The Robert Wood Johnson Foundation and the University of Wisconsin, two prominent health research institutions, released a recent report on the Health of New York State. This report outlined 62 counties and ranked them based on health outcomes.

This is a measure of how long people live and how well they feel. The ranking system is from 1 to 62, with 62 being the worst. The report forces us to confront

In NY District 23, Cattaraugus and Chautauqua were ranked lowest (60, 58). The highest were Yates and Tompkins (6,8). Thirty different health factors were looked at. Health factors are things such as smoking, obesity, physical inactivity, diabetes, rates of unemployment, rates of health insurance coverage, and the number of doctors for a population.

The results of this study are alarming but not surprising. The rate of premature death in the two lowest ranking counties in our district (Cattaraugus and Chautauqua) is associated with the highest percentage of smoking, obesity, physical inactivity, diabetes, and some of the highest rates of childhood poverty and severe housing problems.

It is interesting, after deep analysis of this study, that one finds the following: The ratio of patients to primary care physicians, the percentage of unemployment, and whether or not one has health insurance does not seem to influence the results. The percent unemployed across the District ranges from 4.1 to 6.2. Compare this to New York State (4.6 percent) and nationally (4.1 percent). This suggests that although employed, this group may be the working poor and/or are employed at multiple, low-wage jobs without benefits or access to care. The percent uninsured across the district is 5-8 percent, which when compared to national rates (10.6 percent) and New York State (6 percent) again suggests a more complex problem.

Perhaps being insured in our current for-profit system does not necessarily lead to a good outcome. Perhaps those “insured” have high deductibles, and so still do not have access to care.

Looking further, mortality (death) in the Black community is approximately twice that of Whites, and Hispanic populations are somewhere in between. This does track closely with the percent of children in poverty in each of these groups. Finally, it seems that the factors that drive poor outcomes are mainly socioeconomic.

These influence both behavior and choice. Vital in this equation is access to community resources, good education, and a living wage, stable job.

A community’s poor health is a reflection of four factors: poverty, inadequate housing, food insecurity, and social isolation. This study illuminates the reality that thousands across our district battle every day.

Ultimately, it is when we address the underlying conditions that lead to poor health that we can hope to see the mortality rates in our District begin to fall. When we provide good food, housing, and a stable, livable wage, with a healthy workplace, we can hope to see a change in the degree of health enjoyed by the people across our district. Medicare for all is an affordable system with no deductibles; a simplified, more efficient system of administration; and one focused on prevention rather than intervention.

This is a critical time given the fact that the recently passed tax bill puts the Affordable Care Act and Medicare at risk. Our representative in congress should prioritize health care as a top issue for the good of the district.

I am confident that this system, Medicare For All, will be an effective move in the right direction toward ensuring a healthier NY-23.

Dr. Linda Andrei is a Democratic candidate for Congress in the 23rd Congressional District.