AHI Health Trends Report

POPULATION HEALTH
TRENDS IN THE
NORTH COUNTRY

Adirondack Health Institute is an independent, non-profit organization supporting hospitals, physician
practices, behavioral health providers, community-based organizations, patients and others in our region

to transform health care and improve population health.

CONTENTS

INTRODUCTION

2 Report Overview

Section 1:

HEALTH OUTCOMES

3 Premature Deaths
4 Decreased Rates of Premature Death
5 Increased Rates of Premature Death
6 Years of Potential Life Lost
7 Negative Trends in Mortality
8 Positive Trends in Mortality

Section 2:

SOCIAL DETERMINANTS
OF HEALTH

9 Overview
10 Demographics
11 Income
12 Education
13 Community Characteristics
14 Health Behaviors
16 Access to Health Services

Section 3:

CONCLUSION

17 Overview
20 About the Data
21 Acknowledgement

Adirondack Health Institute: Population Health Trends in the North Country • 1

INTRODUCTION

What is the health status of residents of the
North Country region* of New York State?

*North Country includes Clinton, Essex, Franklin, Hamilton, Warren and Washington counties.

How has the health of the population of the The report also looks at changes in the social
North Country, and the factors that influence determinants of health which have been shown
health outcomes, changed over the recent past? to influence a wide range of health and quality-
How do trends in health outcomes and factors that of-life risks and outcomes. Social determinants of
impact population health inform the region’s future health are the conditions in which people are born,
health status? grow, live, work and age and include such factors
as socioeconomic status, education, neighborhood
This report reviews data that have been collected and physical environment, employment, and social
and reported over time in an attempt to provide support networks, as well as access to health care. 
insight into answers to these questions.
The intent of the report is to provide a perspective
POPULATION HEALTH of the changes in health outcomes and the factors
IS DEFINED AS: that influence health in the North Country. Looking
at changes in health outcomes over time may offer
The distribution of health outcomes within a insight into policies and interventions that could
population. The health of a population is help improve the future health of the region’s
affected by a range of personal, social, residents.
economic, and environmental factors.
The report concludes with information about a
This report looks at changes in the North Country’s resource that is available to communities interested
rates of premature death and mortality due to in embarking on health improvement efforts. This
specific diseases and conditions, to get a snapshot resource includes information about policies and
of the trajectory of the region’s health. programs that specifically address some of the
factors that have contributed to the current health
status of North Country communities.

*North Country includes Clinton, Essex, Franklin, Hamilton, Warren and Washington counties.

2 • Adirondack Health Institute: Population Health Trends in the North Country

HEALTH
OUTCOMES

PREMATURE DEATHS

Premature deaths are deaths that occur before a person reaches age 75. Many of these deaths are
considered preventable. Measuring premature mortality, rather than overall mortality, focuses
attention on deaths that could have been prevented. By examining premature mortality rates
across communities and investigating the underlying causes of high rates of premature death,
resources can be targeted toward strategies that will extend years of life in communities.

The five leading causes of premature death
in the North Country have remained largely
consistent for the period from 2008 to 2015; the
five leading causes during that time period were
cancer; chronic lower respiratory disease; heart
disease; unintentional injury; and suicide.

As the table to the right illustrates, the 2015 rates
per 100,000 population for the leading causes of
premature death in the North Country are higher
(with the exception of unintentional injury) in
comparison to the rates for all of NYS.

Adirondack Health Institute: Population Health Trends in the North Country • 3

HEALTH OUTCOMES

CHANGES IN RATES
OF PREMATURE

DEATH 2008 TO 2015

From 2008 to 2015, the North
Country experienced decreased rates
of premature death due to cancer and
heart disease. During the same time
period, however, rates of premature
death due to chronic lower respiratory
disease, suicide and unintentional
injury increased in the region.

DECREASED RATES
OF PREMATURE DEATH

Cancer Heart Disease

The percentage decrease in the rate of premature The rates for premature death due to heart disease
death due to cancer in the North Country from 2008 decreased in both the North Country and NYS from
to 2015 is good news for the region. During that 2008 to 2015. However, the percentage decrease
time period, the rate decreased by 23% (compared in rates was greater for NYS (16.2%) compared to
to a 13% decrease for all of NYS). While the region’s the North Country (14.6%).
overall rate in 2015 still exceeded the NYS rate
(89.4 and 80.6, respectively), the decrease in the

rate is notable.

