Somerset County: A Crisis in Health
Maryland ranks as the wealthiest state in the country, yet the Eastern Shore of Maryland has some of the highest poverty rates, poorest health status, and the greatest need for health care access in the state. Somerset County, nestled between the Chesapeake Bay and the Atlantic Ocean, is the southernmost county in Maryland. It is also the poorest county in Maryland, with a per capita income of $16,748 and 23.4% of the population living below the poverty line. Somerset County residents have some of the poorest health status indicators and the greatest challenges in health care access. Somerset has a higher rate of diabetes, cancer and heart disease than the rest of the state and ranks in the bottom quartile for life expectancy, obesity, hypertension, high cholesterol, smoking, diabetes, asthma, and anxiety disorder prevalence. With a population of 26,371, Somerset County has only one hospital and is last in affordability of health care while simultaneously having the largest percentage of the population living in poverty. The county is a Medically Underserved Area (MUA), with a ratio of 1 primary care physician for every 2,452 residents, 1 dentist for every 906 residents, and 1 mental health provider for every 621 residents.
A House Near Downtown Princess Anne
The impact of rapid immigration can be particularly severe on isolated, struggling rural health systems like those of Somerset County, already strained with a shortage of providers, high rates of uninsured patients, and limited public resources. Recently arrived immigrants face many barriers to health care access in these rural communities due to lack of insurance, high cost of health services, language barriers, and immigration status. There has been a 65% increase in the immigrant population in the Eastern Shore from 2000 to 2013. Immigrants from Latin America and Haiti, who are attracted to the area’s employment opportunities in seafood, livestock, and agricultural industries, have settled in this region.
We spent time in Somerset County this summer with the local immigrant community and providers who work with these populations. The providers noted that Somerset County has an immense need for basic healthcare facilities (i.e. private and public healthcare services, hospitals, and emergency transport services) and trained healthcare professionals. According to local providers, there are few practicing doctors and they circulate between the clinics and hospitals. In addition, accessible and affordable dental care is nonexistent. One provider told us that people who needed emergency dental care had to be sent to Johns Hopkins University Hospital in Baltimore, Maryland.
Accessing healthcare is particularly difficult for immigrants living and working in Somerset County. Community-based organizations and a handful of dedicated providers and volunteers form a fragile social safety net to assist local immigrants. TLCCS, the only Federally Qualified Health Center (FQHC) and safety net clinic found in the three lower counties, provides the bulk of health services that are accessible to migrants and immigrants on a sliding scale payment, based on the patient’s ability to pay. The health department provides some immunizations; limited reproductive health care services; and cancer, hypertension, and diabetes screenings. Another well-known community-based organization assists residents in accessing supplemental food programs; emergency financial assistance for rent, utilities, and prescription medication; mental health counseling; and immigration services.