Colorado county named healthiest US community: Report scores 3,000 communities on health-related issues
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* Kim Krisberg

Earlier this year, Douglas County, Colorado, was tapped as the healthiest community in the country, moving up from its previous spot at No. 2.

“We give all the credit to our citizens for their healthy choices,” Douglas County Commissioner Lora Thomas told *The Nation’s Health.*

In March, *U.S. News & World Report* and the Aetna Foundation released their second annual Healthiest Communities report, evaluating nearly 3,000 U.S. communities across 81 health-related metrics in 10 categories, ultimately putting Douglas County in the top spot.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/49/4/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/49/4/1.1/F1)

Yoga students stretch during a class in Castle Rock, Colorado, in 2016. Castle Rock is located in Douglas County, which was named the healthiest U.S. community in March by U.S. News & World Report’s Healthiest Communities rankings.

Photo by Anya Semenoff, courtesy The Denver Post/Getty Images

Following the Colorado community in the top five were Los Alamos County, New Mexico; the city of Falls Church, Virginia; Loudoun County, Virginia; and Broomfield County, Colorado. Seven Colorado communities ranked among the top 20, while Iowa had the biggest presence in the rankings, with 62 counties making the top 500.

In addition to the overall rankings, the report also breaks out the highest-performing urban and rural communities, as well as up-and-coming rural and urban communities. While Douglas County took the top spot among high-performing urban areas, Teton County, Wyoming, took No. 1 among top-performing rural communities. Houston County, Minnesota, was No. 1 among up-and-coming urban areas, and Wallowa County, Oregon, was top-ranked for rural up-and-comers.

The rankings list is a popular headline-grabber, said Brian Kelly, editor and chief content officer at *U.S. News & World Report*, but the real insight comes from the data and stories behind the rankings.

“Communities don’t succeed and solve problems in the abstract,” Kelly told *The Nation’s Health.* “It’s people and institutions that take action, potentially making things better or worse, and we’re trying to identify what those things are...We’re trying to understand what makes a healthy community and then help develop a blueprint for how to get there.”

The 2019 Healthiest Communities report scored the nearly 3,000 communities on a wide range of metrics related to health conditions and behaviors, health equity and social determinants of health. Just a few examples include rates of cancer, heart disease and smoking; number of available primary care doctors; racial disparities in income and education; exposure to unsafe air or drinking water; voter participation; housing affordability; and access to large grocery stores. Overall, of the 81 metrics used, researchers found that smoking and diabetes prevalence had the strongest correlation to life expectancy.

In Teton County, Wyoming — which moved from No. 9 to No. 6 in the overall rankings and is the top-performing rural community for two years running — life expectancy is more than 83 years, the smoking rate is below the national median, adults report high rates of leisure-time physical activity, and heart disease prevalence is significantly lower than the national rate. The county also has an above-average high school graduation rate, high median income and a low poverty rate. But it faces big challenges too, such as a lack of affordable housing.

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[Figure2](http://www.thenationshealth.org/content/49/4/1.1/F2)

Kids ride mini tractors at the Teton County Fair in Jackson, Wyoming, in 2009. Teton County was ranked the sixth-healthiest U.S. community in U.S. News & World Report’s Healthiest Communities rankings, scoring high on population health, environment and infrastructure measures.

Photo by DieselDemon, via Flickr/Creative Commons [bit.ly/creativecommons2](http://bit.ly/bit.ly/creativecommons2)

“We have a number of things to be really proud of,” said Natalia Macker, chair of the Teton County, Wyoming, Board of County Commissioners. “We take a lot of pride in being a gateway community to a national park and serving as stewards of this land, but it’s also easy to forget that there are still people here living in the shadows, paycheck to paycheck.”

Teton County is 97% public land, most of which is available for recreational use, “so it’s easy for our residents to access the outdoors,” Macker told *The Nation’s Health.* But it also means that only 3% of the land is available to development, which she said contributes to the community’s affordable housing problems. In fact, Macker noted that during recent community health needs assessments, housing rose to the top of the priority list.