4 • Adirondack Health Institute: Population Health Trends in the North Country

HEALTH OUTCOMES

INCREASED RATES OF
PREMATURE DEATH

Chronic Lower Respiratory Unintentional Injury
Disease (CLRD)
Deaths due to unintentional injuries include motor
Alarmingly, the rates of premature death for CLRD vehicle crashes, drownings, accidental poisonings,
in the North Country compared to NYS are going fires, falls and aspirations. The rate of premature
in opposite directions. The rate increased by more death due to unintentional injury increased by 24%
than 29% in the North Country, while it decreased in NYS from 2008 to 2015; the rate increased by
by more than 8% for the rest of NYS. nearly 8% in the North Country during this time
period. As of 2015, the NYS and North Country
rates were equal at 23.7 per 100,000 population.

Suicide

While the rates of premature death due to suicide
increased in both NYS and the North Country from
2008 to 2015, the rate in the North Country has
dramatically increased by almost 49% during that
time period. The percentage increase in the rest
of NYS was 12%.

Adirondack Health Institute: Population Health Trends in the North Country • 5

HEALTH OUTCOMES

YEARS OF POTENTIAL
LIFE LOST

Years of potential life lost is defined as the years M O R TA L I T Y
of potential life lost due to premature deaths
(before the age of 75). Years of life lost take into Mortality data also provide a valuable measure
account the age at which deaths occur, giving for assessing community health status.  The
greater weight to deaths at a younger age and data provide a snapshot of current health
lower weight to deaths at an older age. problems and suggest persistent patterns
of risk in specific communities. Looking at
From 2006 to 2015, the years of potential life mortality data over time can also provide
lost per 100,000 population decreased by 3.2% insight into changing health risks, as well as
in the North Country; NYS experienced a greater systems of care.
decrease in this measure (6.1%). For 2015, the
years of potential life lost in the North Country
greatly exceeded the NYS value (6,464 to 5,645,
respectively).

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HEALTH OUTCOMES

NEGATIVE TRENDS IN MORTALITY

F rom 2006 to 2015, age-adjusted mortality rates per 100,000 population in the North Country worsened
for the following conditions:

DIABETES • CHRONIC LOWER RESPIRATORY DISEASE (CLRD) • SUICIDE • CIRRHOSIS

Particularly notable and worrisome is the fact that age-adjusted mortality rates for diabetes and CLRD
increased in the North Country while they decreased for the rest of the state.

Diabetes

The age-adjusted mortality rate for diabetes in the
North Country increased by 11% and decreased in
NYS by 7.7%.

Chronic Lower Respiratory Disease

The age-adjusted mortality rate for CLRD is
substantially higher in the North Country in
comparison to NYS and this disparity increased
from 2006 to 2015. In the North Country the CLRD
mortality increased by 11.2% during this time period,
while it slightly decreased (0.3%) for the rest of NYS.

Suicide

The age-adjusted mortality rate for suicide increased
for both the North Country and NYS from 2006
to 2015. The percentage change in the rates for
that time period was greater in the North Country
compared to NYS (26% to 20%, respectively), and
the rate of mortality due to suicide is significantly
higher in the North Country.

Cirrhosis

The age-adjusted mortality rate for cirrhosis
increased for both the North Country and NYS from
2006 to 2015. However, the percentage change in
rates was three times higher in the North Country
compared to NYS (46% to 15.5%, respectively).

Recent international and national studies and
observations have noted a substantial increase in
deaths due to cirrhosis. The North Country and
NYS data attest to this increase.

While more research is needed, preliminary findings
suggest that young people (ages 24 to 35) are dying
from alcohol-related cirrhosis and older people are
dying from liver cancer and non-alcoholic fatty liver
disease most likely due to the obesity epidemic.

Adirondack Health Institute: Population Health Trends in the North Country • 7

HEALTH OUTCOMES

POSITIVE TRENDS IN MORTALITY

Age-adjusted total mortality rates, as well as mortality
rates for a number of specific conditions, decreased in
both the North Country and NYS from 2006 to 2015. Some
notable decreases included:

• Infant mortality;
• Coronary heart disease;
• All cancer (2011 to 2014);
• Lung and bronchus cancer (2011 to 2014); and
• Alcohol-related motor vehicle deaths

and injuries.
The percentage decreases in mortality rates for all cancers,
lung and bronchus cancer, and alcohol-related motor vehicle
deaths and injuries were greater in the North Country in
comparison to NYS.
It should be noted, however, that even with these decreases
in mortality rates in the region, the most recently reported
mortality rates in the North Country still exceeded the
NYS rates for all the conditions noted in the table (with the
exception of the mortality rate for coronary heart disease).

