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Income disparity in Yellowstone County

The number of Montanans experiencing poverty increased by more than 11,000 people last year when compared to 2012, which translates into thousands of residents having inadequate access to health care, according to public health officials.

In 2012, some 152,199 Montanans, or 15.5 percent, lived in poverty; last year, 163,637, or 16.5 percent, people were categorized as living in poverty, according to the U.S. Census Bureau.

That means one in six Montanans lived in poverty in 2013, with poverty defined as $23,830 for a family of four in 2013, or $11,890 for an individual.

In 2013, about 48.8 million people or 15.8 percent of the U.S. population had income below the poverty level. Neither the number nor the rate for 2013 was statistically different from 2012. This is the second consecutive year without a statistically significant change in the poverty rate. In the previous four years, the poverty rate increased each year.

People with low income are three to four times more likely not to have insurance, and there is a direct correlation between those who have insurance and those who access medical care, said John Felton, president and CEO of RiverStone Health, Yellowstone County’s public health agency.

Those with low income are twice as likely to experience a delay in seeking care, which could mean disregarding a necessary procedure or treatment, foregoing medication and even ignoring routine doctor appointments, Felton said. They often work part-time jobs that don’t offer health benefits, and they can’t afford to buy private insurance.

“What we’ve seen over and over is that when people put off getting the routine kinds of care that they need, it tends to result in things getting bad,” Felton said. “Instead of having a couple of doctor visits, maybe they end up in the ER — at a much higher cost and not the ideal venue.”

Similar patterns exist when it comes to dental visits and care, Felton said.

Results of the 2014 Community Health Needs Assessment, which were released earlier this year, bear that out.

Despite a federal law requiring all citizens to have health insurance by 2014, it remains out of reach for many Yellowstone County residents because of costs. And that’s not only for the poor, but many other families as well, according to results of the Yellowstone County survey.

More than 35 percent reported having difficulty accessing health care in the past year, for reasons including long waiting lists to see specialists.

“Our data are pretty compelling,” Felton said. “When people are of lower income, it has immediate and substantial negative impacts on health — both in terms of access and in terms of health status.”

Poverty prevents Americans from buying healthful food, which is one of the biggest contributors to poor health in low-income residents. Many of the poor rely on fast food and processed foods that contribute to hypertension obesity, and diabetes instead of eating fresh fruits and vegetables.

Data in a national study also bears that out.

Yellowstone County is a less healthy place to live than it was last year, two years ago and even three years ago, according to the 2014 County Health Rankings, one of the most reputable rankings in the nation.

The county ranks 22nd healthiest of Montana’s 56 counties, down three notches from last year and eight notches from 2012 when it was ranked the 14th healthiest in the state.

A collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, the County Health Rankings allow each state to see how its counties compare on 29 factors that affect health, including smoking, high school graduation rates, unemployment, physical activity and access to healthy foods.

This year’s report also included six new measures: housing, transportation, food environment, mental health, injury-related deaths and exercise opportunities.

In Yellowstone County, the report shows:

  • 27 percent of adults are obese, compared with 24 percent for the state.
  • 32 percent of the county’s children live in single-parent households, compared with 28 percent for the state.
  • 25 percent of residents are physically inactive, compared with 23 percent for the state.
  • 13 percent of residents have “severe housing problems,” compared with 15 percent for the state.

The increased number of people living in poverty highlights the point that many people have not yet recovered from the recession, said Heather O’Loughlin, research director for the Montana Budget and Policy Center, a nonprofit research organization that focuses on tax and budget policy that affects low- and moderate-income families in Montana.

“It underscores the need for Montana to do more to help struggling families afford basics like decent housing, nutritious food, and reliable child care and transportation,” O’Loughlin said.

To make it easier for people to move from poverty to economic security, Montana should consider creating a state Earned Income Tax Credit to help working families make ends meet and invest in quality pre-K programs to support Montana’s families.

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