Where You Live Matters to Your Health

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The County Health Rankings — the first set of reports to rank the overall health of every county in all 50 states — were released recently by the University of Wisconsin’s Population Health Institute and the Robert Wood Johnson Foundation. The 50 state reports, available on www.countyhealthrankings.org, enables consumers, public health and community leaders, policy-makers and others to see how healthy their county is, compare it with others within their state and find ways to improve the health of their community.

County Health Rankings

The County Health Rankings

The County Health Rankings identify the healthiest and least healthy counties within every state in the nation. Health outcomes in the County Health Rankings represent how healthy a county is. Two types of health outcomes are measured: how long people live (mortality) and how healthy people feel while alive (morbidity).

Counties are ranked on four key factors that affect health: health behaviors, clinical care, social and economic, and physical environment factors. Each of these factors is based on several measures, including the percentage of adults that smoke, the percentage of adults that are obese, the percentage of a county’s population that binge drinks, access to primary care providers, rates of high school graduation, rates of violent crime, air pollution levels, liquor store density, unemployment rates and number of children living in poverty. A fifth set of factors that influence health (genetics and biology) is not included in the Rankings. Although other studies have ranked states based on health factors, this is the first study where researchers have examined multiple factors that affect health in each county in all 50 states.

Indiana health outcomes map

Each state snapshot includes color-coded maps for health outcomes and health factors, comparing each county’s overall health with other counties. In addition, a detailed list of rankings for health outcomes and health factors is also provided. A summary report (PDF) for each state is available for download.

Researchers used the latest data available for each county, ranging from 2000 to 2008, to develop the Rankings. The data collection process gathered information from thirteen national data sources.

National comparisons and trends

When the 50 healthiest counties (one from every state) are compared with the 50 least healthy counties, several striking trends emerge:

  • Healthier counties are urban/suburban, whereas least healthy counties are mostly rural. While 48% of the healthiest counties are urban or suburban counties, 84% of the least health counties are rural.
  • The least healthy counties have significantly higher rates of premature death — 2.5 times higher than the healthiest counties.
  • People living in the least healthy counties reporting being in significantly poorer health — the rate of people who report being in fair or poor health is 2.1 times higher than people in the healthiest counties.
  • People living in the least healthy counties are much more likely to smoke; over 26%, compared to only 16% in the healthiest counties.
  • People living in the least healthy counties are 60% more likely to be admitted to the hospital for preventable conditions — a sign of poor outpatient and primary care.
  • The least healthy counties have higher rates of poverty, with 30% of children living in poverty — over three times higher than the rate in the healthiest counties (9%).
  • The 50 least healthy counties have fewer places where people can find healthy food. Only 33% of zip codes in the least healthy counties have at least one grocery store, compared to almost half (47%) of zip codes in the healthiest counties.

Patrick Remington, M.D., M.P.H., Associate Dean for Public Health at the University of Wisconsin School of Medicine and Public Health said [1]:

For the first time, people have a tool to help identify what is making people in every county unhealthy. We hope this kind of check-up will mobilize community leaders to take action and invest in programs and policy changes that make their counties healthier places to live.

The Rankings demonstrate that much of what influences an individual’s health happens outside the doctor’s office. To see how the county you live in ranks, visit www.countyhealthrankings.org.


  1. How Healthy Is Your County? New County Health Rankings Give First County-by-County Snapshot of Health in Each State. County Health Rankings press release. 2010 Feb 17.
About the Author

Walter Jessen is a senior writer for Highlight HEALTH Media.