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How Healthy Is Your County? A Few Miles Can Make a Big Difference

Bike path to Oberlin, Ohio; Creative Commons photo courtesy Ed Chadwick (flickr.com/echadwick)

What difference can a few miles make? It may be the difference between living a healthy life and struggling against a sea of health problems, according to a new study that ranks the relative health of counties.

The study and website, from the University of Wisconsin and funded by the Robert Wood Johnson Foundation, find sharps differences between counties that are near one another and even counties that share borders. The study takes a long list of health factors and indicators — everything from smoking and drinking to obesity and low-birth weight delivers — and uses them to rank counties within each state from healthiest to least healthy.

Of course the idea that neighboring counties can be very different is nothing new to Patchwork Nation. In the almost four years we have studied our breakdown of 3,100 counties into 12 types of places, we have often been surprised at how many differences exist at the local level – how many of our cultural and economic differences occur there. This report only makes those differences more clear.

The lines between healthy and less-healthy America follow some well-worn paths.

Better to Be a Middle Class County Than Rich?

Take a look at the map above and you will notice a few trends. First, it’s good to live in the counties we call the Monied Burbs, places mostly around the nation’s biggest cities. Look at the counties around Cleveland, Chicago, Dallas, Detroit, Houston, Milwaukee, Philadelphia and St. Louis and you will see a lot of green, making places with relatively high health ratings.

The Burbs have many things going for them. The people there have higher incomes, which allows people to spend more money for good food, and better jobs, which means they are more likely to have health insurance. They are also better educated, meaning they are probably less likely to practice high-risk behaviors bad for their health.

But look at many of the big-city counties they surround, counties we call the Industrial Metros. They are often islands of brown in a sea of green. Those places are also wealthy and, on the whole, well-educated, but many of them also hold large pockets of poverty. And that’s even true of places that we do not think of “poor” per se.

Look for instance at New York City (Manhattan), a very wealthy Industrial Metro. Almost 10 percent of the households there make more than $200,000 a year. And yet nearby Rockland County, a Monied Burb where only about 5 percent of the households make that kind of money, is healthier. It scores in the top quartile of healthy counties in New York state, while Manhattan is in the second quartile.

The same is also true of the Monied Burbs of Suffolk and Nassau counties — fewer very wealthy people, but better overall health scores.


Because, even today when Manhattan is the home to the super rich, it is still home to some who are very poor as well. And that does matter. Those poor people put a strain on the health system. They take up hospital beds and use social services.

In the end, if you have a choice, it seems better to build a community around having a lot of well-off people rather than a smaller stable of super-rich — at least where health care is concerned. That may raise issues for the country at large as health care costs continue to rise and, as we have noted on this blog, the divided between the richest and poorest places is growing, squeezing the middle class.

Differences Hard to Ignore

Of course, like all indices, the numbers from this health report are not perfect. The measures are done within states, not nationally. The researchers on this study say that is only fair. There are specific health challenges in specific states. It’s the best way to compare apples to apples.

And, like all surveys, many of the numbers in this effort — smoking, excessive drinking — are “self-reported.”

But the fact that such stark differences can exist in places we think of as cohesive “places” — regions or metro areas — shows just how steep the challenges are for health care reform. (The site’s health care calculator lets users examine their own county in-depth.)

If nothing else, these data show health care reform and expanded coverage won’t fix the problems that linger at the local level. Those problems can be very different even for counties that are next door to one another. Things like problem drinking, obesity and low-birthweight babies will require different solutions — and time.

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