It’s always discouraging to be ranked near the bottom on anybody’s list, but it’s all the more distressing when the ranking concerns our health.

We were disappointed, though not surprised, to find our county yet again ranked very poorly on the County Health Rankings. Douglas County ranked 31st out of 36 Oregon counties in the rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, about the same as it has for the past seven years.

Over the past five years, we’ve seen a sea of change in the way health care is provided locally. A mental health department collapsed, to be replaced by a private organization with a state contract. Now that organization has been taken over by Adapt. Public health services have been privatized, with local nonprofits taking up the work that county employees used to provide. And Oregon Health Plan patients saw the rise of an entirely new type of health care management, with the creation of coordinated care organizations like the local Umpqua Health Alliance. Companies like UHA take the state’s Medicaid money and decide how to allocate it for local OHP patients’ care.

Umpqua Health Alliance’s mission sounds impossible on its face — to improve care while decreasing costs. However, proponents of the system argue the job is doable if preventative care gets the emphasis it deserves, preventing smaller health problems from snowballing into expensive emergencies.

So with all these changes, are we getting anywhere? Is our health improving? Only time will tell.

There is some reason for optimism. Plenty of dedicated health care professionals at all the aforementioned organizations have worked to improve access to care, and show every sign they intend to continue in that mission. New clinics are opening. Immunizations are easier to access. And smoking rates are down — a testament to the good public health work that’s been done locally on this important problem.

Not all the news in the County Health Rankings is bad, either. For the quality of our clinical care we rank quite well. At 12th place, we squeak into the top third of counties statewide on that measure.

There’s also room for improvement.

Some of state Rep. Mitch Greenlick’s ideas about reforming coordinated care organizations are good, especially those around transparency. The Umpqua Health Alliance and other organizations like it are taking a lot of public money. We deserve the right to observe and provide input as they make decisions about what to do with it.

As everyone knows, we need more health care providers — more primary care doctors, more psychiatrists, more of just about everything. Our local health care companies are working hard to attract them here. We wish them luck.

Some of our issues are systemic. To put it bluntly, we’re poor, and poverty itself is part of the County Health Ranking. Our child poverty rate — 31 percent — ought to shock our conscience. So should our high school graduation rate of 64 percent. (The statewide figures, for comparison are 20 percent for child poverty and 75 percent for high school graduation.)

But perhaps the biggest factor in why our score remains low, and why we’re dying younger than other Oregonians (because that, when it comes down to it, is what the health ranking is really all about), is something we absolutely can take action on today. We’re shockingly fat — 31 percent of us being obese compared with 26 percent statewide — and 20 percent of us don’t exercise at all.

So here’s a suggestion: Now that you’ve read this editorial, put down the paper, get up off the couch and go for a walk. The rest of our articles will still be here when you get back.

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Another reason for the poor health ratings is due to the opioid epidemic. Over prescribing of oxycotin, oxycodone and other highly addictive drugs by health care providers (who are pressured by the drug companies, whose reps downplay the deleterious effects, and their 'pain management' seminars that also push the use of these drugs). It has also been shown that large VA populations and the homeless & mentally ill populations have a higher incidence rate (which we have plenty of), and a long standing drug culture in our area (with the meth problem). Physicians need to stop prescribing these highly addictive medications and/or monitor their very limited use in treating acute pain for a very short period of time (one week or less). Then they need to follow up on getting patients off the stuff, should their patients become addicted (which can happen in as little as 8-10 days). Unless these problems are addressed, we will continue down this road.

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