Health equity in Idaho? 2018 County Health Rankings show disparities

2018RankMap

We may think of health as something that is influenced by genetics, diet or exercise, but the point behind the annual release of a trove of Idaho and national county-level data comparisons known as the “County Health Rankings and Roadmaps” (CHRR) is that health is more than what happens at a visit to the doctor’s office.

Increasingly, research shows that the economic, social and environmental conditions in the communities where we live, work, and play also factor into our ability to make healthy choices and live healthy lifestyles. In general, living in Idaho provides the environments and opportunities for those healthy choices and lifestyles, from easy access to recreation for exercise, safe communities, family and social support systems and access to clinical care.

Idaho’s standings in the 2018 county health rankings were published last week by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The annual county-by-county report analyzes multiple databases to evaluate overall health and well-being at the community level. It then ranks individual counties based on a calculation of overall health outcomes based on life expectancy and overall quality of life.

So how does the county where you live compare to other Idaho counties in this latest survey? Two counties (Camas and Clark) were not ranked in the new study’s health outcomes criteria for highest length of life and quality of life due to not having enough data for a representative sample, so those two are not part of the comparisons. Looking at the remaining 42 Idaho counties, the five highest for 2018 health outcomes in Idaho were basically a reshuffling of the 2017 top five:

  1. Ada (2017: Valley)
  2. Valley (2017: Ada)
  3. Blaine (2017: Blaine)
  4. Latah (2017: Teton)
  5. Teton (2017: Latah

And for the five lowest Idaho counties for 2018 health outcomes (out of 42 counties), there was not much change from the 2017 rankings:

42. Benewah (2017: Benewah)
41. Shoshone (2017: Shoshone)
40. Lemhi (2017: Lemhi)
39. Power (2017: Custer)
38. Custer (2017: Gooding)

While the question of “Why?” does not have a simple answer, one factor considered in measuring health equity is economics. It’s worth noting that the three top-ranked counties above also have Idaho’s highest per capita income, according to the 2010 Census: Ada at $27,915, Valley at $27,577 and Blaine at $32,656. In fact, those are the only three counties in Idaho that have a higher per capita income than the national median of $27,334. Idaho’s 41 other counties all have lower per capita income than the national average.

But it’s important to do a deeper dive on the data released to avoid drawing conclusions that are too broad. In several areas, Idaho health factors exceed the national average. And there are factors that may not directly correlate to the size of our individual waistlines but are extremely important to understanding overall health in Idaho communities and areas where special attention or awareness may be needed.  These include the percent of youth who graduate from high school, the crime rate in our neighborhoods, teen pregnancy rates, and preventable hospital says.

All told, the rankings evaluate 35 measures that all play a key role in our individual and community health.  In examining Idaho’s well-being, there are several measures that jump out as either prominently exceeding or falling short of the national median. Here are a few we found in the study:

The Good State Measures
Percent of population with adequate access to locations for physical activity
U.S Median Idaho Idaho Counties Range Best County
83% 80% 20% – 92% Kootenai – 92%
 
Preventable hospital stays: Number of hospital stays for ambulatory-care sensitive conditions per 1,000 Medicare enrollees
U.S Median Idaho Idaho Counties Range Best County
49 per 1,000 32 15-78  Blaine – 15%

 

 
Percent of children who live in a home headed by a single parent
U.S Median Idaho Idaho County Range Best County
34% 25% 7% – 40% Madison – 7%

 

The Not-So-Good State Measures
Sexually transmitted diseases: Number of newly diagnosed chlamydia cases per 100,00 population
U.S Median Idaho Idaho Counties Range Best County
479 per 100,000 345 40 – 514 Madison – 53

 

 
High School Graduation: Percent of 9-graders who graduate in four years
U.S Median Idaho Idaho Counties Range Best County
83% 79% 60% – 94% Valley –94%
 
Percent of driving deaths with alcohol impairment
U.S Median Idaho Idaho Counties Range Best County
29% 32% 0% – 57% Tie: Madison, Oneida – 0%

 

Much of the impetus behind the County Health Rankings is to focus attention on deaths that could be prevented. One measurement intended to help communities target high-risk areas and provide support is the measurement of premature mortality, rather than just overall mortality rates in a county. The way the rankings measure premature mortality is to evaluate the years of potential life lost before the age of 75 per 100,000 people, a measurement sometimes known as YPLL-75.

As an example, a person who dies prematurely at age 30 contributes 45 years of premature death to the measurement calculation. A person who dies at age 70 contributes five years. By calculating the number per 100,000 people, the study provides a comparable rate for both large and small counties.

With this measurement, the national years of premature death was calculated at 6,700. Idaho’s rate of years of potential life lost before age 75 was slightly better at 6,300. The Idaho counties with the lowest rate for premature death in the 2018 rankings include:

  • Madison – 3,600 (2017: Valley – 2,900)
  • Blaine – 4,800 (2017: Madison – 3,600
  • Ada – 4,900 (2017: Blaine – 4,300)
  • Valley – 5,000 (2017: Ada – 5,000)

The Idaho counties with the highest rate of premature death in the 2018 rankings include:

  • Benewah – 12,100 (2017: Shoshone – 10,400)
  • Shoshone – 11,000 (2017: Benewah – 10,200)
  • Custer – 10,100 (2017: Clearwater – 10,000)
  • Lemhi – 10,050 (2017: Lemhi – 9,400)
  • Clearwater – 9,000 (2017: Custer – 9,300)

The rankings provide more than data. The website is interactive and highlights areas that counties can explore to improve. The Robert Wood Johnson Foundation also provides community coaches who will work with county leaders to plan strategies to improve the health of their residents at the local level.

To research your county or other communities around the country, view the full listing of data, rankings, and information about how to improve the health of communities at www.countyhealthrankings.org .

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