In a recent presentation to Montana Tech Professor Doug Cameron’s pre-professional health class, I spoke to students about health disparities that can be illustrated by geographic regions — in other words, I spoke to the class about how your zip code can be more important to your health outcomes than your genetic code.
One health outcome that can be looked at, I told the students, is length of life, which can specifically be looked at through the lens of premature death — or the years of potential life lost before age 75. The County Health Rankings, published annually by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, uses this “years of potential life lost prior to age 75” as its measure of premature death and produces applicable data as a rate.
The County Health Rankings says its premature death rate measures the number of deaths in a county over a three-year period, divided by the number of people in that county; this value is then multiplied by 100,000 to calculate the years of potential life lost under age 75 per 100,000 people. Developing such a rate helps to compare data across counties with different population sizes. “Years of potential life lost measures mortality by giving more weight to deaths at earlier ages than deaths at later ages,” says the County Health Rankings. “For example, when a person dies at 20, this death contributes 55 years of potential life lost, whereas when a person dies at age 70, this death contributes only five years of potential life lost to a county.” The data used for this measure are age-adjusted “to remove the effect of differently aged populations as a risk factor for premature death,” says the County Health Rankings. “Since we all age, aging is not preventable; and as we age, our risk of premature death increases. Counties with older populations are more likely to have higher crude premature death rates than counties with younger populations. Using an age-adjusted rate allows us to make a fair comparison of premature death rates across counties.”
With that out of the way, let’s get back to the Montana Tech students. On an overhead screen in the classroom, I went to the County Health Rankings website and selected on a map Montana and then Silver Bow County (the site is very interactive and simple to use). Once Silver Bow County was up on the screen, the students and I were able to look at how our county matches up on a variety of measures with the rest of Montana — but we honed in on length of life, specifically the premature death measure. For the 2017 rankings, Butte-Silver Bow had 8,700 years of potential life lost before age 75 compared to 7,100 years for Montana as a whole and 5,200 years for top U.S. performers in this measure — counties setting a benchmark.
The students and I were able to collectively determine that we in Butte-Silver Bow have more years of life lost prior to age 75 than the rest of Montana. In other words, our life spans as a whole are shorter. (After class, I looked on the website for the leading causes of death under age 75 in Butte-Silver Bow: cancer; heart disease; chronic lower respiratory diseases such as bronchitis, emphysema, and asthma; suicide; and accidents.)
Since students in the class were from all over the state, we went to various other counties, and here’s what we found for years of potential life lost:
• Cascade County (Great Falls): 7,200
• Yellowstone County (Billings): 7,000
• Missoula County (Missoula): 5,600
• Lewis and Clark County (Helena): 5,900
• Gallatin County (Bozeman): 4,200
• Flathead County (Kalispell): 6,700
And because one student was from Phoenix, we looked up:
• Maricopa County: 6,100
Trying to drive home my point about our zip codes being a huge factor in our health outcomes, I told the students that Native Americans throughout our country can expect to live many years fewer than other populations. On the overhead screen, I went to Roosevelt County, home to the Fort Peck Reservation; we learned the county, whose county seat is Wolf Point, had 23,400 years of potential life lost before age 75.
One student gasped.
After class, I looked up the years of potential life lost measure for counties that are home to Montana’s six other reservations:
• Big Horn (Crow Reservation): 15,100
• Blaine County (Fort Belknap Reservation): 11,500
• Glacier (Blackfeet Reservation): 14,100
• Hill County (Rocky Boy’s Reservation): 7,600
• Lake County (Flathead Reservation): 8,200
• Rosebud (Northern Cheyenne): 13,800
As I told the Montana Tech students, where you live has a lot to do with how healthy you are. Many areas in Montana, including tribal jurisdictions, have some incredibly heavy lifting to do to prompt healthier living and longer lives.
Butte-Silver Bow is right in that mix.