PERCENTAGE DECREASE IN
AGE-ADJUSTED MORTALITY RATES
(PER 100,000 POPULATION) OVER TIME

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SOCIAL DETERMINANTS
OF HEALTH

There is increasing recognition that improving health and reducing health disparities will require broader
approaches that address social, economic, and environmental factors that influence health.
This section looks at the North Country’s experience, compared to the rest of New York State, in a number
of factors that impact population health.

Adirondack Health Institute: Population Health Trends in the North Country • 9

SOCIAL DETERMINANTS OF HEALTH

DEMOGRAPHICS

Aging Population As of 2018, the median age in the North Country
is more than four years older than the median age
From 2000 to 2016, in comparison to all of NYS, the for NYS (43.4 and 39.0 years of age, respectively).
North Country experienced a greater percentage
decrease in the population 19 years of age and Declining Population Growth
younger and a greater percentage increase in the
population 60 years of age and older (calculated Between 2010 and 2018, the population of the
as percentage of the total population). North Country decreased by almost 3%, while the
state’s total population increased by more than 2%.

10 • Adirondack Health Institute: Population Health Trends in the North Country

SOCIAL DETERMINANTS OF HEALTH

INCOME

* Children from low-income families are eligible for free or reduced-price school meals.

Increasing Poverty

Both New York State and the North Country experienced deteriorating economic conditions between 2008
and 2015 as measured by several indicators of poverty. However, as in other health-related measures, the
North Country has been challenged by larger negative changes in economic conditions in comparison to
the rest of the state.

Adirondack Health Institute: Population Health Trends in the North Country • 11

SOCIAL DETERMINANTS OF HEALTH

E D U C AT I O N

Lower Levels of Educational has traditionally and significantly lagged behind the
Attainment NYS percentage. The percentage of North Country
residents age 25 and older with a Bachelor’s degree
Studies have confirmed the level of education a did increase by 3.4% from 2008 to 2015, but that
person attains has a dramatic effect on health was lower than the 4.3% increase the rest of the
outcomes. In particular, individuals with a high state experienced.
school education or less experience significantly
poorer health outcomes compared to individuals
with a college degree.

The North Country has a strong history of young
people attaining a high school diploma. For example,
in 2015, more than 87% of North Country residents
age 25 and older had a high school diploma,
compared to 85% for the rest of the state. This
represented a 1% increase from 2008 for the region.

In contrast, the percentage of North Country
residents who have a four-year college degree

12 • Adirondack Health Institute: Population Health Trends in the North Country

SOCIAL DETERMINANTS OF HEALTH

COMMUNITY CHARACTERISTICS

Changing Family Structure Country (51 per 10,000 population age 16 to 21) is
still significantly higher than the rate for the state
The structure of families changed for both young (30), excluding New York City.
and older people in the North Country and in NYS
from 2008 to 2015. These changes provide some Housing
insight into the changing economic conditions in
the region and state. The North Country experienced positive, albeit
small, trends in two of three housing measures.
The percentage of single-parent households
increased by more than 8% in the North Country • From 2008 to 2015, the percentage of homes
during this time period; NYS experienced an overall in the region built prior to 1950 decreased by
increase of less than 1%. The percentage of single- more than 6%.
family households in the North Country in 2015
exceeded the NYS percentage (37.6% and 34.9%, • From 2006 to 2014, there was a slight
respectively). improvement (1%) in the percentage of
households considered to have severe problems
At the other end of the age spectrum, the (e.g., overcrowded, lacking kitchen or plumbing
percentage of people age 65 and older who lived facilities).
alone decreased in both NYS and the North Country
from 2008 to 2015. The decrease in the North • A measure of housing affordability, renters
Country was a modest 3% compared to the 40% who spend 30% or more of their household
decrease for NYS. In 2015, the percentage of people income on rent, increased by more than 2% in
65 and older living alone in the North Country and the North Country from 2008 to 2015. Almost
in the rest of the state were the same at 28%. 53% of North Country renters in 2015 were in
this category.
Also, during the 2008 to 2015 period, the percentage
of families living in poverty increased in the North Built Environment
Country (by 7%) and in NYS (by 14%).
The North Country experienced negative trends
Safety in two measures that indicate a community
environment that can contribute to poor population
Two measures of community safety trended in health outcomes.
opposite directions from 2013 to 2016.
• The food insecurity rate in the North Country
Reports of violent crime (e.g., murder, robbery, increased by more than 2% from 2012 to 2015;
aggravated assault, forcible rape) increased by a the NYS rate deceased by more than 10%
dramatic 66% in the North Country during this during the same time period. The absence or
time period. However, even with this increase, the lack of supermarkets and grocery stores in a
violent crime rate (per 100,000 population) in the community can contribute to food insecurity.
region in 2016 is half the rate for all of NYS (187
compared to 375, respectively). • From 2010 to 2013, the North Country
experienced a significant increase (25%) in
A positive sign is that the rate of young adults liquor store density per 100,000 population;
arrested for driving while intoxicated decreased NYS experienced a 10% increase during this
by more than 17% from 2013 to 2016. However, time period.
the arrest rate for intoxicated driving in the North

