County Rankings Show Multiple Contributors to Health

How does health vary by county? The 2016 County Health Rankings from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute combine county-level measures from national data sources to assess and rank health factors and health outcomes for nearly every county in the United States. Length of life and quality of life are given equal weight in the health outcomes rankings. The health factors ranking is combined as follows: social and economic factors (40 percent), health behaviors (30 percent), clinical care (20 percent), and physical environment (10 percent).

Rankings for counties’ physical environment are based in part on the percent of households with severe housing problems. Many of the other measures have documented correlations with households’ housing status, including low birth weight, physical health, mental health, obesity, preventable hospital stays, violent crime exposure, and high school graduation. Since segregation of blacks and whites has been found to contribute to health disparities in the United States, residential segregation was added as a health measure in the report for 2016, although it does not contribute to the rankings.

The key findings report explores how health outcomes and factors vary between the following types of counties: large urban metro, large suburban metro, smaller metro, and rural. Health rankings within states are combined to show which states are overall performing better on health and how consistent the health rankings are between a state’s counties. A related roadmap provides guidance for counties to improve.

Major findings:

• Rural counties have consistently had the highest premature death rates and, following a few years of improvement, overall rates of premature death are increasing.
• Large urban counties have seen the greatest declines in premature death rates since the late 1990s.
• Large suburban metro counties and rural counties rank best on violent crime rates.
• Thirty-five percent of U.S. counties have a black population of less than 100 people. These counties were excluded from the analysis of intra-county black/white residential segregation.
• Intracounty black/white segregation is highest in the Northeast and Great Lakes region and lowest along the southeastern coast.
• The least segregated counties have a residential segregation index score of less than 23. This means that the county would have a completely integrated population if less than 23 percent of households changed census tracts.
• The most segregated counties have a residential segregation score of 67 or higher.