County health rankings data can spur improvement
Rural Juneau County, Wis. received a wake-up call in 2006 when it was ranked least healthy of the state’s 72 counties. But rather than bemoan the dubious distinction, County Health Director Barb Theis decided to use the ranking “to identify our areas of weakness and to move forward.”
The Robert Wood Johnson Foundation (RWJF) adopted Wisconsin’s methodology, and for the first time, has issued a ranking of the health of all U.S. counties (see Research News, page 8). The rankings, developed with the University of Wisconsin’s Population Health Institute, were released Feb. 17 (www.countyhealthrankings.org).
Ranking factors included access to primary care providers, rates of violent crime, air pollution levels, liquor store density, unemployment rates and number of children living in poverty.
“We were the unhealthiest county in the state,” Theis recalls. “But we turned it around, we challenged ourselves. We’re now moving forward and we have committed stakeholders that are working together to make our county one of the healthiest. And none of this would have happened without that county health ranking report.”
After the low rankings in 2006, Theis’ department began to focus on some of the county’s poor health indicators — among them, nearly 30 percent of pregnant women in the county smoked cigarettes, which can lead to low-birth-weight babies. In addition, nearly 40 percent of county residents said they had not visited a dentist in the past year.
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Photo by Charles Taylor
Donald Shell, M.D. (center). Prince George's County, Md. health officer, participates on a County Health Rankings panel with David Williams, Ph.D., HArvard School of Public Health, and Judith Monroe, M.D., Indiana's state health commissioner.
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To address the latter, Theis consulted with a neighboring county that had a better track record on oral health and found that it has a safety net dental clinic. She worked with partners in Juneau County to establish a similar clinic in her county, one that accepts Medicaid and treats patients on a sliding income scale.
In 2010, the county ranks 52nd out of the state’s 72 counties.
Prince George’s County, Md. Health Officer Donald Shell, M.D. was among the panelists who discussed the health rankings at the Washington event. His county, too, ranked low in his state in health outcomes — 17th out of 24.
Risa Lavizzo-Mourey, president and CEO of RWJF, cited a recent news report that highlighted a two-block strip in Prince George’s County that has 11 fast-food restaurants.
Health advocates and state lawmakers in the county, a suburb of Washington, are proposing state legislation to place a moratorium on new fast-food restaurants in areas of the county with a “high index of health disparities,” such as high rates of obesity and diabetes. “We’re saying where there is health data that suggests that there should be interventions that we should put a stop to permits,” State Sen. David C. Harrington told The Washington Post.
Dr. Shell said the health rankings can help county leaders to prioritize scarce resources in a time of economic stress.
“If we ask our elected officials to put money in their line-item budgets for things that are going to really have an action or impact on the health of our residents, county health rankings such as these allow us to focus in and zero in — not to talk about what we think, but to talk about what we know,” Dr. Shell said.
“And in talking about what we know, it allows us to be much more focused on what things work based on what the data says, not what we’ve [always] done….”
Robert Pestronk is executive director of the National Association of County and City Health Officials (NACCHO). He said the rankings can be a “call to action.”
“I think also that they will help to stimulate conversation between NACCHO members and the members of NACo, who are often the governing board or the governing officials in communities to recognize that health really is foundational to all activities in a community,” Pestronk said.
County Health Rankings National Comparisons
The County Health Rankings do not identify the healthiest and least healthy counties in the nation. However, when comparing the 50 healthiest counties (one from every state), with the 50 least healthy counties, there are striking differences, according to the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
Population size: Healthier counties are urban or suburban, whereas least healthy counties are mostly rural. About half (48 percent) of the 50 healthiest counties are urban or suburban counties, whereas most (84 percent) of the 50 least healthy counties are rural.
Premature death rates: The least healthy counties have significantly higher rates of premature death — 2.5 times higher than the healthiest counties.
Self-reported health: People living in the least healthy counties reported being in significantly poorer health — 2.1 times higher rates of people who report being in fair or poor health, compared with the healthiest counties.
Smoking rates: People living in the least healthy counties are much more likely to smoke — over 26 percent, compared to 16 percent in the healthiest counties.
Preventable hospitalizations: People living in the least healthy counties are 60 percent more likely to be admitted to the hospital for preventable conditions — a sign of poor outpatient and primary care.
Children living in poverty: The least healthy counties have higher rates of poverty, with 30 percent of children living in poverty — over three times higher than the rate in the healthiest counties (9 percent).
Access to healthy foods: The 50 least healthy counties have fewer places where people can find healthy food — only 33 percent of zip codes have at least one grocery store, compared to almost half (47 percent) of zip codes in the healthiest counties.
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