SULLIVAN COUNTY, NY — According to the latest county health rankings by the Robert Wood Johnson Foundation (RJF) report, Sullivan County remains 61st out of 62 New York counties in overall health.

“It takes many years of targeted focus and investment in a variety of community initiatives to change overall health rankings,” said Nancy McGraw, director of public health, in a statement. “These efforts, over time, will propel us in the right direction, but it will take a few years for the data to catch up with current efforts.”

A problem of place and poverty

The Robert Wood Johnson rankings (there are others) focus primarily on social and economic factors and health behaviors.

So health is seen through a complex prism. There’s economic security—or the lack of it, whether schools are well funded, whether childcare is available, whether there are jobs that pay a living wage. Is there housing? Is the county struggling with opioids?

And, of course, there’s COVID-19. “The COVID-19 pandemic both revealed and worsened barriers to health and well-being such as racism, discrimination and disinvestment,” the RWJ site notes.

Those problems aren’t easily fixed.

“The policy and practice interventions needed to improve outcomes are often outside the direct control of the local health department, mental health and social services agencies,” said Health and Human Services commissioner John Liddle. “The effectiveness of the interventions we’re putting in place are going to take three to five years to truly reveal themselves. That’s just the nature of how the data is collected. We have to be patient and persistent in our approach.”

Rankings: where they came from, why they’re hard to shake

Almost 30 years ago, J. Michael McGinnis and William Foege published a paper in the Journal of the American Medical Association on what was really killing people. Tobacco topped the list, at 400,000 deaths in 1990. That was followed by diet and activity levels, alcohol, microbial agents, toxic agents, sexual behavior (the NYC AIDS memorial cites 31,000 deaths that year from AIDS) and guns. (Illegal drug use had killed 20,000.)

“Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified,” wrote McGinnis and Foege. “Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.”

Researchers and pundits took note. Many of those causes could have been averted.

“It now is universally agreed that the health of a community depends on much more than good health care,” wrote Robert Laskowski, M.D. in the Delaware Journal of Public Health in 2018. But from 1990 to now, “the America’s Health Rankings website reveals that the relative rankings of the vast majority of individual states have varied very little over the past 25 years.”

It’s not just Sullivan County. What’s causing the health problems is “so complicated by multiple sources of potential interaction that causal links are very difficult to discern,” Laskowski wrote.

What’s the county doing?

“Fortunately, this year’s data suggests we are focusing on the right things,” Liddle said, “and the work done by Public Health and local providers indicates we’ve fared better with COVID than any other Hudson Valley or downstate county.”

He cited three reasons to be optimistic. “Our internal collaboration across government departments is getting better; government and private sector agencies in the county are much more collaborative; and we’re focusing on the priority issues that are dragging us down more than any other: access to care, substance use, community development and unhealthy behaviors like smoking and physical inactivity.”

County spokesman Dan Hust highlighted the health-related measures the county has developed over the last few years.

United Sullivan was rolled out to medical and mental health providers and human service agency partners in March 2022. Over time, the project will ensure, Hust said, that anyone requesting help from a human service agency or healthcare provider gets a referral and better customer service. That way, “anyone in Sullivan County who needs help with life’s challenges is connected to any and all agencies that can serve them.”

An intervention and prevention dashboard was created by Sullivan County to explain available services such as substance use treatment, transportation and food pantries.

Sullivan 180 produced a 2022 Community Resource Guide. Tens of thousands of these guides have been distributed throughout the county.

A request for proposals has been drafted and will soon be released to bring 24/7/365 crisis response and peer support services to those in need. This will also reduce the burden placed on fire, police and EMS personnel in our community, Hust said, by diverting calls from the 911 system to mental health and social work providers as needed.

Contracts are being finalized with Astor Children’s Services and Lexington Center for Recovery. Astor provides pediatric mental health care and Lexington focuses on substance use treatment services.

Catholic Charities is providing inpatient substance abuse services in Monticello and the Bridge Back to Life mobile treatment van brings substance-abuse treatment throughout the county, Hust said. New private sector treatment providers are in Monticello and coming soon to Liberty.

Medication assisted treatment is being offered at Garnet Health–Catskills and at the county jail. Access to Narcan has been increased and more training is being held.

The Hope Not Handcuffs pre-arrest diversionary program has begun and there are more drug drop-off sites, Hust said.

Sullivan 180 has been working in schools to add health and wellness activities. The group also provides mental health first aid and suicide prevention training.

There have been changes to public health. “In the past, [the department] was expected to carry a lot of this burden on their own while also expected to run rabies clinics, tick talks and transportation to pre-school for special needs kids, among many other tasks big and small,” Liddle said. Public health is working more now with other agencies and departments, such as a partnership with Langone Health to look into food insecurity in the county and assess the impact of COVID-19.

“While our ranking has not yet improved, our response to myriad public health issues continues to improve,” notes District 4 Legislator Nicholas Salomone, chair of the legislature’s Health & Human Services Committee. “We can’t and won’t give up on making Sullivan County a vastly healthier place.”