Big Horn County Health Trends

Stephen Asay

I had the chance to call and talk to Esther Wynne, public health nurse for Big Horn county in Southeastern Montana.  

When asked to identify some trends or patterns that affect the health of Big Horn county, the first pattern to come to mind was one of the social determinants of health: transportation.  Big Horn county is unique in that it is home to the Crow Indian reservation.  Despite having the government provide free access to healthcare on reservations like this, many health problems persist as a result of factors related to the populations status on the social gradient.  Mrs. Wynne indicated that a large part of the problem was due to the fact that there is no public transportation on the reservation and few have money for cars or fuel to get themselves to health centers for treatment. While other social determinants of health affect the community, transportation stands out as the biggest obstacle to creating better health outcomes in the community.

The second trend Mrs. Wynne identified was pertussis.  She said that this disease is especially dangerous among children under 12 years old.  The sickness is characterized by persistent coughing that can last for weeks.  In a community where healthcare is already inaccessible to many, pertussis can be frightening because it spreads easily.  This year several epidemics of pertussis around the world including one here in the United States.  While vaccines and antibiotics exist, pertussis remains a threat to already risky communities like this.

The third trend Mrs. Wynne identified was rabies.  She said that it is very common for rabid bats to bite the horses or cattle which abound in this rural setting.  Once infected, these large animals appear to be choking, which prompts ranchers to try and dislodge whatever it is that’s choking their animal themselves.  Exposure to the saliva of the animal can infect the owner.  Mrs. Wynne said that while she does not see too many cases of human cases of rabies, it is still their responsibility to warn the public and help deal with any rabies outbreaks in the county, human or otherwise.

The fourth trend Mrs. Wynne identified was chlamydia.  According to studies looking at statewide trends, Big Horn county ranks 2nd in number of chlamydia cases annually.  Mrs. Wynne indicated that they see several hundred cases per year.  This is especially startling considering the population of the entire county is around 12,000.  Other sexually transmitted disease are also problematic in the county, but chlamydia seems to be the most prominent.

Finally, the fifth factor in the health of the county is an abnormally high fertility rate.  She said that this is especially true among teenagers.  Some studies indicate that for girls 15-17 years old, the fertility rate fluctuates over time, but can reach almost three times the state and national averages.  While the on average is lower than this, the county usually maintains a considerable margin above the fertility of other counties in the state.  Many of these pregnancies are unplanned and Mrs. Wynne is a proponent of community involvement in educating teens the consequences of decisions they make and how to avoid dangerous behaviors.