Such assessments have been key to rallying local stakeholders around health, said APHA member Jodie Pond, MPH, director of health at the Teton County Health Department. With the help of 30 local groups, the county completed its first Mobilizing for Action through Planning and Partnership process in 2015 and a second in 2018. MAPP is a framework from the National Association of County and City Health Officials that helps officials prioritize public health issues and identify resources to address them. Pond said the process has sparked a number of local collaborations, such as work to address the county’s high food insecurity rate through expanded access to summer lunch programs and rescuing usable food waste.

Pond noted that access to data has been crucial to the health department’s work. About three years ago, the agency joined the Network of Care platform, which generates instant access to health data specific to Teton County. Previously, without the resources to hire a full-time epidemiologist, the department had had to send their data requests to the state.

“Having this platform helps us quickly hone in on problems, come up with solutions and rally our partners,” Pond told *The Nation’s Health.* “It’s revolutionized the way we do business in a small, rural health department.”

Back in Douglas County, Colorado, the top-ranked community is no stranger to healthy accolades, having ranked among the state’s top two healthiest counties for nearly a decade.

According to Healthiest Communities, average life expectancy in Douglas County is nearly 84 years, the uninsured rate is below 4%, cancer and heart disease prevalence are lower than national averages, median household income is more than $105,000, and the obesity prevalence is far below the U.S. median. Like Teton County, there is a shortage of affordable housing in Douglas County.

John Douglas Jr., MD, executive director of the Tri-County Health Department, which includes Douglas County, noted that like Teton County, a large part of Douglas County is public lands, giving residents easy access to nature. It is also a relatively new county with new infrastructure, which may give it an advantage, he said. He added that local county officials are responsive when health issues arise, such as its “very proactive” response to rising suicide rates.

Still, Douglas said the top-ranked county is a telling example of the powerful influence of social determinants of health.

“Whether the county creates certain determinants or attracts people who bring those determinants with them, the impact of the social determinants of health are on full display in Douglas County,” Douglas told *The Nation’s Health.*

Kelly of *U.S. News & World Report* called on both the public and health professionals to visit the Healthiest Communities portal and use its tools to leverage the massive database to address local health needs.

“We love it when people take our data and go raise hell with it,” Kelly said. “This is powerful information.”

To access this year’s Healthiest Communities report and resources, visit [www.usnews.com/news/healthiest-communities](http://www.usnews.com/news/healthiest-communities).

## County Health Rankings highlight housing costs

Health professionals who want to see how their county compares head-to-head to others on health measures have a second resource to use.

Also released in March, the 2019 County Health Rankings report complements the new annual scorecard from *U.S. News & World Report*. The rankings allow web visitors to see where their county fares on health in comparison to other counties in their state or with other counties from across the nation.

This year’s report includes a look at housing expenses, finding that more than 1 in 10 U.S. households face severe housing cost burdens. That means they pay more than half of their incomes on a place to live, according to the report.

“Housing is so fundamental to everyday existence,” said Marjory Givens, PhD, MSPH, associate scientist at the University of Wisconsin Population Health Institute, which produces the annual report in partnership with the Robert Wood Johnson Foundation. “This is a problem that we saw across the nation, and it really is a problem that plays out in a local context.”

The rankings report zeroes in on the social determinant of housing, noting that severe housing costs are associated with barriers to good health and longevity. In particular, researchers reported that among those who own their homes, the burden of housing costs have gone down in the last decade, while renters have experienced no such improvements. White residents have consistently experienced the highest rates of home ownership, at rates up to 30% higher than for people of color.

Nearly 1 in 4 black households spend more than half their incomes on housing, the report found, while more segregated counties have greater rates of severe housing costs for both black and white residents. Overall, the rate of severe housing cost burden varied widely among counties, ranging from 1% to more than 30% of households.

Housing problems often occurred in the same context as child poverty, poorer health and food insecurity, Givens told *The Nation’s Health.*

“We want to spark conversations and catalyze action,” Givens said of the report. “We want to empower local change-makers because that’s really where the ball starts rolling.”

To download this year’s County Health Rankings report and its accompanying tools and resources, visit [www.countyhealthrankings.org](http://www.countyhealthrankings.org).

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