As mayor of Kansas City, Kan., Joe Reardon is justifiably proud of the University of Kansas Medical Center, which has trained several generations of physicians and nurses for more than 100 years. After all, the medical center is consistently rated as the best hospital and treatment center in the state, according to a popular ranking of health institutions. So when Mayor Reardon—who heads the government of both the city and Wyandotte County, in which it sits—first learned that Wyandotte had come in dead last among the state’s counties in a rigorous analysis of health measurements in 2009, he was shocked. “We have great access to excellent health care in a state where some counties have essentially no access,” Mayor Reardon says. “And we’re ranked last out of 105 counties? My first reaction was, ‘How could this be?’”
The answer, Mayor Reardon discovered as he delved into the statistics behind the claim, is that proximity to fine hospitals and first-rate doctors is only one of many factors—and not always the most important—determining how long people live and how vulnerable they are to serious illness. Evidence collected by public health experts over the past few decades repeatedly shows that less obvious forces, including proper diet and exercise, higher levels of education, good jobs, greater neighborhood safety, and underlying support from family and friends, provide a powerful, and often unappreciated, boost to a community’s health and well-being. By the same token, studies demonstrate, a poor showing in any of these areas can sink the health of individuals or of communities—even if they have access to topflight medical facilities.
The goal of the County Health Rankings project, which has given Wyandotte County low marks for health but high praise for its commitmennt to change, is to bring these hidden health factors to light and thereby help elected officials, civic leaders and community groups take concrete steps that can improve the health of local residents. The initiative originated at the University of Wisconsin–Madison, covering solely that state in 2003. A similar project began in Kansas in 2009, and in 2010 the Robert Wood Johnson Foundation in Princeton, N.J., provided funding so that the University of Wisconsin could expand its investigation to include within-state comparisons of counties in all 50 states.
Among the biggest lapses identified in Wyandotte County, for example, were much higher than average rates of smoking and obesity, lower than average rates of high school graduation, a distressing number of babies who weigh too little at birth, and a relative scarcity of fresh fruits and vegetables in grocery stores compared with the rest of the state. Mayor Reardon says these measurements have already transformed his approach to budget priorities. Changes include earmarking money for the addition of mentoring programs for high school students, new parks and sidewalks, and the opening of more and better supermarkets and community gardens in impoverished neighborhoods. And that is just the start, Mayor Reardon says. “The measure of our success as a city is not just how many jobs we create but also the health of our citizens.” He believes that potential employers who want to stay competitive in today’s global marketplace are more likely to settle in communities where workers are both highly skilled and relatively healthy.
Public Health Strategy Has Deep Roots
The notion that government officials can use public health statistics to improve policy decisions is not new. In 1854 physician John Snow, one of the founders of modern epidemiology, traced a cholera outbreak in the overcrowded London neighborhood of Soho to a contaminated public water pump by noting how many cases of illness clustered around the pump. (The pump was later found to be too close to a leaking cesspool.) Snow convinced officials to disable the pump, which helped to stop the spread of disease.