What’s killing the poor in Northwest Indiana? - May 8, 2016

Courtesy of The Times • May 8, 2016

By Giles Bruce

GARY — David Pyle admits he didn’t always lead the healthiest life.

He still smokes, used to eat poorly and was never a big sleeper. But he says he didn’t realize those behaviors could cause him to suffer a stroke in his early 50s. He slurred his speech and walked with a cane during a recent checkup at his doctor’s office in Gary.

“You never think nothing like that’s going to happen,” said Pyle, 52, a former welder who lives in Hammond. “It’s mostly how people live out here.”

A recent study that garnered national attention found the same thing. Largely because of factors such as obesity, smoking and lack of exercise, low-income residents of Lake, Porter, Newton and Jasper counties have shorter life spans (77.4 years) than poor people in any of the 100 largest “commuting zones” in the U.S., the research found. The study was published last month in the Journal of the American Medical Association.

The research, which looked at millions of anonymous earnings records and death certificates, proved what long had been known: That rich Americans live longer than their poorer counterparts.

But by showing that the life expectancy of low-income Americans differs greatly depending on where they reside, it added a new wrinkle to the debate over income inequality.

A person in the bottom quartile of household income (less than $28,000) in New York City, which ranked first in life span for the poor, will live nearly 4 1/2 years longer than a similar earner in Northwest Indiana, the study found.

“To put that into context, the CDC says if we cured cancer tomorrow, the change in life expectancy would be 3.2 years,” said Ben Scuderi, an author of the study and researcher at Harvard University.

Northwest Indiana itself is one of the most unequal areas for life expectancy in the country, the study determined. A 40-year-old Region resident in the top quartile of annual household income (more than $100,000) can anticipate living seven years longer than one in the bottom quartile. That’s the same gap in life expectancy that exists between the U.S. and Guatemala.

Risk factors different around Region

Scuderi noted that because resources and conditions aren’t the same in each of the regions the study looked at, it will require local solutions to tackle this problem.

That goes for Northwest Indiana, too, as the risk factors for premature death among the bottom quarter of earners differed by county. For instance, more than a third in Lake County are obese. Nearly a third in Newton and Porter counties smoke. The vast majority in Jasper and Newton counties don’t exercise. About a quarter enrolled in Medicare in Lake and Porter counties don’t see a primary care physician.

Of the four counties, Lake had by far the highest rates of economic and racial segregation, as well as the most income inequality and poverty.

Like many rural areas, Jasper and Newton struggle with a lack of health care providers and access to exercise opportunities such as parks and gyms.

According to research by the Robert Wood Johnson Foundation, Jasper County has one primary care physician and one mental health provider for every 2,000 residents, above the state averages of one for every 1,490 and 701 residents, respectively.

Newton has just one of each for its entire population of 14,087. Neither Jasper nor Newton counties has a full-time pediatrician, OB/GYN doctor or surgeon. Only about a third of Newton County residents and 58 percent of Jasper residents have access to exercise opportunities, the research also found.

“Here, it’s tough on everybody,” Mike Bayci, director of operations for Franciscan Health Rensselaer, said of the dearth of health care and physical activity infrastructure.

“But it’s tougher on those who are either uninsured or in poverty. They can’t leave the community to seek that care or seek that behavior. It’s magnified on those folks who don’t have the ability to leave.”

He said the main reason the former Jasper County Hospital was sold to Franciscan Alliance in September was because the health care system has a built-in physician recruitment network.

The Robert Wood Johnson Foundation also has identified another area where all four counties do poorly: a large percentage of residents who either drive alone or have long commutes to work.

“If you’re in a lower socioeconomic group in New York City, you walk a lot of places. If you’re in Porter County, you don’t do that a whole lot,” said Dr. Maria Stamp, a Valparaiso family physician and health officer for Porter County Health Department.

“If you’re in New York, you have a grocery store, businesses, places to work, frequently within walking distance. There are very few areas that are that way in Porter County. It’s kind of the way it was planned, or not planned, as it may be.”

