Athens sits in a paradox of poverty and health

Athens residents, among the poorest in Georgia, are healthier than anyone would expect.

The poverty is well known. Clarke County has the seventh highest poverty rate in the state out of 159 counties. Nationally, Athens contains the fifth highest poverty rate among counties with populations higher than 100,000 people, according to recent census data.

And, experts say, that with this level of poverty comes poor health. This is the outcome for most counties in Georgia. Nearly 80 percent of Georgia’s counties with high poverty rates contain health statistics that match up just as poor.

But, a new study shows just the contrary for Athens. Clarke County ranks 14th for the best health rates in the state. They sit just above Henry County who oppose Clarke with the eighth lowest poverty rates.

An assembly of experts offered a range of explanations as to why these statistics contest one another. They include: a UGA Public Health professor, the state’s most well-known demographer, a volunteer physician, and an office manager at a health clinic for the underprivileged.

Three primary explanations from experts:

• Athens is a young town with a small percentage of the population 65 years or older, which lowers the mortality and morbidity rate.
• Athens has a large number of highly educated people who make smart health decisions.
• Athens is a social and economic hub with two regional health centers that attract commuters. There are also free health clinics that help the uninsured.

Athens is a young town.

Multiple news sources, from CNN to Kiplinger, have ranked Athens, Ga. as one of the top places in the country to retire, yet only 8 percent of the population is 65 years and above. That is lower than the rest of Georgia where an average of 11 percent are in their retirement years. In Clarke County, 74 percent of the residents are between the ages of 19 and 64 years old.

“If you have a population that is on the younger end of things,” said Dr. Monica Gaughan, UGA assistant professor in the College of Public Health, “than you are going to have lower mortality rates because older people are the ones who tend to be sicker.”

The University of Georgia plays a slight role in this statistic; however, only a small percentage of students declare Clarke County as their permanent residence so they do not effect the census results.

Almost two-thirds of UGA students come from about ten counties in the metro-Atlanta area, said Dr. Doug Bachtel, UGA professor of demographics. A significant number of these students drive back and forth from school each day or live in university dormitories.

The facts are simple. Younger people tend to be healthier people. Athens has a significant number of young to middle aged citizens who push the mortality and morbidity rate down; therefore, the overall health rate of the county is elevated.

Athens entices the highly educated. 

“Better educated populations are going to live longer and they are going to be healthier while they are living,” Gaughan said. “One of the weird things about Athens-Clarke County is that we have extremely low income levels and extremely high education levels.”

The high school graduation rates of Clarke County are at 66 percent, which is only one point lower than the rest of Georgia; however, there is an overwhelming number of of the population with a bachelors degree or higher. The University of Georgia, located in the center of Athens, obviously plays a part in this statistic. A large portion of the population consists of highly educated professors and professionals, all who contain premiere health insurance and can afford to live healthy lifestyles.

Athens has a bimodal distribution of education and poverty levels, meaning there are large populations of people resting on two extremes of the spectrum. Forty percent of the Clarke citizens have a bachelors degree or above, which is twice the percentage of rest of the state.

“If you aren’t poor in Athens you are actually very well-off,” Gaughan said. “These are the people who are going to have access to good health care. They have money to buy healthy food. Yes, poor people are going to be unhealthy people and they are going to be more likely to die, but if half of the population is extremely wealthy, which is what happens in Clarke County, than they can pull that statistic up.”

Those classified within the 34 percent who live under the poverty line are not all uneducated. Gaughan stressed the necessity to remember the people who contain a college degree, but are voluntarily poor.

“Think about all of the musicians, and the artists and the hanger-oners that are part of Athens,” Gaughan described. “You have the education which will reduce your mortality and reduce your morbidity, but it doesn’t necessarily mean that education is translating into higher income.”

Athens is a medical hub.

Athens is a lively town with shops and shows that people from all parts of the state travel to be a part of. They also commute in for medical care because of the two regional hospitals: Athens Regional Hospital and St. Mary’s Hospital.

“It’s all about the location,” Bachtel said. “There is a large number of state and federal agencies that are headquartered here. You’ve got a large number of people with Blue Cross and Blue Shield health insurance. Plus Clarke County and Athens tends to be a social, retail, service and educational hub in northeast Georgia. That’s why a lot of things cook here.”

About 20 percent of Athens’ residents contain Medicaid. Another 23 percent contain jobs but are still uninsured because they are ineligible for Medicaid and make too little to afford insurance. Most of the private physicians in town refuse to see either type of person, choosing to only care for those on the upper half of the bimodal distribution.

Those struggling in the lower half are not left completely uncared for. A multitude of free clinics are offered through Athens Health Network, an organization committed to filling in the holes of medical care within the health system of Athens. The program started from an umbrella organization through UGA called OneAthens, and then broke off in 2010 to be more focused on underprivileged healthcare.

“Its confusing because most populations have a much more normal distribution than our population,” Gaughan said. “Athens-Clarke County is comprised of extremely affluent, white retirees and professors and professionals, and extremely poor African American people who clean our toilets, and that is the ugly little secret of Athens. These clinics constitute the health safety net in town so poor people, who don’t have insurance, can use these practices to get access to the system.”

The two most popular clinics are Mercy Health Center and Athens Nurses Clinic. Both care for those who are completely uninsured, with no way of paying for health services.

One their main goals, said Dr. Paul Buczynsky of Mercy in a World Magazine article, is to get their patients involved in their own health by educating them on their illnesses. When a patient is treated for diabetes, one of the most perpetual chronic diseases seen at the clinics, he or she is required to take a six-week course that teaches the patient about the illness in order to get a prescription refill. The volunteer physicians highly enforce lifestyle changes over quick treatment so that more patients can be seen over time.

Not a perfect system.

Despite the glowing census numbers, not all experts agree on the accomplishments of Athens’ healthcare system.

Dr. Bachtel feels confident in the success of the services provided by the faith community and free clinics; however, Dr. Gaughan and those at Athens Health Network know the harsh reality.

“We do not have enough resources for the poor,” Gaughan stated. “I think it is a convenient little fiction that we tell each other when we say, ‘There’s so much charity care. Athens is just too busy to hate.’ That’s crap.”

Demand for free healthcare in Athens is rising, according to an AthensPatch article. The clinics are first-come, first-serve, and only have the resources to see a limited number of patients per day, said Mary Baxter, office manager of Mercy.

When the clinics are closed, 75 percent of the patients go to the Athens Regional ER, even though most of their health issues are not emergencies. This increases their wait time and many leave without being treated.

“The poor have pretty hard lives and don’t have a lot of access to care,” Gaughan said. “They go to the emergency rooms which is not necessarily the highest quality of care. If you have diabetes and you are having a diabetic episode than you don’t need to be in the emergency room, you need to be with a physician that has been managing your care. Very few physicians take people who don’t have health insurance, or even take people with medicaid.”

Athens-Clarke County is one of the few places in Georgia who has defied the standard of poor people with poor health rates. However, as seen nationally and locally, there is always room for improvement in the public healthcare system.

Statistics taken from: CountyRankings.org, Census.gov, GeorgiaStats.uga.edu