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Nationwide health rankings a ‘tool’ for IDing local problems

April 11, 2011

A recent study has ranked counties in all 50 states in various health related categories. The data is complicated and broad-based, but, according to one of the study’s authors, the study is to be considered a starting off point for counties to focus on local health concerns. Photo courtesy

A recent survey ranking the health conditions of U.S. counties reveals mixed results for Inyo.
In the same study, titled “County Health Rankings,” Inyo is ranked second for “clinical care” and “physical environment” but 50th out of 56 counties for “health outcomes.”
Inyo-Mono Public Health Officer Dr. Rick Johnson said this year’s rankings will be compared to last year’s rankings to see what can be gleaned from the information.
The study, conducted by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, is being considered a “starting off point” by one of the study’s authors, researcher Jessica Athens.
The rankings can also be a way to access various grants or other funding that can be used to remedy a county’s problem areas brought to light in the study.
Athens confessed that some of the numbers and rankings in the study can be confusing, but its usefulness is to get counties to look into the findings and find local causes. Johnson agreed and said that, while the rankings are done from afar, broadly based and generalized, the study is another tool for identifying potential problems related to health care.
The ranking of 50 for “health outcomes” is based on both mortality and morbidity data from death records compiled by the U.S. government. The data does not include details as to the cause of the deaths.
And, the numbers for the mortality rate are based on premature deaths, defined in the study as any life lost before the age of 75. The numbers are represented by “years of potential life lost before age 75” or, YPLL-75. The study states that, “Every death occurring before the age of 75 contributes to the total number of years of potential life lost. For example, a person dying at age 25 contributes 50 years of life lost.”
Inyo’s premature death number is 9,306 with a margin of error of 7,564-11,048. These include all Inyo County residents regardless of where the death occurred, so tourist and visitor related deaths are not included. The state average is 6,128.
Athens explained, “This suggests that people are dying at a younger age compared to the rest of the state.”
This could be caused by a number of factors, including high infant mortality, that would contribute greatly to the YPLL, or socioeconomic factors or lifestyle choices.
“The measure can be difficult for laypeople and public health practitioners to interpret,” states the website, “For example, the Epidemiology Bureau in Florida investigated this issue and learned that county Public Health Units often did not understand how to interpret YPLL.”
Athens said the study’s authors do not have the resources or the knowledge of local issues and situations that may be contributing to or causing some of these numbers. She explained that local health departments and county leaders have the best knowledge of what may be the problem and how best to address it. Athens said it is up to the local experts to try and find causation for these problems.
This high premature death rate seems contradictory to the “clinical care” ranking of 2, with higher than average numbers of Inyo residents having access to physicians, and health care professionals. But Athens explained there are many more factors than access to health care that can lead to death before 75 years of age.
“Clinical care is very critical, but there are lots of things that influence a person’s health beyond access,” Athens said.
For example, neighboring Kern, Tulare and San Bernardino counties also have high premature death numbers, suggesting that there could be a regional, non-county specific causation, Athens explained.
While the rankings are not necessarily meant to show comparisons, Athens said, there are some trends, according to the study. These include: people nearly twice as likely to be in fair or poor health in the unhealthiest counties; unhealthy counties having significantly lower high school graduation rates; unhealthy counties having more than twice as many children in poverty; unhealthy counties having much fewer grocery stores or farmer’s markets; and unhealthy counties having much higher rates of unemployment.
“It’s hard to lead a healthy life if you don’t live in a healthy community,” Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, said in a press release.
Johnson said that trying to get funding to address these healthy living issues will be more and more difficult as state and federal budgets shrink and programs get chopped.
“The ability to intervene will be very difficult,” Johnson said.
States are made aware of the rankings, Athens explained, and the information is passed down to the local levels.
The University of Wisconsin has been doing a county-by-county ranking for its own state from 2003-08, with a widespread and continued response, Athens said. This is only the second year the University of Wisconsin has completed a nationwide, county-by-county ranking.
“The rankings are used as a jumping off point to go deeper,” Athens said. She said she also knows that the rankings can be used in applying for grants.
To view the rankings, go to

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