Adirondack Health Institute: Population Health Trends in the North Country • 13

SOCIAL DETERMINANTS OF HEALTH

HEALTH BEHAVIORS

Health behaviors such as tobacco use, diet and exercise, alcohol and
drug use, and sexual activity are, of course, significant contributors
to health outcomes. The three top causes of premature death in the North
Country – cancer, heart disease, and chronic lower respiratory disease
– can be prevented through engaging in healthy behaviors.

There are limited long-term longitudinal health behavior-related data
collected and reported at the state and regional level in NYS making it
difficult to determine clear trends in changing health behaviors. The
consistent collection and public reporting of such data will be essential
in helping to develop effective interventions and policies specific to
improving the region’s and state’s population health.

Despite this current limitation, some positive trends in health behaviors
can be reported for the North Country.

Adults Who Smoke Adults Who Binge Drink

Of all the regions (as designated by the NYS From 2009 to 2014 there was a 17% reduction in
Department of Health) in NYS, the North Country the percent of North Country adults who reported
had the highest percentage of adults who smoke as binge drinking (defined as when men consume
reported for 2016 (22.9%). This represents a 3.4% five or more drinks or women consume four or
decrease from 2015. This decrease is encouraging, more drinks in about two hours) compared to a 2%
but the region still uses tobacco at a very high decrease for all of NYS.
rate with continuing extremely negative health
outcomes as a result.

14 • Adirondack Health Institute: Population Health Trends in the North Country

SOCIAL DETERMINANTS OF HEALTH

HEALTH BEHAVIORS

Teen Pregnancy Chlamydia

The reduction in teen pregnancy has been a public The reduction in the teen pregnancy rate in the
health success story in NYS. From 2009 to 2014, North Country has been a great success, but the
NYS experienced a 31% decrease, and the North increase in the chlamydia rate is concerning. While
Country a 27% decrease, in the teen pregnancy still substantially below the 2015 rate for all of NYS
(503 per 100,000 population compared to 271 for
rate per 1,000 females age 15 to 19. the North Country), the rate in the region increased
by 17% from 2010 to 2015. The rate of chlamydia
decreased by 3% in NYS during this time period.

Obesity

Similar to what is happening in the nation, the
percent of adults who are obese is increasing in
NYS and the North Country.

However, obesity among North Country adults
has increased by a far larger percentage than the
increase for all NYS adults. The percentage of
adults who are obese in NYS increased by 10.4%
from 2009 to 2016 (2009 data for the percentage
of adults in the North Country are not available).
In comparison, the percentage of adults who are
obese in the North Country increased by 14% in
just the 2014 to 2016 time period.

2009 data for the North Country is not available.
Adirondack Health Institute: Population Health Trends in the North Country • 15

SOCIAL DETERMINANTS OF HEALTH

ACCESS TO HEALTH SERVICES

A s measured by increases in the number of
health care professionals, the North Country
has experienced positive trends in access to health
care services. The rates of health care providers
(primary care, mental health, dentists) have
increased in the recent past in the North Country,
as well as in NYS.
However, even with these positive trends, the rates
of each provider type per 100,000 population are
substantially lower in the North Country compared
to NYS.
There has been a very modest increase in the
primary care provider rate in both NYS and the
North Country.

