Last week, the Robert Wood Johnson Foundation released their county health rankings for most of the counties in the nation. But what do the numbers really mean?
By Rose Hoban
Last week, health leaders in almost every county in the United States had the opportunity to see how they’re doing compared to the other counties in their state when the Robert Wood Johnson Foundation released its third annual county health rankings.
In North Carolina, Wake County ranked as the number one, or ‘healthiest’, county in the state. Other counties along the I-40 and I-85 corridors, including Durham, Orange, Alamance, Guildford Forsyth, Cabarrus and Mecklenberg all ranked in the top quarter of healthy counties in the state.
Columbus County, on the South Carolina border, was listed at the least healthy in North Carolina. Other counties ranking near the bottom in the rankings are clustered along the southeastern South Carolina border and the northeastern Virginia border.
“The rankings actually just serve as some type of platform for us to be able to advocate and educate,” said Wake County Public Health Director Sue Lynn Ledford when asked what the rankings actually mean to county health officials.
“There are just so many variables that go into the rankings, and it’s not all public health effort,” she said.
Ledford said it would be a mistake for county commissioners to use a poor ranking to criticize a health director. She said lawmakers can’t just look at health officials when if they want health outcomes to improve.
“if we look at the factors for poor outcomes, it’s going to involve people other than health care workers, and health related services,” Ledford said. “It’s education, it’s government policy, and the plans that lawmakers allow us to carry out in caring for people.”
Ledford also made the point that even though Wake County ranked as number one, it’s a dubious honor in a state that ranks in the bottom half of all states in terms of health outcomes.
Research shows the number one factor determining a person’s health in the long run is education, said Tom Ricketts, a researcher from the Sheps Center for Health Services Research at UNC Chapel Hill.
“Just dropping out of high school will make you sicker,” he said.
Ricketts explained a person’s education tends to influence the conditions in which they live, how prepared they are to understand symptoms when they get sick, and how and when to pursue treatment.
Finally, Ricketts said the research shows that people with more education tend to exercise more, eat better, maintain a healthier weight and refrain from tobacco use, all factors measured in the county rankings.
Ricketts attributes some of the education advantages to people’s ability to assess risk.
“We prepare people for making better choices when they go to school,” he said. “They’re strongly influenced in terms of health, whether they’ll be sicker or be able to prevent sickness, whether they have developed the decision making process for themselves to observe, understand, calculate and anticipate risks.”
“A lot of those things are taught in school, and by the people we’re around when we’re in school,” Ricketts said.
Ledford said it’s possible to educate students on good health choices around tobacco, nutrition and physical activity, and integrate that into other subjects.
“You don’t have to have extra classes to do that. You can blend it into the curriculum and it becomes a thought pattern for those students,” she said. “They begin to understand that choices have outcomes and if they don’t get that education early, it makes them more susceptible to challenging situations later.”
Numbers make a difference
Ledford used to be county health director in Cherokee County, in the far western mountains. Cherokee ranked 81st in mortality in the state, but neighboring Clay County, with similar demographics, levels of education and poverty ranked 19th in mortality.
Both counties have similar rates of obesity, smoking and lack of physical activity in adults, both have similar rates of educational attainment and rates of children in poverty. In each county, 20 percent of residents are uninsured
But Cherokee has more fast food restaurants per capita, a higher crime rate and higher unemployment. More people surveyed in Cherokee rated their health as fair or poor, with more days of poor health in the previous month.
“One factor can make a big difference in the numbers,” Ledford said, noting the difference in the two counties.
In the end, Ledford said, counties are competing with themselves, not with their neighbors.
“These numbers give us some measures,” she said. “There are many other measures that are important, but these can be replicated and looked at over a long period of time for trends. Many of us are already doing that.”
Ricketts agreed the rankings are just numbers.
“You have to have a mechanism to react to them and do something with the data. Otherwise it’s just fishwrap,” he said.