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Report Measures Counties’ Health

Valley News Staff Writer
Published: 3/23/2018 11:59:53 PM
Modified: 3/23/2018 11:59:55 PM

West Lebanon — Communities through much of the Upper Valley continue to have problems with access to dental and mental health care and high rates of binge drinking, according to a new annual ranking of health across U.S. counties.

Public health experts and communities in both Vermont and New Hampshire use information from the County Health Rankings, which is produced annually by the Robert Wood Johnson Foundation and the University of Wisconsin, to help prioritize policies and programs to improve health in the region.

“County Health Rankings is great in terms of saying ‘we need to pay attention to that,’ ” said Greg Norman, director of community health improvement at Dartmouth-Hitchcock Medical Center.

The rankings include an evaluation of more than 30 health outcomes and health factors. Outcomes measure the length and quality of life, while health factors include social contributors to health such as childhood poverty.

This year’s findings, which were released on March 14, do not differ significantly from previous years, said Laura Cody McNaughton, district director for the Vermont Department of Health in White River Junction.

Overall, the two Upper Valley counties in New Hampshire rank at opposite ends of the spectrum, with Grafton County ranking first out of 10 for health factors and second for health outcomes and Sullivan County ranking seventh for health factors and ninth for health outcomes.

The two Vermont counties in the Upper Valley came in close to the middle of the state’s 14 counties. Orange County ranked fifth for both health outcomes and factors, while Windsor County ranked ninth for health outcomes, but fourth for health factors.

In many categories, such as the rate of childhood poverty, the Upper Valley counties rank well nationally. But they lag in other areas.

In particular, McNaughton pointed to the low number of dentists per capita as a cause for concern.

“We can feel this data,” McNaughton said. “There’s a lot of need out there.”

In Windsor County, there is one dentist for every 1,590 people, less than the number of dentists available on average in the U.S., which is one dentist per 1,480 people. In Orange County, the dearth of dentists is even more stark, with one dentist for every 3,210 people. And in Sullivan County, oral health also is a challenge, with one dentist for every 2,870 people.

The only Upper Valley county ranking better than state and national averages for the availability of dentists is Grafton County, which has one dentist for every 1,200 people.

The number of dentists doesn’t paint a full picture because some dentists do not accept all forms of insurance or they are not accepting new patients, McNaughton said. In some cases, the result is that some people are forced to travel long distances for dental care, she said.

Transportation is an issue that affects public health in many ways, said Aurora Drew, a lecturer for The Dartmouth Institute who also assists the Public Health Council of the Upper Valley and the Greater Sullivan County Regional Public Health Network. The four counties in the Upper Valley hover around the national average of 76 percent of people driving alone to work and 35 percent of people commuting long distances.

That reliance on individual adults driving in cars as a means of transportation makes it difficult for people to access health care and good jobs, Drew said.

“Transportation is a public health problem ... the public health world is having a really hard time tackling,” she said.

Workforce issues also struck Drew in a first glance of the County Health Rankings.

In addition to the shortage of dentists in Sullivan County, there also is a shortage of mental health providers, she said. In comparison with the national rate of one mental health provider per 470 people nationally, Sullivan County has one for every 560 people.

These shortages are not new, Drew said. To help improve access to care, teams across the Upper Valley are working to better integrate mental health care into primary care and to increase access to dental care through community clinics, including those in schools, she said.

Another issue in the Twin States highlighted by the County Health Rankings is the rate of excessive drinking.

Three of the four Upper Valley counties have a higher rate than the average county in the U.S. Nationally, 18 percent of adults reported binge or heavy drinking, while 21 percent of adults in Windsor County, 20 percent of adults in Orange County and 19 percent of adults in Grafton County report heavy drinking. Sullivan County came in just below the national average with 17 percent reporting such behavior.

On a related note, two out of four Upper Valley counties also have higher rates of driving deaths involving alcohol than the national average of 29 percent. Orange County had the highest rate in the region, with 38 percent of driving deaths involving alcohol. In Grafton County, 31 percent of driving deaths involved alcohol. Sullivan County came in close to the national average with 28 percent and Windsor County came in quite a bit lower with 13 percent.

New Hampshire could make changes to its alcohol pricing that might help address this concern, Drew said, noting that in the Upper Valley people often travel across the border to shop.

But she also acknowledged the likely resistance to that change.

“New Hampshire really values our cheap alcohol,” Drew said. “Our state funding is tied to our sales of cheap alcohol.”

Public health officials in both states are focusing their efforts on preventing people from starting to use alcohol at a young age. Vermont has a campaign focused on helping parents talk with their children about substance use,, McNaughton said. In addition, the health department helps communities develop policies that require stores that sell alcohol to be located away from playgrounds and schools, she said.

Both states have seen some success in reducing youth drinking rates. Norman pointed to efforts in Upper Valley schools and by community partnerships for reducing these rates.

In terms of teen drinking, the Upper Valley has gone from being “among the worst in the country to not good, but getting a little closer to where the average is,” he said.

As there is more to do to address issues highlighted by the County Health Rankings, the website,, offers ideas of how to respond in individual communities. Drew said these suggestions are helpful to her and others who work in public health, but also to the general public.

“There’s a role for everybody,” Drew said.

To help inform future public health efforts in the Upper Valley, community members are invited to participate in hospitals’ ongoing community health needs assessments. A survey can be found at

Nora Doyle-Burr can be reached at or 603-727-3213.

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