From 2012 to 2016 there was a 7% increase in the
rate of dentists per 100,000 population in the North
Country and an 11% increase for all of NYS.

Both the North Country and NYS experienced
significant growth in the rates of mental health
providers from 2013 to 2017. During this time
period, the rate increased by 44% in the North
Country and by 34% in NYS.

Due to the rural and isolated nature of the North
Country, access to health care services in the
region is greatly impacted by the lack of reliable
transportation options. One measure of access,
households without a vehicle, became more
challenging in the region between 2008 and
2015. During this time period, the percentage of
households without a vehicle in the North Country
increased by almost 4%.

16 • Adirondack Health Institute: Population Health Trends in the North Country

CONCLUSION

A recent study by the Centers for Disease of potentially-preventable deaths were higher in
Control and Prevention, Leading Causes of rural areas than in urban areas.
Death in Nonmetropolitan and Metropolitan Areas
in the U.S. 1999 – 2014, documented that Americans The study further noted several demographic,
living in rural areas are more likely to die from environmental, economic, and social factors put
five leading causes (cancer, heart disease, chronic rural residents at higher risk of death. Residents
lower respiratory disease, unintentional injury, and of rural areas tend to be older and sicker than
stroke) than their urban counterparts. The report their urban counterparts. They have higher rates
concluded many deaths among rural Americans of cigarette smoking, high blood pressure, and
were potentially preventable and the percentages obesity. Rural residents report less leisure-time

Adirondack Health Institute: Population Health Trends in the North Country • 17

CONCLUSION

physical activity and lower seatbelt use than their Of particular concern are the substantially
urban counterparts. They also have higher rates of increasing rates of mortality in the region due to
poverty, less access to health care, and are less likely diabetes, chronic lower respiratory disease, suicide
to have health insurance. Long travel distances to and cirrhosis. From 2006 to 2015, mortality rates
specialty and emergency care also adds to the risks for these conditions in the North Country increased
encountered by residents of rural areas. at significantly higher percentages than in NYS.

The findings of the CDC study describe the PRIMARY CARE PROVIDER RATE 83
North Country.
82
The most recently reported North Country rates for
four of the five leading causes of premature death 63 64
in the region – cancer, heart disease, chronic lower
respiratory disease and suicide – exceed the NYS 2011 2015
rates. The rate of premature death for the fifth NORTH COUNTRY NEW YORK STATE
leading cause – unintentional injury – equals the
NYS rate. The increases in mortality rates for diabetes
and cirrhosis speak to the need to address the
Over the past decade, the North Country has rising obesity epidemic in the region. The diverging
experienced significant reductions in the rates trends in rates of mortality and premature death
of premature death due to heart disease and due to CLRD (rising in the North Country and
cancer. However, these positive trends are offset declining n NYS) highlight the toll that chronic high
by the worsening rates of premature death due
to chronic lower respiratory disease, suicide and
unintentional injury.

Similarly, the trends in mortality rates in the
North Country is a mix of good and bad news. The
region has experienced positive trends in reducing
the rate for total mortality, as well as mortality
rates for infant mortality, all cancers, lung and
bronchus cancer, and alcohol-related motor vehicle
deaths and injuries. Even with this progress, these
mortality rates for the North Country still exceed
the NYS rates.

18 • Adirondack Health Institute: Population Health Trends in the North Country

CONCLUSION

rates of adult cigarette smoking have taken in the • Increase cancer prevention and
region. The percentage of adults who smoke has early detection; 
decreased dramatically in NYS and this success has
resulted in a decline in death rates due to CLRD in • Encourage physical activity and
the state. The North Country experience has been healthy eating to reduce obesity;
the direct opposite.
• Promote smoking cessation; 
The increases in rates of death due to suicide
and unintentional injuries in the North Country • Promote motor vehicle safety; and 
mirrors the increases experienced across rural
America. These increases speak to the changing • Engage in safer prescribing of
and challenging nature of the North Country and opioids for pain. 
rural life in general. Examples include: an aging
population that is more susceptible to deaths due These suggestions, when universally applied
to falls; the disproportionate impact of the opioid throughout the region, will have a positive impact
epidemic on rural communities; and the longer on improving health outcomes. But what can be
distances required to travel to health centers that done to address the social determinants of health
can treat severe trauma. These challenges speak present in the North Country that play a large part
to the need to intensify efforts to increase access in producing the poor health outcomes noted in
to health and mental health services including the this report?
expanded use of telemedicine, the co-location of
health and behavioral health services, and attracting Declining population growth, an aging population,
more health care professionals to the region. increasing percentages of the population living
in poverty, little growth in the percentage of the
In its study of health disparities between rural population graduating from four-year colleges,
and urban areas of the U.S., the CDC offered some persistent high rates of smoking, rapidly increasing
guidance for health care workers to address the rates of adult obesity, and lower rates of health
gaps in health outcomes. The CDC suggested that care providers are major challenges confronting
rural health care providers and systems: the North Country.

