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Stewart County Coroner Sybil Ammons says non-compliance with prescriptions and doctor visits is a big problem.(Photo: Michael A. Schwarz, USA TODAY)
The rate of early death is dropping in most parts of the country, according to county-by-county health rankings out today.
However, people in many poverty-stricken areas still die young — that is, before age 75 — at a stubbornly high rate, and the percentage of children in poverty is up. One in four children lived in poverty in 2013, up from one in five in 2007, the Robert Wood Johnson Foundation says in its sixth annual county health rankings.
Abbey Cofsky is in charge of the Robert Wood Johnson Foundation's annual county health rankings. She says education -- especially graduating from high school -- makes a huge difference in health outcomes.<span style="color: Red;">*</span>(Photo: Peter Murphy)
"It reminds us our health is influenced by so much more than what happens in a doctor's office," says Abbey Cofsky, RWJF's senior program officer in charge of the county rankings program.
To determine how healthy counties are and will be, the foundation looks at things not generally considered to be related to health, such as counties' employment and schooling.
It uses national data about individual counties and standardizes and combines them based on scientific weighting.
"Why poverty leads to poor health is not just about an inability to buy a gym membership or buy healthy foods," Cofsky says. "It's the nature of the communities where they are living."
Violence, crime, access to healthy foods and exercise facilities and walking paths all play a role.
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Income plays a major part in access to the best health care because it is often tied to education and affects people's ability to adhere to their treatment plans.
"Wealth equals health," says Wayne Rawlins, an internist who is national medical director for the insurer Aetna.
That's been evident in Stewart County, Ga., which ranked 129th out of 160 Georgia counties for health outcomes, which looks at length and quality of life.
"People are non-compliant with follow-up visits, and part of that is transportation, and part of it is education," says County Coroner Sybil Ammons, former director of nursing at the now-shuttered Stewart-Webster Hospital in Richland. "A huge part of this county hasn't even finished high school."
Though genetics and health care affect early death, research shows personal behaviors such as smoking, eating too much fast food and choosing not to exercise represent 40% of the causes of premature death, Rawlins says. He calls these the "things we do to ourselves."
Where people live, whether they're employed and how much money they make all contribute to health behaviors. For example, an unemployed, poor person may live in a crime-ridden county where it's unsafe to exercise outside and difficult to find fresh fruits and vegetables, while a rich person may live in a safe area with abundant grocery stores, parks and gyms, Rawlins says.
Still, he says, there are lots of ways communities can improve health, such as targeting food deserts. Aetna, for example, sponsors a farmer's market in Hartford, Conn., that aims to give residents easy access to fresh and affordable produce.
The Kentucky County faring worst on health outcomes is Perry in the heart of the state's Appalachian region. The county's ranking is attributable to problems with access – to health care, nutritious food and places to exercise, says Renee Neace, health education director for the Kentucky River District Health Department, which includes Perry County.
"Here, you're really restricted," Neace says. "We just don't have flat land. We have mountains."
It can be difficult to get to doctors' offices and to the hospital because it can take an hour to get from one end of the county to another on narrow, winding mountain roads. And smoking rates are high, Neace says, partly because tobacco has long been an accepted part of the culture.
"We grew up with many people in the community growing tobacco," Neace says, recalling a late uncle with a tobacco farm.
Conversely, Oldham County, which consistently ranks among Kentucky's wealthiest, tops the list in health outcomes. Employment, income and educational attainment are all important, and Oldham fares comparatively well on such measures. For instance, 86% of county residents have graduated from high school, compared with 79% statewide.
The county is close to Louisville, the state's largest city, giving residents relatively easy access to primary care physicians, specialists and several hospitals. Healthy food is easy to get, and the area includes walking paths and other places to exercise. The foundation also ranks counties based on access to healthy food and walking trails.
"A lot of that is where we're located," says Dori Livy, nurse program manager for the Oldham County Health Department.
The rankings have made a difference, Cofsky says.
"The big thing the rankings have driven is the mere recognition of the importance of thinking beyond health care," she says.
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