Today’s health statisticians still search for instructive patterns of behavior and illness in communities, although they have moved beyond simply tracking infectious disease rates and deaths. Nowadays, says Julie Willems Van Dijk, a researcher at the University of Wisconsin Population Health Institute who helps county leaders figure out what to do with the data, public health officials also monitor quality of life and trends in chronic, noncommunicative disorders, such as depression, diabetes and heart disease.
The trick for researchers, Willems Van Dijk says, is to sift information from broad studies of large populations to identify behaviors and other influences on health that can be modified. The next step is to see how those factors play out at the level of the city, county and town, where many of the policy decisions that most directly affect people’s health are often made. Individual cities started enforcing smoking bans in restaurants, Willems Van Dijk notes, after studies showed that secondhand smoke increased the number of heart attacks and cases of asthma in nonsmokers. The County Health Rankings project, now updated annually, is an attempt to provide reliable health statistics on a scale and in a format that public officials can use to take action, such as altering zoning rules to allow for beneficial placement of grocery stores, bike paths and parks.
Four Broad Categories
In comparing the counties within each state, Willem Van Dijk and her colleagues at the University of Wisconsin gather no new data. Instead they base their ratings on public information scoured nationwide from various sources, including the National Center for Health Statistics, the FBI and the U.S. Census. Their aim is to identify robust, reliable indicators that are measured the same way from county to county within each state for four broad categories—behavior, clinical care, socioeconomic status and physical environment—that research shows shape health.
Within these groupings, some of the most influential factors—such as smoking (behavior)—come as no surprise. Others include education level attained by most of the population (socioeconomic status), the relative number of sexually transmitted diseases diagnosed each year (behavior), and the number of car crashes related to drunk driving (behavior).
Researchers analyze a host of patterns in the data to help community leaders spot where improvements are most needed. For example, Wyandotte County scored particularly low on education in 2011. Part of the reason for that result is that just 60 percent of its ninth graders graduated from high school within four years, and only 42 percent of adult residents aged 25 to 44 had spent some time in college. Mayor Reardon hopes the high school internship and mentoring programs he has helped establish within the city government and within some of the county’s high-technology firms will help turn around those low scores on education. Students need to see the link between college and a good job, he says, and to imagine themselves following that path.
Not Everyone Believes
Not every Kansas official has responded as enthusiastically as Mayor Reardon has. At a 2009 public meeting in Shawnee County (home to the state capitol, Topeka), then County Commissioner Vic Miller dismissed Shawnee’s low health ranking (78 out of 105) as misleading. “Frankly, I can’t imagine what argument you’re going to promote that dropout rates in schools relate to public health,” Miller was quoted as saying in the Topeka Capital-Journal.
Willems Van Dijk says that Miller’s skepticism is understandable, but the evidence that socioeconomic factors like education play a major role in health is solid and growing. For example, high school dropouts tend to die earlier than graduates. Further, their children are more likely to be born prematurely, robbing another generation of a healthy start. Every year of additional education improves those outcomes. “Research is now showing that many health effects once attributed to racial differences are actually tied to educational and economic disparities,” she says.