• Screen patients for high blood Focusing solely on solutions to improve the delivery
pressure and make control a quality of health care services in the region will not address
improvement goal;  these challenges. Improving health outcomes and
reducing health disparities will require broader
approaches that address social, economic, and

Adirondack Health Institute: Population Health Trends in the North Country • 19

CONCLUSION

environmental factors that influence health in the decreasing the gap in health outcomes between
North Country. the North Country and the rest of New York State.

A report by County Health Rankings & Roadmaps ABOUT THE DATA IN
and the University of Wisconsin Population Health THE REPORT
Institute, What Works? Strategies to Improve Rural
Health, provides guidance on identifying and The population health measures discussed in this
implementing broader approaches to community report are limited to those with data that met the
health improvement. The report outlines key steps following conditions:
toward building healthy communities and offers
specific policies and programs that have been • Data were reported over a period
tested in rural communities. The full report can of time; and
be accessed at:
• Data were reported at the
www.countyhealthrankings.org/what-works- regional level.
strategies-improve-rural-health
Health outcome and social determinants of health
Effectively addressing the health, economic, measures with data that did not meet these
social and community environmental challenges conditions were not included in the report. The
confronting the North Country, and reviewed in time periods for the data measures vary and are
this report, requires the involvement of members noted in the report.
from a wide spectrum of community sectors who
have a stake in improving the health of communities The data trends are noted as percentage changes
in the region. Broad and meaningful community from the earliest to the latest year the data were
involvement will assist in the selection of effective reported. The North Country trends are compared
approaches that will have a greater likelihood of to the rest of New York State (inclusive of New York
ultimate success. City, unless otherwise noted).

The challenges confronting the region are daunting, The data presented in the report are from publicly-
but not insurmountable. Reductions in the total available and standard data sources including the
mortality rate since 2006 and in rates of premature New York State Department of Health’s Community
deaths due to cancer and heart disease since Health Indicator Reports and Behavioral Risk
2008 attest to the possibility of improving the Factor Surveillance System, the U.S. Census
health of the North Country’s residents. There are Bureau American Community Survey, and the
many efforts underway, involving a large number U.S. Department of Health and Human Services.
of dedicated individuals and organizations, to
improve the quality of life in the North Country. The health outcome data reported for the North
These efforts, if properly coordinated, resourced, Country region was provided by the New York
sustained, and expanded, can have a positive impact State Department of Health.
on slowing and reducing the negative trends and

20 • Adirondack Health Institute: Population Health Trends in the North Country

CONCLUSION

ACKNOWLEDGEMENT

AHI and the North Country Population Health Improvement Program thank the members of the Regional
Health Trend Report Advisory Group who reviewed and offered comments on the report. The reviewers’
insights and comments greatly improved the report’s content.

AHI AND THE
NORTH COUNTRY POPULATION
HEALTH IMPROVEMENT PROGRAM

Adirondack Health Institute is an independent, non-profit organization supporting hospitals, physician
practices, behavioral health providers, community-based organizations, patients and others in our region
to transform health care and improve population health.
The North Country Population Health Improvement Program (NC PHIP), a program of AHI, is supported
through a grant from the New York State Department of Health. The NC PHIP promotes initiatives to improve
the health of communities in Clinton, Essex, Franklin, Hamilton, Warren and Washington counties.
Many of the data measures presented in this report can be found in HealthyADK, a website of the NC PHIP.
HealthyADK is a resource to locate a diverse set of data indicators associated with community health,
explore promising practices, and access key information that describe the challenges and opportunities for
improving the health of North Country communities.

HEALTHYADK CAN BE FOUND AT:

www.healthyadk.org

Adirondack Health Institute: Population Health Trends in the North Country • 21

22 • Adirondack Health Institute: Population Health Trends in the North Country