This year’s County Health Rankings once again illustrate why geography and good health go hand-in-hand. They’re also a poignant reminder that there may be no better way to improve health for all than by focusing on the social determinants of health.
Released earlier this week, the 2014 County Health Rankings compare each state’s counties on 29 factors that impact health, from tobacco use to high school graduation rates to access to healthy food choices. In examining the differences between counties, the report found that the least healthy counties were home to twice the premature death rate, twice as many children living in poverty and twice as many teen births. The country’s healthiest counties have better access to healthy foods, parks, exercise facilities, primary care physicians and mental health providers. They’re also home to lower rates of food insecurity and higher rates of high school graduation and college attendance (see our previous coverage of the link between good health and high school graduation). The least healthy counties have higher unemployment, more childhood poverty, more violent crime, weaker social support systems and more unhealthy housing.
What’s particularly interesting about the county rankings is viewing the state maps by health outcome and risk factors. Time and time again, counties that are literally right next to each other are wildly far apart in their health outcomes. For example, take Erath County, Texas — ranked 18 of 232 in health outcomes — and Eastland County, Texas, ranked 203 out of 232. Even though they share a border, Erath residents reported an average of 3.9 physically unhealthy days in the previous month; in Eastland, it was 6.9. Surprisingly, though, Eastland County ranked higher than Erath in health factors. For example, in Eastland, 91 percent of ninth-graders graduated high school in four years; in Erath, only 59 percent did. However, in Erath the primary care provider to population ratio was 1,739 to 1; in Eastland, it was 3,727 to 1. It’s an interesting illustration of how a complexity of components comes together to produce better health for some than for others.
This year’s county health rankings, which are a joint collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, introduced six new categories as well: housing, transportation, food environment, mental health, injury-related death and exercise opportunities. For example, in housing, the report found that in the top-performing counties, less than 10 percent of households had severe housing problems, such as lead-based paint or improper insulation. Rates of intentional and unintentional injury, such as motor vehicle crashes, suicide or poisoning, are 1.7 times higher in the nation’s least healthy counties compared to the healthiest counties. Access to exercise opportunities, like a park or recreational facility, is 1.4 times higher in the healthiest counties when compared to the least healthy counties.
Some encouraging trends rose to the surface as well. Teen birth rates have decreased by nearly 25 percent since 2007, adult smoking rates have dropped, the number of adults who’ve completed some college has gone up, and violent crime is down. Unfortunately, the rankings noted that childhood poverty is up from 18 percent in 2007 to 23 percent in 2012, and sexually transmitted disease rates have risen as well.
“The County Health Rankings show us how health is influenced by our everyday surroundings — where we live, learn, work and play,” said Bridget Catlin, director of the County Health Rankings. “The County Health Rankings often provide the spark for businesses, community planners, policy-makers, public health, parents and others to work together for better health.”
To read how your county fared, visit County Health Rankings & Roadmaps.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Notice what's missing, as in, totally absent from the rankings: Vaccination.
If you search the County Health Rankings website for "vaccination," you get 8 results, exactly none of which point to vaccination as a county health measure. One of them mentions policies to control second-hand smoke. Excuse me, but what about second-hand measles and second-hand pertussis?
Here's how bad it gets:
Marin County California was at the top of the California rankings, despite being what fellow ScienceBlogger Orac (Respectful Insolence) calls a hotbed of anti-vax conspiracy theory, not to mention "medical woo woo" quackery: "energy healing," and suchlike nonsense:
I frankly find it disgusting that Marin gets praise for "healthiest county in California" while wallowing in anti-science quack nonsense.
Vaccination rates should be a major factor in the rankings. Any county that's below the threshold for herd immunity should get downrated accordingly. And while we're at it, counties with the highest rates of quackery in health care (yearly sales level of homeopathic "remedies" is a decent metric) should get downrated.