obesity
Hollandsworth also commented on the Shore’s obesity rate, saying:
“Body mass index is determined at each Eastern Shore Rural Health well child exam and patients who are clinically overweight or obese are counseled. Health educators at Eastern Shore Rural Health also meet with patients and families (at no charge) to help develop a program of healthier weight maintenance with improved diet and physical activity.”
Childhood poverty
Clay commented on the childhood poverty rate, saying:
ESRH “offers programs to combat the social determinants of health that many low-income Eastern Shore residents face. Social determinants of health are the economic and social conditions that influence individual and group differences in health status. Services to counter negative social determinants of health including discounted visits based on family size and income; help getting prescriptions to those who qualify; and transportation are available to Rural Health patients. Low-income children in particular benefit from Rural Health’s school-based dental program with Accomack County Public Schools — dental offices at Metompkin and Pungoteague Elementary see children ages 6 months to 18 years. Children attending these two elementary schools are pulled from class for a dentist visit after parents grant permission. Rural Health sees children primarily at four other ACPS schools through its Traveling Oral Health Prevention Program. Using portable equipment, Rural Health dentists conduct oral exams outside of Rural Health locations.”
The 2021 Northampton County rankings can be viewed at https://www.countyhealthrankings.org/app/virginia/2021/rankings/northampton/county/outcomes/overall/snapshot
The Accomack County rankings can be viewed at https://www.countyhealthrankings.org/app/virginia/2021/rankings/accomack/county/outcomes/overall/snapshot