This year’s County Health Rankings elevate the intrinsic connections between health and opportunity, underscoring the considerable inequities that put certain communities at greater risk of poor health and disease.
Released earlier this week and for the ninth year in a row, the County Health Rankings & Roadmaps ranks nearly every county in the country by both health outcomes and health factors. For example, Travis County, Texas, (where I live) ranks eighth in the state on health outcomes and 10th on health factors. The health outcome ranking is based on indicators such as premature death, low birthweight newborns and self-reported health status; while the health factor ranking considers a wide range of behaviors and social determinants, such as smoking, insurance status, poverty and air quality.
Anyone can visit the database to see how their county is faring and access tools and resources shown to make a difference locally. (The site even lets you request a free personal consultation with a “Community Coach,” who can help you find the right approach for your community’s health needs.) While each county faces its own difficulties, researchers found a number of common threads and gaps that illustrate the steep challenge of eliminating health disparities and improving health for all people.
For example, the rankings report documented striking disparities in the rate of babies born at a low birthweight, which puts newborns at greater risk of lifelong health problems and is often used as an indicator of maternal health. Researchers found that gaps in the percentage of low birthweight babies were wider among racial groups than between counties. And in every state, the percentage of low birthweight babies born to black women was worse than the bottom-performing county in the state. Nationwide, the report found that the percentage of low birthweight babies is on the rise after years of improvement — the rate experienced a 2 percent increase from 2014 to 2016.
On the social and economic determinants of health — factors that often shape life expectancy, disease burden, disability and well-being — researchers found “meaningful differences” by place and race. For example, more than one in every five youth in the least-healthiest counties don’t graduate from high school, while the adult unemployment rate in such counties is more than twice as high as the unemployment rate in the healthiest counties. Among communities of color, the gaps were even more prominent. Across counties, one in four American Indian, Alaskan Native, black or Hispanic youth don’t graduate from high school within four years, with American Indian, Alaskan Native and black adults experiencing the highest unemployment rates. Both unemployment and not graduating from high school are associated with adverse health effects.
Child poverty rates for black and Hispanic children were worse across all types of counties, according to the report, with that rate often higher in suburban counties than for white children in rural counties, which were home to the highest child poverty rates overall. Nationwide, child poverty rates are still higher than they were before the Great Recession, with child poverty particularly high in rural counties and in counties with a greater share of people of color.
On child poverty, the researchers wrote: “Children living in poverty are less likely to have access to well-resourced and quality schools, and have fewer chances to prepare for living-wage jobs leading to upward economic mobility and good health. Children in poverty is an upstream measure that assesses both current and future health risk.”
To better illustrate the connections between health, race and place, the report highlighted the impacts of residential segregation, a “fundamental cause of health disparities in the U.S.” (The U.S. has a long history of policies and practices that limit where people of color can live. For example, the practice of “redlining,” or denying financial services to black neighborhoods, often meant communities of color were cut off from investments that facilitate affordable housing, good schools and access to health care.) The new rankings report found that black residents are more affected by levels of segregation than whites, with black children in more segregated counties doing far worse on child poverty scores and high school graduation rates than those in less segregated counties. Child poverty rates were also higher among Hispanics, American Indians, Alaskan Natives and Asians in more segregated counties. White residents did not experience the same adverse effects of segregation.
Fortunately, a number of community-based programs are making a difference, as highlighted in the rankings report. For example, a community initiative in Kansas City, Missouri, organized around a goal of decreasing an eight-year life expectancy gap between black and white residents. The effort, which zeroed in on determinants such as violence, education, access to care and economic justice, has help pushed the disparity down to 6.9 years. It’s efforts like that, researchers write, that will bring the country closer to achieving health equity. Researchers write:
Imagine a place where everyone has a fair and just chance to lead the healthiest life possible – communities with high quality schools, good paying jobs, access to healthy foods and quality health care, and affordable housing in safe environments. Imagine a place where differences in race, culture, and perspectives are not only tolerated, but are celebrated as fundamental to health and wellbeing. Imagine that this is how we all experience our communities, regardless of where we live, the circumstances we were born into, or how we look. This is the vision of health equity.
To learn more about health in your county, visit the new County Health Rankings & Roadmaps.