A first-of-its-kind ranking of the health status of the 105 Kansas counties has been released by researchers at the Kansas Health Institute.
Kansas County Health Rankings 2009, is the first of what are expected to be periodic updates on the relative health of Kansas residents by location.
There is a published report and also a more detailed, interactive, online version that includes maps and tables.
The rankings were modeled on a similar project started in 2003 by the University of Wisconsin Population Health Institute.
Researchers there have repeated the rankings each year since and say the primary value is in provoking public awareness and discussion of how to improve the general health of Wisconsin residents. The target audience there for the report has been local health officers, health care executives, legislators and other policymakers, advocacy groups, and the media.
The Kansas rankings were based on 31 indicators that measured everything from the prevalence of binge drinking to the number of flu vaccinations and visits to the dentist.
Levels of education, employment and poverty also were considered as factors because so-called socioeconomic factors have proven to be strong predictors of a person’s health and by extension, that of their communities. Generally speaking, the more affluent and better educated a person is the more likely they are to be healthy.
“Many people do not realize that the factors that most powerfully influence our health have little to do with health care provided in doctors’ offices and hospitals,” wrote Dr. Gianfranco Pezzino, author of the report. Primary data analysis for the report was provided by KHI analyst Cheng-Chung Huang.
“Health is not just about the absence of disease,” Pezzino said in a later interview. “There also are socioeconomic influences but we rarely have them in a framework for reference such as this.”
Pezzino said the primary goal of the rankings was to inspire discussion and debate at the local level about how various health outcomes might be improved. But he cautioned against attaching too much significance to which counties in the summary, “rank 1, 2, or 3.”
“I have tried really hard to find patterns that can explain some of these results,” he said. “We can’t say rural counties are better than urban counties or some region is better than another.”
The exception to that, he said, was southeast Kansas.
“We know we have some problems there,” he said.
Common in many southeast counties are low incomes, poor access to health care and poor health behaviors including relatively high rates of smoking during pregnancy.
Better use of the rankings, Pezzino said, would come from “drilling down” and examining each of the health determinants for a specific county to see what might be done locally to make improvements.
“We are always interested in stimulating debate at the local level to improve health,” he said.
The rankings showed wide variation in the types of counties that showed strongly.
For example, four of the five healthiest counties were in the sparsely populated High Plains part of the state where the population tends to be older. But the other county in the top five was Johnson, which is one of the state’s most densely populated where income and education levels are among the highest found in Kansas.
“I wouldn’t make too much of those differences by area,” Pezzino said. “People can be healthy just about any place in Kansas. Communities can be healthy just about any place in Kansas. It would be foolish for every place to try to imitate the healthiest county. See what is specific in your county and see what opportunities you have for improvement.”
Gove County, according to the ranking, was the healthiest county in the state.
The county has a population of about 2,500, of which the fastest growing segment is people ages 85 and older. The county has one hospital in Quinter. The public health team is small and staffed by part-timers including Administrator Cheryl Goetz.
Goetz said she hadn’t yet reviewed the report so couldn’t guess why Gove County ranked so highly.
She said a countywide health assessment was done several years ago and some steps were taken to remedy the problems identified.
“We looked at the needs of the youth in our county and the first year we did a presentation on alcohol abuse,” Goetz said. “We did that in the Grinnell school system with student leaders and administrators. We applied for Juvenile Justice Authority funds to promote our program. But you know lots of people were doing that around the state, so I don’t know if that made a difference,” in the rankings.
The disparity in the ranking positions of Johnson and Wyandotte counties also stood out. Though they share a border and many health care providers, they are separated by 102 positions. Johnson is ranked as the third healthiest county, Wyandotte is last at 105.
Joe Connor, director of the Unified Government Public Health Department in Wyandotte County, said it would be tough to compare his county to any other in the state because of its composition.
“We’re an older, urban community that still has a good-sized industrial base, which makes us unique in Kansas,” he said. “I think a lot of these determinants and outcomes are not unusual if you look at similarly situated communities across the country. But that doesn’t mean that it’s not something we shouldn’t be working on, either.
“We’re not totally surprised, but we will remain diligent in trying to address these outcomes and determinants.”
Two recent efforts to improve seat belt usage and reduce lead poisoning in children, he said, have been successful in improving health outcomes after targeted programs were put in place to address the public health concerns.
Funding for the health ranking project was provided by the Kansas Health Foundation of Wichita, a philanthropic organization whose mission is to improve the health of all Kansans.
-Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at mshields@khi.org or at 785-233-5443, ext. 123.