County effort focuses on environmental health

Affordable housing is a major issue for Havre resident Leslie Sherman and her three children. The family lives in an government-subsized apartment complex, but would like to move into a house.

"That's my dream," Sherman said, adding that she has been on a waiting list for Section 8 housing since January of last year. She is now 32nd on the list, meaning a house may not become available for another four to six months, Sherman said.

Although her ultimate goal is to live in a house, Sherman said she has benefited from another government program that allows her to rent a four-bedroom apartment based on her income. Sherman moved her family here from Browning in January 2003.

"It if wasn't for that, I would be in big trouble right now," said Sherman, who is a Head Start teacher in Rocky Boy. "I wouldn't be able to afford some things."

Affordable housing was one of a number of concerns identified when nearly 300 Hill County residents responded to surveys about environmental health earlier this year. Among the tops concerns were drinking water, tobacco use, and infrastructure like roads and bridges.

The group that collected the surveys plans to host two public meetings about environmental health this week, one specifically to address water issues.

Results were compiled by the Hill County Community Environmental Health Assessment Committee from responses to three surveys. One was distributed to people at a local health fair, one was mailed to property owners and another was hand-delivered to business owners.

The environmental health committee is one of five groups in the Hill County Health Consortium, a collaborative effort by the Hill County Health Department, community members and health care providers to assess health needs within the county. The other four groups within the consortium are: primary care; dental, vision and hearing health; behavioral health; and children's health.

As part of its responsibilities, the environmental health committee has analyzed information rom the three surveys, said Dr. Carley Robertson, the committee's facilitator.

"They're consistent in that water came back the top concern for all of them," Robertson said.

The survey distributed at the health fair had 192 respondents. It included questions about a broad variety of health issues. A section called "Environmental Health" asked participants to rate environmental health issues on a scale of 0 - "terrible" - to 5 - "perfect."

The issues listed were: water; air; soil; safety; social services; streets, roads and bridges; sanitation and sewage services; and emergency services. It also included a space for respondents to write comments or list issues that were not included in the survey.

More than half of the respondents said water was "OK," while 30 percent gave it a less than favorable rating, with nearly 10 percent calling it "terrible." Only three survey participants out of 176 who answered the question gave water a "perfect" rating, and 39 respondents gave it a 4.

Streets, bridges and roads were also rated poorly, with a full third of the respondents rating their condition between 0 and 2.

The other subjects fared better, with the vast majority of the respondents rating them "OK."

The write-in section of the survey yielded both negative and positive comments about environmental health in Hill County.

"County roads are maintained quite poorly. I have had company that have hit so many washboards in the road they had car parts fall off - and they drive slow," one respondent wrote.

"We need to have more health care that excepts (sic) Medicaid-disabled and elderly persons," said another.

Other people cited concerns about drug use, soil and water contamination, and secondhand smoke.

Positive feedback included statements like, "We are lucky to live in such a nice community," and "We have good medical facilities in Havre."

In a section of the survey that addressed primary health care, at least several respondents cited concerns about the availability of medical services in Hill County.

Providers need "to expand services to 'at risk' low income/middle income folks," wrote one.

Other participants said they perceive a need for cancer specialists and for dental services for Medicare and Medicaid patients.

A different survey asking questions about environmental health issues was distributed to 100 local businesses. About 50 were returned.

The survey listed 25 environmental health issues and asked respondents to rate their importance on a scale of 1 to 5, with a 1 meaning the respondent "strongly agrees" the item is an important environmental issue, and a 5 meaning the respondent "strongly disagrees." The survey also asked participants to list environmental health concerns that were not listed in the 25 items, including those at home and in the workplace that may be contributing to the illness of a family member.

Of the 25 issues listed, West Nile virus, alcohol use, teen suicide, heat and shelter during winter months, water pollution, and teen pregnancy were the most commonly cited concerns.

Write-in comments expressed concern about health care for the indigent and unemployed, high utility bills, "outrageous water deposits," smoking and affordable housing for seniors.

In the space asking about conditions at home that contributed to family illnesses, respondents cited smoking, tap water, West Nile virus and mold as their primary concerns. Participants cited stress, welding smoke, mold and hantavirus as conditions in the workplace that may be contributing to the illness of a family member.

A third survey, also focusing on environmental health, was mailed to 100 property owners in Hill County, with 49 owners responding.

The survey listed 27 environmental health issues - very similar to the 25 from other survey - and asked participants to place an "X" next to those they believe should be considered a priority. The survey provided a space to identify issues not included on the list. It also asked respondents to identify issues at home and in the workplace that might be contributing to health problems.

Of the 27 items, those most frequently checked by respondents were: drinking water, cited by 78 percent of the respondents; tobacco use, 37 percent; and abandoned buildings, 31 percent. The fourth-most common response - at 27 percent - was a four-way tie among soil contamination, food safety, surface water quality and violence.

The write-in comments included drug and alcohol use, sexually transmitted diseases, and road maintenance.

Twenty percent of respondents said they believe environmental health problems in their neighborhoods may be contributing to family illnesses. When asked to identify those conditions, the most common responses were smoking and water quality.

Twenty percent also said they believe their home is environmentally unsafe, citing family members' tobacco use, dust, Zonolite insulation, poor maintenance and neighborhood violence.

"(I live in) Section 8 housing and (it) is falling apart," one wrote.

The "quality of living for underprivileged families" is a problem, wrote someone else.

Eight percent of respondents said working conditions are affecting the health of someone in their family, and cited lead exposure, poor air circulation and pesticide use.

While the surveys help identify residents' priorities about environmental health issues, Robertson cautioned that there is more work to be done. The environmental health committee plans to conduct a more comprehensive survey later this month.

The survey will be conducted by phone and should last about 10 minutes. The committee plans to poll at least 370 county residents.

"That puts us in the range of saying, 'This is a statistically significant survey,'" she said.

A draft copy of the survey contains questions about air and water quality, lead pollution, food safety, drug use and meth labs, affordable housing, infrastructure, and teen pregnancy, among other things. It also asks participants about the presence of certain diseases in their households, including asthma and diabetes.

The environmental health committee held a meeting March 17 attended by local health experts and community leaders. Robertson asked people to prioritize how they would address environmental health issues using a hypothetical $300 million grant.

The five priorities, in order, were: ensuring water quality and quantity, increasing low-income and senior housing, improving access to health care and health insurance, building a garbage processing plant, and establishing a better preventative health care system.

One of the issues discussed at the meeting was that health priorities will be different for different groups of people.

"If you went and asked a single mother on the north side whether she'd rather have better water or health insurance for her five kids, I guarantee you she'd say health insurance," said Havre Mayor Bob Rice.

Surveys and public meetings are helpful, but are not enough to assess a community's environmental health, Robertson said during an interview last week. A thorough assessment of the community's health needs will require research.

For instance, one common perception is that the Hi-Line has abnormally high cancer rates, and water contamination is often blamed, Robertson said. However, she added, no tests or concrete data have shown that to be true.

It is also important to look at environmental health issues in a social context, she said.

The three leading causes of death in Hill County are cardiovascular disease, cancer and cerebrovascular disease, Robertson said. Dr. Petrov Latkovich, a pathologist at Northern Montana Hospital, is compiling information about cancer rates across the Hi-Line, she added.

The environmental health committee plans to host a public meeting about cancer, likely in July to coincide with the local Relay for Life efforts.