How healthy is your county?

New data about the health of counties throughout the US tells us that Marin is the healthiest county in California. The least healthy? Trinity County, in California’s rugged and rural far North.

That’s according to The University of Wisconsin Health Institute and the Robert Wood Johnson Foundation (RWJF) recently released County Health Rankings and Roadmaps, an annual ‘check-up’ of over 3,000 counties in the United States.

But researchers who crunched the numbers on health want to go beyond a best and worst list. That’s why this year’s data also includes information about projections about counties’ future health and incentives, in the form of grant money, to take a turn towards healthful living.

“It shows people that there’s a lot more to health than healthcare,” said Bridget Booske Catlin, the Director of the County Health Rankings and Roadmaps program. “So much of what influences peoples’ health happens outside of the doctor’s office, and so the data that we provide reflects some of these other important factors that influence health.”

The Rankings site allows users to do a side-by-side comparison of the counties in their state. It uses two different sets of criteria, so a county ranked as the ‘healthiest’ is a current measure of how long its people live, the Health Outcomes, and their general quality of life, the Health Factors.

In California, Marin County is ranked the highest in both criteria, and its Health Outcomes score indicates a low rate of premature death (defined as deaths before age 75.) Marin residents lost 3,846 years of potential life before age 75 per 100,000 people. California averages 5,922 years of life lost before age 75 per 100,000 population, and the national benchmark, or the 90th percentile for the nation (that is, only 10% of counties are higher), is at 5,466 years lost. On the other end of the spectrum, Trinity County residents lost 10,546 years of potential life per 100,000 people.

Two counties in California – Alpine and Sierra – are not ranked. Catlin said this is because the population size of the data is not large enough to determine reliable indicators, but there is still some data available for them.

The other set of criteria used to rank the counties, is what are called Health Factors, or things that affect the health of the population. Health factors fall under four categories: health behaviors (things like smoking, physical activity, motor vehicle crash rate), clinical care (number of uninsured people, primary care physicians, or the percentage of people receiving diabetic screening), social and economic factors (percentage of unemployment, violent crime rate, level of education), and physical environment (air pollution measures, access to healthy foods or access to recreational facilities).

Catlin said that these health factors are actually a prediction of how healthy an area will be in the future. A high-ranking county now is Colusa, just shy of the top ten with a ranking of #11 in Health Outcomes. But taking the health factors into account, the county weighs in at #44. Two health factors that stand out in Colusa are unemployment (20.4% compared to 12.4% overall in CA) and the ratio of primary care physicians to patients (1763:1 compared to 847:1 overall in CA).

The ratio of primary care physicians to patients is important so that people have access to a doctor to get preventative and primary care, as well as referrals to specialty care when appropriate.

Unemployment is often associated with a number of unhealthy behaviors – like increased alcohol consumption, poor diet – that can contribute to disease. Unemployment is also associated with a lack of healthcare access, since employers are often the providers of healthcare. Unemployment is also related to an increased number of self-reported physical illnesses and deaths, including suicide.

These two pieces of data – high unemployment and a low number of primary care physicians – will likely mean that Colusa will have a lower health outcome in the future, whether that translates into poor health or more premature deaths. However, Catlin said that the specific contributors are likely to be more than just these two measures, and that education level, particularly some college, also has a significant impact on a populations’ health.

While the County Health Rankings have been released annually for the past three years, this is the first year for what’s called the County Roadmaps Project. The Roadmaps Project provides an action center where site visitors can learn strategies to mobilize their communities to take action to improve their health.

For Catlin, a longtime scientist whose roots are in data, it is exciting to work on the Roadmaps portion of the project that seeks to put the data into action. “[It’s] really providing tools and guidance for communities to really be able to move forward,” Catlin said.

As part of the Roadmaps Project, communities can also apply for grants to work on implementing policy or system change. Catlin said that communities are encouraged to apply for the Roadmaps to Health Prize Opportunity, where communities can compete for up to six awards of $25,000 for 2013.

Last year, Alameda County was awarded one of these community grants for the Alameda County Prosperity Project a program that aims to improve health by addressing problems with the economic tools available to low-income residents.

Many low-income people of color in Alameda County rely on short-term financial services – check cashers, payday lenders, or pawnshops – to meet their banking and credit needs. Many residents lack access to mainstream financial products and services like no-cost checking or short-term loans, and data indicates that 1 in 6 households in Oakland lacks access to a checking or savings account.

Families struggle to afford basic health needs like food, shelter, transportation and healthcare, and as a result they’re unable to save for the college or buy homes, both of which are also related to improving health outcomes.

“We know that economic wellbeing is fundamentally related to personal health and the health of our communities,” said Alexandra Desautels, a Local Policy Manager for Alameda County Public Health Department.

As part of its Roadmaps project, the Robert Wood Johnson Foundation awarded the Public Health Department and its multiple partners a $200,000 grant over a 2-year period. The funding is intended to help make consumer-focused banking services available to low income neighborhoods and educate people about cost-effective methods for handling their money.

“This grant has been an excellent opportunity for us to push strategies that we know will help eliminate health inequities,” Desautels said. “It is great to have an opportunity to bring in resources to work on some of these efforts that address the structural and root causes of the health inequities we see.“

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