SULLIVAN COUNTY, NY — In the wake of the announcement of county health rankings in New York State, in which Sullivan County came in next to last, local groups and individuals related to the health sector are rallying together to improve that standing. Among them are health providers—e.g. doctors, hospitals, mental health practitioners, nurses and the like. One such key provider to the area is Catskill Regional Medical Center (CRMC), a non-profit acute-care facility that serves all 44 municipalities in the county. Its team of doctors and professionals are on hand to provide care, and its emergency room, like all such facilities, must by law take all comers.

One first step Catskill Regional is taking to create a healthier and better place for people to live is simply letting people know that they’re there. “From a primary care perspective, improving the overall health of the community is marketing and getting people engaged,” Debra Martin, the practice administrator of Catskill Regional Medical Group, said.

But in a poor, rural county, just knowing they’re there may not be enough. “Transportation is one of the biggest barriers,” Martin said. In addition, even if people can get to the doctor or hospital, they may not have a local pharmacy to receive medication.

CRMC is also focusing on two other top problem areas: preventing chronic disease and promoting healthy women, infants and children. These needs were gleaned from the outcome of a comprehensive Community Health Needs Assessment, led by Greater Hudson Valley Health System in 2015. The Greater Hudson Valley Health System (GHVHS) is a not-for-profit health system that includes member hospitals Orange Regional Medical Center (ORMC) and CRMC.

The purpose of the assessment was to gather information about local health needs and health behaviors. The assessment examined a variety of indicators including risky health behaviors (alcohol use, tobacco use) and chronic health conditions (diabetes, heart disease). CRMC contracted with Holleran, an independent research and consulting firm located in Lancaster, PA, to conduct research.

After gathering the data and listening to many representatives of the community, CRMC developed an implementation strategy to outline what community health needs it plans to address, as well as specific goals and measures to evaluate community health improvement initiatives. Based on the findings, they generated the following list of needs: prevent chronic diseases; promote healthy women, children and infants; promote mental health and prevent substance abuse; promote healthy and safe environments; and prevent HIV, STDs, vaccine-preventable diseases and healthcare associated infections.

Once the master list was compiled, Holleran facilitated discussion to identify overlapping strategies, cross-cutting issues, and the ability for regional health and human services providers to effectively address the various needs. After further dialogue and consolidation, two topics rose to the top: prevent chronic diseases; and promote healthy women, infants and children.

The Sullivan County Public Health Services, another key player in the alliance to improve health in the county, performed its own comprehensive health study (both studies can be found on the Public Health website). It will soon update the plan and engage the community in receiving feedback. Nancy McGraw, the Public Health Director, said the department looked at all available data and, similar to the CRMC effort, did a comprehensive study to identify priorities. She said the state agenda asked all counties to identify three top needs. The top concerns they have come up with are similar to those determined by CRMC: chronic disease, mental health/substance abuse and women and children’s health.

McGraw and the department also looked at the gaps in access to health care, which is present especially among low-income and rural groups. “There are segments of the population that have challenges with to health care,” McGraw said. “But it is getting better.” She specifically mentions that the hospitals are expanding primary care, and Crystal Run Health Care, which has Sullivan County locations in Liberty and Rock Hill as well as numerous Orange County locations, has expanded its range of specialists. But, like CRMC, McGraw notes that transportation remains a problem.

Barriers to access are not only physical; they are financial. McGraw and her group are looking at this part of the problem as well. She pointed out that more people now have health insurance thanks to the Affordable Care Act, and that it made being self-insured more affordable. However, there are still parts of the county that have problems, she said. There are pockets of the county, amounting to 13 to 16% of the population, that do not have insurance, and many are migrant workers or undocumented immigrants.

“They don’t engage in preventative care,” McGraw said. “They wait until an emergency.”