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County health rankings in Kentucky show few changes, but ranks are less important than the trove of data they reflect

By Tara Kaprowy
Kentucky Health News

The health evaluation tool that calls itself "the annual check-up of over 3,000 counties in the nation" was released today, showing little change from last year in how Kentucky counties compare when it comes to factors like obesity, smoking rates and mortality. But the data provide plenty of fresh angles for stories about the health status of individual counties and regions.

The County Health Rankings for Kentucky, which are compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation, ranked Appalachian counties at the bottom and Central Kentucky counties in the Lexington and Louisville markets at the top. The far western portion of the state ranked lower as well.

The rankings fall into two categories: health outcomes and health factors. Health outcomes, left, include factors such as premature death rates, low birthweight and how many days of the past 30 that someone said they felt bad physically or mentally. Boone, Oldham and Calloway counties ranked first, second and third in health outcomes category, and Wolfe, Martin and Owsley were at the bottom.

In health factors, right, Woodford, Boone and Fayette counties were first, second and third, and Jackson, Clay and McCreary at the bottom of the list. Health factors include the percentage of adults who smoke, are obese or drink excessively; and assess a county's health care landscape: the number of primary-care providers and what percentage of adults are uninsured, for example. Social and economic factors in this ranking include unemployment rates, high-school graduation rates, percentage of children in poverty, pollution rates, access to healthy food and the number of recreational facilities. (The last item replaced the number of liquor stores. "Some of the data were not available for the availability of alcohol and it was difficult to interpret," said Dr. Patrick Remington, project director and associate dean for public health at the University of Wisconsin. The change could have affected the rankings, because Kentucky has many "dry" counties and liquor stores often cluster in "wet" counties adjacent to dry ones.)

Interestingly, the rankings between the two categories vary considerably. Fayette County, for example, ranked third in the health factors list but 10th in the health outcomes assessment. McCracken County was listed eleventh in the health factors list but 45th in health outcomes.

Though Appalachian counties in Kentucky, West Virginia and Tennessee generally ranked very low, there was one very bright spot: Morgan County, which ranked 23rd in health outcomes despite being surrounded by counties that were down in the 100s. It also ranked high last year.

While the rankings didn't change drastically from last year, there was some deviation downward in the Southern Kentucky, including Adair, Clinton, Cumberland and Wayne counties. But Shawn Crabtree, executive director of the Lake Cumberland District Health Department, didn't see much reason for concern. "Naturally, the rank of counties are going to go up and down each time," he said. "I don't know that the communities are any sicker or that anyone is doing anything any different."

Crabtree said it is important to remember the assessment is ranking one county against another, not making a comment on if counties are getting healthier or not. "That's not to say our area isn't an unhealthy area; it is," he said. "That doesn't mean we don't need to improve; we do."

Also, statistical data from counties with small populations can greatly affect rankings. "That number is a little bit volatile," Remington said of certain disease numbers. "It's not a survey, it's the actual experience of what happened." He added, "When you present a statistic for an entire community, you realize it's an average. This is like a screening test. It tells people in a community where the problem areas are, but it really doesn't make the diagnosis."

Researchers assembled the snapshot county portraits with information from several sources, including the Behavioral Risk Factor Surveillance System, a random telephone survey by the Centers for Disease Control and Prevention. They also used data from the National Center for Education Statistics, the National Center for Health Statistics and the Census Bureau's American Community Survey and Small Area Income and Poverty Estimates. For a complete list of sources, click here.

Given the number of sources used and the conclusions drawn, researchers hope the data will spur community interest and, ultimately change. In a conference call with reporters, Mayor Joe Reardon of Kansas City, Kan., said, "It was a call to action for me personally and a wake-up call for our community."

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