She also mentioned another factor that could be affecting the health of the northern two counties: an economy, dominated by manufacturing and health care, that is heavily dependent on shift work.

Working at night or on rotating shifts disrupts the body’s natural circadian rhythms. Lack of sleep is a risk factor for such chronic health conditions as high blood pressure, obesity and diabetes.

Stamp noted that several of the areas with the lowest life expectancy for the poor were in the Rust Belt.

Scuderi, the Harvard researcher, pointed to another area where Northwest Indiana differed from the higher performing areas: a lack of immigrants. According to the study, nearly 30 percent of residents of New York City residents were foreign-born, compared to less than 5 percent in the Gary commuting zone.

He said people who are able to migrate to another country are generally in better health than those who can’t. The immigrants’ native diets and lifestyle behaviors also are often healthier than those of Americans.

A lot of work to do in Gary

Improving health behaviors and outcomes in Gary, the Region city with the largest number of low-income residents, would go a long way toward increasing life expectancy among the poor in Northwest Indiana.

“If you look at a community that has multiple disparities in regards to housing, schools, educations, lack of resources including grocery stores, the economy and unemployment, all of those would be a factor in how long a person is able to live in that community,” said Dr. Janet Seabrook, executive director of Community HealthNet, a safety-net clinic based in Gary.

Dr. Adolphus Anekwe, an internist with Methodist Physician Group in Gary, said the city has particularly high rates of lung disease, a likely result of being located so close to the steel mills.

“On a very clear day, come out of Gary and see how many stars you can see. If you see one, you’re lucky,” he said. “Drive 20 miles south and you can’t count the number of stars you see.”

He noted that the poor in a place like New York City live close to large academic medical centers, where researchers often study the unique medical problems of the native populations. He has always wondered why colon cancer affects so many young people in Gary, but no medical researchers have looked into the issue. If this were, say, Boston, with Harvard Medical School in town, he doesn’t believe that would be the case. People in those cities also have easy access to the high quality, specialty medical care provided at those institutions.

Dr. Roland Walker, the city’s health commissioner, said there isn’t enough emphasis on wellness and disease prevention in Gary.

“When I’m running or on a bike, I can notice the difference in our community. Sometimes the motorists don’t know how to respond to a bicyclist or runner in the road. If they don’t know how to respond, that’s something that hasn’t crossed their mind.” he said, noting he’s tried to start running groups in Gary, to no avail.

He pointed out the lack of usable, secure trails that connect to pathways in the rest of the county doesn’t help. And even if Gary residents wanted to eat better, there aren’t a lot of places to buy healthful food.

“The main problem for Gary is that Gary is a food desert,” said state Rep. Charlie Brown, a Gary Democrat and ranking member of the House Public Health Committee. “There are two, maybe three grocery stores in the city.”

Personal stories abound

Faith Myricks, a Hammond nurse, knows a lot about losing people to an early death. The father of her four children, Gary resident Darrick Myricks Sr., died in 2014 at age 54.

She said he was diabetic, and when his kidneys started to fail he refused dialysis.

“Nobody educated him about how important it was,” she said.

The 50-year-old has her own health issues, including lung damage her doctor believes may have been caused by residing so close to heavy industry all her life. All four of her children have asthma.

“A lot of the people I grew up with have passed,” she said, listing the causes: stroke, cancer, diabetes, heart attacks.

David Pyle said he’s also lost of a lot of his peers to similar diseases, as well as automobile accidents, the likelihood of which are increased in an area with so many highways.

As he sat in his doctor’s office the other day, discussing his various medications, treatments and specialists, he said he wishes he would have known earlier about the risk factors for stroke. That way, he might have eaten fewer hamburgers and more than once a day. He would have slept more. He wouldn’t have smoked.

“I didn’t know there was going to be a stroke involved in something like that,” he said, speaking out of one side of his mouth.

“We have relatives who are seniors in the area who are still living,” said his wife, Leticia, 46. “It’s how you take care of yourself.”