Smoking in Bars

Junior Zimmerman sits in his bar, Tom Thumb Tavern, smoking a cigarette in March 2017, before the Howard County smoking ban was implemented. Tim Bath | Kokomo Tribune

Howard County is one of the least healthy counties in Indiana, according to rankings released Tuesday that measure length and quality of life and behaviors ranging from smoking to obesity.

The Robert Wood Johnson Foundation (RWJF) and University of Wisconsin Population Health Institute unveiled their annual County Health Rankings, which “show that where you live influences how well and how long you live.”

Howard County was ranked 80th out of Indiana’s 92 counties in health outcomes, which measure how long people live and how healthy they feel. It finished 81st in health factors, based on behaviors, clinical care, social and economic factors and physical environment.

In 2018, the county was ranked 66th in health outcomes and 74th in health factors.

The rankings also highlight a sharp disparity in childhood poverty, with 56 percent of black children living in poverty in Howard County, compared to 27 percent of Hispanic children and 19 percent of white children.

Those figures changed slightly from the 2018 rankings, which found that more than 60 percent of black children in Howard County lived in poverty, compared to 19 percent of white children and 13 percent of Hispanic children.

The state average of children in poverty is 18 percent.

"The issue of racial disparity is one that the U.S. has struggled with forever, and is too big and systemic for our local United Way to be able to point to one, or even 10, reasons why it exists,” said Jeff Young, interim president and CEO of United Way serving Howard and Tipton Counties.

"What we are able to do is ensure our programs, and our community in general, approach the issue of local poverty with equity in mind. At UW we recently received training in and began implementing this approach in our internal programming."

He added: "We know that one solution will not work for every family. If we meet families exactly where they are, we are in a better position to make a real difference."

Black children were also found to have a higher chance of low birthweight in Howard County, classified as less than 5 pounds, 8 ounces.

The RWJF report found that 10 percent of black babies had a low birthweight, compared to 9 percent of Hispanic babies and 8 percent of white babies. Data was used from 2011 to 2017 to find the totals.

Additionally, the child mortality rate was more than double for black children than white children in Howard County.

The county has an overall population of 82,363 residents, with more than 6,100 black residents; roughly 2,800 Hispanic residents; and more than 2,200 residents who report two or more races, according to U.S. Census Bureau figures.  

“All communities have the potential to be places where everyone enjoys full and equal opportunity. But the data show that’s not happening in most communities yet. Children of color face a greater likelihood of growing up in poverty, and low-income families struggle to pay rent and get enough to eat,” said Sheri Johnson, acting director of County Health Rankings & Roadmaps, in a statement.

“It is time to do the difficult work of coming together to undo policies and practices that create barriers to opportunity. The Rankings can help communities ground these important conversations in data, evidence, guidance, and stories about challenges and success.”

The county, specifically black residents, also ranked significantly worse than the state average in length of life, which is measured by premature death, or years of potential life lost before age 75.

The life expectancy in Howard County was listed at 74.8 years, compared to 77.1 across Indiana. The life expectancy for black residents was 73, compared to 75 for white residents and 84 for Hispanic people.

Meanwhile, Howard County ranked 90th in health behaviors, finishing worse than the state average in smoking, physical inactivity, access to exercise opportunities, teen births and alcohol-impaired driving deaths.  

The county finished equal with the state in obesity, with 33 percent of its adult population (age 20 and older) reporting its body mass index at an obese level.

In conjunction, Indiana has the ninth highest obesity rate for youth ages 10 to 17, according to the 2018 State of Obesity Report.

Local officials have attempted to make inroads against some of these measures, most notably by installing a comprehensive smoking ban in 2017 that pro-ban organization Breathe Easy Howard County said was meant “to improve public health … improve the health of staff and patrons while also reducing health care costs.”

The ban includes bars, private clubs, playgrounds, outdoor festivals and events and more.

It expanded on Kokomo’s first smoke-free ordinance in 2006, which had exemptions for tobacco outlets, bars and taverns and fraternal organizations. Additionally, a statewide smoking ban went into effect in July 2012 that prohibited smoking in all public places, with similar exemptions, and 8 feet from an entrance.

City officials have also made infrastructure improvements they believe provide physical health opportunities, like extended bike lanes, an enhanced trail system, increased walkability and new amenities at places like Kokomo Beach.

“Your diet is important to your health, but your built environment has more of an impact,” Kokomo Mayor Greg Goodnight said in a previous interview with the Tribune. “We’ve been focusing on that built environment and making the community more pedestrian-friendly.”

In one specific example, Goodnight referenced a new splash pad opened along the Industrial Heritage Trail last fall.

“We are trying to at least make it convenient for people to be healthier,” he noted. “It’s about creating a destination so people have another reason to enjoy the trail, and hopefully parents can get their kids excited to bike a little further or walk a little further to get to the splash pad.”

Notably, Howard County was ranked 87th in social and economic factors in this year's report, falling behind the state in unemployment rate, high school graduation, some college, children in poverty, children in single-parent households, income inequality and injury deaths.

That ranking, however, is potentially slightly skewed since it includes violent crime data that Kokomo and Howard County’s law enforcement officials have said was warped by a reporting software change in 2015 that drastically upped the amount of crimes categorized as aggravated assaults.

As for unemployment rates, Howard County was ranked with the 20th highest rate in Indiana, at 4.6 percent, according to figures released earlier this month by the Indiana Department of Workforce Development.

Indiana’s overall unemployment rate was 4.1 percent.

One criticism of the RWJF’s annual reports are the large margins of error cited by the organization. The county’s obesity rate, for instance, has an error margin from 28 percent to 37 percent for the 33 percent finding cited in this year’s report.

In addition, the finding that 28 percent of Howard County adults report no leisure-time physical activity has an error margin of 24 percent to 32 percent.

"Some of these margins are very high. The measures mean very little until these processes are fully understood — particularly data that isn't 'real-time,' citing high margin of error,” noted Howard County Health Department Administrator Kent Weaver after the release of last year’s data.

Howard County did rank well in multiple categories in the RWJF report, finishing 12th in clinical care – Kokomo possesses two major hospitals, St. Vincent Kokomo and Community Howard Regional Health – and 33rd in physical environment.

The county finished one point better than the state average, at 13 percent, for residents with severe housing problems.

The data, gathered from 2011 to 2015, included a percentage of households with at least one of four housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities, according to the report.

Similarly, 11 percent of residents in Howard County were listed as having a severe housing cost burden – spending 50 percent or more of their household income on housing – compared to 12 percent across the state.

Across Indiana, notes the report, 49 percent of children living in poverty were in a household that spends more than half of its income on housing.

That situation, say experts, makes it difficult for families to afford things like healthy food, medicine or basic transportation to work and school.

Race also plays a factor, with 24 percent of black Hoosiers battling severe housing costs, compared to 10 percent for white resident households.

“Our homes are inextricably tied to our health,” said Richard Besser, RWJF president and CEO. “It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing.

“This leaves them with fewer dollars to keep their families healthy. Imagine the stress and pain that come with unplanned moves. We are all healthier and stronger together when everyone has access to safe and affordable housing, regardless of the color of their skin or how much money they make.”

George Myers can be reached at 765-454-8585, by email at or on Twitter @gmyerskt.

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