Report Compares Health County-By-County

Report compares health county-by-county

By Mary Brophy Marcus, USA TODAY, February 17, 2010

For the first time, a new report reveals how counties across America stack up when it comes to health.

Today, whether you live in Malibu or Atlanta, you can learn if your community is holding its own in health. "County Health Rankings: Mobilizing Action Toward Community Health," a health report card for almost every one of the nation's more than 3,000 counties, is being released by the Robert Wood Johnson Foundation and the University of Wisconsin's Population Health Institute.

"This is a complicated story about what makes a community healthy and another not so healthy," says report author Pat Remington, the associate dean for public health at the University of Wisconsin.

For example, researchers point to cities reputed for their top-quality medical centers — Baltimore and Philadelphia— that ranked near the bottom in their respective states.

"Social, economic and health habits may be at play there," says James Marks, senior vice president and director of the foundation's health group.

A detailed analysis

For the report, researchers cobbled together federal and state health-related data on 3,016 counties in the USA, Remington says. The information was then analyzed by researchers who have been conducting similar reports for the state of Wisconsin for six years.

Remington says other researchers have produced state health reports, but his group wanted to "bring it down to the ground level" by learning where strengths and weaknesses lie within individual counties.

The report ranks each county in two ways: "Health Outcomes" and "Health Factors." Health outcomes are derived from a county's disease and death rates.

The health factors rating is more complex, culled from sources that keep tabs on obesity rates, tobacco use and alcohol consumption. Social and economic factors, such as unemployment, income and community safety, also were accounted for in addition to access to health care and environmental factors.

"The 'Health Outcomes' rank is about where they are now. The 'Health Factors' rank is about where they are going — predictors of health," Marks says.

The researchers don't recommend making state-to-state comparisons. The reason: Data collection methods vary by state, says Bridget Booske, project director for the rankings and a senior scientist at the University of Wisconsin's Population Health Institute.

Yet some nationwide generalizations can be made, Booske says. Healthier counties tend to be urban and suburban, while most (84%) of the 50 least-healthy counties are rural, sparsely populated areas where care is poor and the economy is depressed. Rates of premature death are also significantly higher (2.5 times) in low-ranked counties.

A call to action

Barbara Theis, health officer for the Juneau County (Wis.) Health Department, says that when her county ranked last out of 72 counties in 2006, Juneau residents were deeply concerned.

"It's been an exceptional tool to motivate my community. We've made some drastic changes," says Theis, whose county has since inched up in the rankings. One recent success: the county received a grant and opened a dental clinic in December.

Margaret Rivello, director for health for the Chester County (Pa.) Health Department, attributes her county's success to communication between county officials, local business partners and health care leaders, who meet regularly to evaluate how health programs are going.

"We have a great history of collaboration," Revello says.

She also says that even though the community is high-income, it doesn't overlook its more vulnerable residents.

Community Volunteers in Medicine in West Chester is one of four free clinics in the county that provide medical care to low-income families.

"Since the first day we opened 12 years ago, we've been committed to having a medical home model in place — primary care, dental care and medications people need. We keep people out of the emergency rooms," says clinic president Maureen Tomoschuk.

Now that counties have a clear picture of their health gaps, experts say, everyone in a community will have to pull together.

Juneau's Theis says: "It's going to take businesses, educators, faith-based organizations and politicians to answer to those who'll start asking questions when they see these rankings."