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Counties Ranked on Wellness

Saturday, March 28, 2015
West Lebanon — Upper Valley public health officials say an annual ranking of the health status of each county in the United States will help guide them as they create action plans to address the challenges area communities face.

The 2015 County Health Rankings released Wednesday by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation is one of several reports utilized by public health officials to evaluate existing health systems and plot steps for the future.

“I think these are good because they tell us where we need to work,” said Dr. Robert Greene, chief population health management officer at Dartmouth-Hitchcock Medical Center.

The report includes two categories of rankings for counties in each state : health outcomes, including the length and quality of life, and health factors, including health behaviors, health care, social and economic factors, and the environment.

“Health is more than what happens with a doctor,” said Jan O’Neill, an associate researcher and community coach with the County Health Rankings and Roadmaps Program, which produced the report. “Income and poverty have a lot to do with health.”

According to the report, social and economic factors are 40 percent of the reason a county is healthy or sick, while health behaviors such as smoking, alcohol or drug use and physical activity account for 30 percent of the reason for a county’s health status.

Clinical care weighs in at 20 percent and physical environment, including air and water quality and housing, at 10 percent.

In New Hampshire, Grafton and Sullivan counties rank at nearly opposite ends of the spectrum, highlighting the variations in health among populations in the Twin States.

The report ranks Grafton County second for health outcomes and third for health factors among New Hampshire’s 10 counties.

Sullivan County ranks ninth for both outcomes and factors, just above Coos County, which sits in last place.

In Vermont, Orange and Windsor counties both rank in the middle, between Chittenden County, which is first, and the Northeast Kingdom counties of Essex and Orleans, which are ranked last.

Windsor County, which is ranked fifth for health outcomes and fourth for health factors, is above Orange, which is ranked eighth for health outcomes and seventh for health factors.

Both Vermont and New Hampshire have some environmental risk factors to contend with, according to the report. Both states have higher than average risks of exposure to contaminated water and severe housing issues, such as overcrowding and high costs.

They also struggle with alcohol abuse — posting above average numbers in the areas of excessive drinking and alcohol-impaired driving deaths — according to the rankings, which are based on data collected by research groups including the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the USDA Economic Research Service and the U.S. Census Bureau.

Though Vermont and New Hampshire continue to face public health challenges, both states rank well in comparison with national medians overall.

In both states, there are fewer children in poverty and lower unemployment rates than the national median.

Both states have high school graduation and some college education rates that are higher than the national median. They also rank above the national median in health care screening such as mammography and diabetic monitoring. They have more health care providers, greater access to exercise opportunities, lower rates of obesity and smoking and fewer uninsured people and teen births than the national medians.

Jane Kolodinsky, director of the Center for Rural Studies at the University of Vermont, could not speak to the specifics of this report, but said, “Vermont is a relatively healthy state compared to a lot of places in the U.S.”

The report identifies areas in which counties might improve public health and offers suggestions of how they might do so.

Sullivan County Manager Jessie Levine said she was aware that primary care providers are in relatively short supply in Sullivan County, but the report also highlighted the relative dearth of dentists and mental health providers in her county.

The report indicates there is one primary care physician for every 1,389 people in Sullivan County and nearly three times as many in Grafton County, where there is one for every 537 people.

Similarly, there are more than twice as many dentists and mental health providers in Grafton County than in Sullivan County.

“I wish there were something inherently attractive in the more needy communities that could draw the professionals here where we need it so much,” said Levine. “I would love to know why we can’t draw people here.”

Aurora Matzkin, a consultant for the Greater Sullivan County Public Health Network — one of 13 regional networks across the state — and a Sullivan County resident, said the dearth of dentists in the county has forced her to bring her children to Burlington, Vt., for pediatric dental care.

Because of her own experience, she said, “that number just made me chuckle.”

Having data to support anecdotal evidence of public health challenges may help the community to attract grants to support initiatives to address those challenges, she said.

Matzkin, who is also an instructor at the Geisel School of Medicine, also said the high number of teen births in Sullivan County — 31 per 1,000, compared with the state average of 17 per 1,000 county elsewhere in New Hampshire — “jumps off the page” when she looks at this report.

Levine said the data indicate the county needs to work to support teens.

“We need to focus on our kids and our teens and try to identify some early preventative measures to support the people in our community,” said Levine.

Both Matzkin and Levine said the report comes at an appropriate time in Sullivan County’s creation of a community health improvement plan.

A kick-off event for the plan is set for Tuesday, April 7, at Sugar River Bank in Newport at 10 a.m. The state’s director of public health services, Dr. Jose Montero, is scheduled to speak and Matzkin will collect community input.

Alice Ely, director of the Public Health Council of the Upper Valley, struck a cautionary note about county rankings data. She said it’s exciting to see Grafton County ranked so highly, but the county-wide data may obscure differences among communities within a county.

“All of the counties in New Hampshire tend to be very large,” she said. “Whereever you sit in these rankings does not mean that every community shares the same good health or bad health.”

The Upper Valley council is working to address public health issues such as obesity — 27 percent of adults in both Grafton and Sullivan Counties are considered obese, which is consistent with the state average — by promoting existing initiatives such as the Upper Valley Healthy Eating Active Living Partnership, a collaboration between area school districts, hospitals, recreation groups and businesses to encourage physical activity and healthy eating.

Other examples of such collaborations include efforts to provide support to enable Upper Valley seniors to live as independently as possible, for as long as possible in their own homes and efforts to instruct first responders and school employees in mental health first aid.

Monica Boyd, quality management specialist at Gifford Medical Center in Randolph, said Vermont’s results in the report are not surprising and are unchanged from previous years.

“The biggest challenges facing our counties are the same challenges that most counties and states are facing,” said Boyd. “They are smoking (and other substance abuse), obesity, chronic disease management and poverty.”

In Orange County, 17 percent of children live in poverty, which is above Windsor County’s average of 14 percent and the state average of 15 percent. Both Upper Valley New Hampshire counties have a greater percentage of children in poverty than the state average of 11 percent — Sullivan County has 15 percent and Grafton County 13 percent .

Boyd said the best way to address these challenges is to engage families and community groups in strategies to improve their overall health.

“Making healthier choices as a family or a group of friends can lead to greater success,” she said.

For example, Boyd said Gifford offers healthy living workshops, tobacco cessation programs and self-management strategies for chronic illness. Though access to parks and gyms may be limited in rural areas, there are opportunities to hike, bike or walk on quiet roads or trails, she said.

“Residents should feel empowered to take ownership in managing their health,” said Boyd. “We encourage everyone to talk to their primary care provider. Ask about the programs and support services available.”

Nora Doyle-Burr can be reached at or 603-727-3213.

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