Online-only: New report highlights health differences among the nation’s counties
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* Teddi Dineley Johnson

County lines reflect more than just geographic boundaries and political jurisdictions. In many cases, the borders that separate and define the nation’s 3,000-plus counties can mean significant differences between good health and poor health, including quality and length of life, according to a new report.

Released in March, the second annual county health rankings report assesses the overall health of nearly every county in the United States. Developed by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, the report ranks a state’s counties based on a range of measures that affect health, including the number of people who die before age 75, high school graduation rates, access to healthy foods, air pollution levels, violent crime, income levels, tobacco use and teen birth rates. The rankings are intended to help counties understand the factors influencing residents’ health, including life expectancy.

“The rankings really show us — with solid data — that there is a lot more to health than health care,” said Patrick Remington, MD, MPH, director of the county health rankings project and associate dean for public health at the University of Wisconsin School of Medicine and Public Health. “Where we live, learn, work and play affect our health, and we need to use the information from the rankings to shine a spotlight on where we need to improve so we can take action to address our problems.”

In addition to comparing the overall health of counties against other counties in a state, the rankings provide national benchmarks against which counties can compare their performance in specific health areas, such as diabetes screening rates or numbers of uninsured adults.

Online at [www.countyhealthrankings.org](http://www.countyhealthrankings.org), the rankings reveal some expected weaknesses. For example, people living in the unhealthiest counties are nearly twice as likely to be in fair or poor health, have significantly lower high school graduation rates and more than twice as many children in poverty. Moreover, people living in the unhealthiest counties have access to fewer grocery stores or farmers markets and have higher levels of unemployment, according to the report.

The rankings also illustrate how cultural and economic differences can position a state’s healthiest county next to — or just a few miles away from — the state’s unhealthiest county. For example, Maryland’s Howard County is the healthiest of the state’s 24 counties, but it is only a few miles down the road from Baltimore City, the state’s unhealthiest jurisdiction.

The report, “County Health Rankings: Mobilizing Action Toward Community Health,” highlights the need for people and organizations from all sectors of each county to work “deliberately and collaboratively” to improve the public’s health through policies, programs and services, said APHA member Robert Pestronk, executive director of the National Association of County and City Health Officials.

“The nation’s local health departments are on the front lines of protecting the public’s health,” Pestronk said. “Unfortunately, no single agency can address all of the health issues that people in our communities face today. The county health rankings are, and will continue to be, an excellent way for local health departments to engage a wider spectrum of community partners to improve the public’s health in their jurisdictions.”

Pestronk said local health departments and their community partners can use the rankings to identify priority areas for improvement and work together to solve them, “whether they are health behaviors — like smoking and obesity — or health equity factors, like poverty and unemployment.”

Since debuting last year, the county health rankings have already spurred a number of communities to take actions such as passing smoke-free laws, boosting educational opportunities for young children or pushing for healthier grocery stores and farmers markets.

For more information or to view the rankings, visit [www.countyhealthrankings.org](http://www.countyhealthrankings.org).

*   Copyright The Nation’s Health, American Public Health Association