To Be Healthy, Live Among the Wealthy?

If you want to be healthy, then be wealthy. Or at least live in a wealthy county.

That’s the obvious message you get from combining the recently released County Health Rankings with poverty and income data from the 2010 U.S. Census.

Source: US Census and County Health Rankings, 2012

But if you look closer, you see something else.  It’s not just that poorer people are less healthy than their wealthier counterparts. 

People are less healthy where too few resources are invested in public health.

Earlier this month, the 2012 County Health Rankings were released by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.  In the release, Dr. Risa Lavizzo-Mourey, President and CEO of RWJF, said that “where we live, work, learn, and play has a big role in determining how healthy we are and how long we live.”

She’s right.

The poorest counties – as measured by the percentage of people living below the poverty level – are usually home to the least healthy people.  And the wealthiest counties – as measured by income – are home to the healthiest.

That much isn’t news.  We’ve known for a long time about the relationship of poverty to poor health. 

But we usually think about that relationship in terms of individuals – the poorer the individual, the worse his or her health status is likely to be.

The county-level data suggest that we look at the relationship in another way – as a community problem.

Then we discover something more.

The poorest counties often have both the least healthy residents and some of the poorest public health infrastructures in their state. 

Consider these examples from three different states.

• The three poorest counties in America – Ziebach (the only county in America where over 50% of the population lives in poverty), Todd, and Shannon – are in South Dakota.  Of the 59 South Dakota counties in the County Health Rankings, they are at the bottom, placing 53^rd, 58^th, and 59^th, respectively.
• Owsley County, Kentucky, is also one of the nation’s poorest counties.  It is the poorest county in Kentucky, and it ranks last in the state’s county Health rankings.
• South Carolina’s Allandale County is one of the poorest counties in America.  It, too, ranks last in its state county health rankings. 

What do they share besides poverty and poor health?

The North Dakota communities are worst off.  They have very limited governmental infrastructure and services.  All are Native American reservations.  Two don’t even have a County Seat. 

Owsley County shares its health department with six other rural southeastern Kentucky counties.  The regional health department covers a geographical area larger than some states, and its central office is located over an hour away from Booneville, the Owsley County Seat.

Allandale County also lacks its own dedicated public health infrastructure, sharing public health services with several other South Carolina counties.

Is it poverty or poor public health infrastructure that matters most? 

That’s hard to say, but poorer public health infrastructures are common in relatively poorer counties in wealthier states – even when those counties are well-off compared to the nation as a whole.

• Windham County, though relatively wealthy by national standards, is Connecticut’s poorest county.  It also ranks 7^th of Connecticut’s eight counties in health. 
• And Washington County, Maine, is Maine’s poorest and least-healthy county. 

What about their public health infrastructures?  Unlike many Connecticut cities, none of Windham County’s fifteen towns has its own public health department.  Public health services are delivered through three regional health districts shared by several communities. And in all of Washington County, there are just two district offices of the Maine Health and Human Services Department.

So it appears that poor health may go hand in hand with poverty because economically disadvantaged communities often don’t take care of their public health infrastructure – not just because poorer individuals often don’t take care of their health.

Florida is home to one of the exceptions that may prove the rule.  DeSoto County is Florida’s poorest county.  But DeSoto ranks in the top half – 28^th – of Florida’s 67 counties in health.

Why?  It may be because of DeSoto County’s strong public health infrastructure.  Its residents have better-than-average access to diabetes screening and better-than-average low birth weight numbers.  Behind these achievements are a diabetes screening program housed in a county-run primary care clinic and a county-run women’s health clinic.

Living well isn’t always about how much wealth an individual has to spend for a healthy life.  It’s often about how much a community is willing and able to spend for healthy lives.