Rankings Tally Health Of Counties

Valley News Staff Writer
Thursday, April 13, 2017

White River Junction Newly released county-by-county health rankings reflect marked disparities in public health between Grafton and Sullivan counties, and indicates potential areas for improvement in Windsor and Orange counties.

The eighth annual County Health Rankings are based on “health outcomes” — that is, length and quality of life — and “health factors,” which include socioeconomic conditions, physical environment and health behaviors such as smoking and dieting.

Grafton County ranked third out of 10 New Hampshire counties for overall health outcomes — one spot lower than it ranked in 2015 — and second for positive health factors, while Sullivan County ranked ninth for positive health factors, and seventh for health factors.

The two Vermont counties in the Upper Valley reflected a lesser disparity in health, with Windsor County ranking eighth among 14 counties for overall health outcomes and fourth for positive health factors, and Orange County ranking sixth for both health outcomes and health factors.

“One thing to keep in mind is that Vermont is a very healthy state overall,” said Laura Cody McNaughton, district director for the Vermont Department of Health in White River Junction, and member of the Public Health Council of the Upper Valley.

But she admitted that there were “certainly areas for us to improve,” citing obesity and smoking as ongoing public health concerns, despite the Twin States’ relatively low obesity rates compared to the rest of the nation. ​

The County Health Rankings were released last week by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute in conjunction with National Public Health Week

Grafton and Sullivan counties reported an obesity rate of 25 percent and 29 percent respectively, compared to a 28 percent statewide obesity rate in New Hampshire. Windsor County’s 24 percent obesity rate matched the statewide average in Vermont, while Orange County reported a 27 percent obesity rate. All four counties — as well as statewide averages — stacked up favorably against the national obesity rate of 36.5 percent, according to the Centers for Disease Control and Prevention.

McNaughton attributed the low obesity rate in Vermont — which she said has gone down in recent years — in part to community initiatives that aim to raise awareness about the causal relationship between lifestyle choices and long-term health.

One of these is the “3-4-50” campaign, so named for its emphasis on three habits (smoking, inactivity and unhealthy diet) that lead to four diseases (heart disease, diabetes, cancer and lung disease) responsible for 50 percent of deaths in Vermont, she said in a news release accompanying the County Health Rankings.

But the problem of how to overcome disparities in health, in New Hampshire counties in particular, remains a point of concern, said Kirsten Vigneault, director of community health preparedness for the Greater Sullivan County Public Health Network, in a separate news release.

“While both (New Hampshire) counties compare favorably with the state average for violent crime, air pollution-particulate matter and preventable hospital stays, disparities between teen birth rates, children living in poverty, and access to mental health and dental health providers point to the need for continuing action to address public health issues,” she said in the release.

Sullivan County had the highest teen birthrate in New Hampshire, with 27 births per 1,000 women aged 15 to 19. Rural Coos County was second, with 25. Grafton County reported 12 teen births per 1,000 women aged 15 to 19 years, which is just below the New Hampshire statewide average of 15 teen births per 1,000 female teens in that age range.

Windsor and Orange counties both had slightly higher rates of teen birth than the Vermont state average of 17 births per 1,000 teen females, with Windsor reporting 21 and Orange reporting 18 births per 1,000 teens.

Three of the four Upper Valley Counties reported more children living in poverty than than state averages. In New Hampshire, where 11 percent of children live below the poverty line, Grafton County reported a 15 percent child poverty rate and Sullivan County 18 percent.

Orange County also reported a 15 percent child poverty rate, a percentage point above the state average of 14 percent. In Windsor County, 13 percent of children were reported to be living in poverty.

But child poverty is only one aspect of broader lifestyle disparities between Grafton and Sullivan counties, where health can also be a symptom of socioeconomic status.

“These are not necessarily decisions we make for ourselves, but rather ones that are built into our environment,” McNaughton said in a phone interview.

D. Wesley Miller, the Upper Valley public health emergency preparedness coordinator, echoed this sentiment, citing education level as one of the “major supportive structures” associated with long-term health outcomes.

“That’s when you get into the question of how things like language, career (and) income level support one’s ability to make good health care choices,” he said.

Sullivan County’s 87 percent high school graduation rate is a percentage point lower than the statewide average, and considerably lower than Grafton County’s graduation rate of 94 percent. And while 58 percent of Sullivan County’s adults aged 25 to 44 have received some form of college education, this is lower than the statewide average of 69 percent, as well as Grafton County’s.

Windsor County’s high school graduation rate is 85 percent, which is three percentage points lower than the statewide average, and 65 percent of adults have had some college education. Orange County has an 88 percent high school graduation rate, and 59 percent of adults have received some college education.

Miller also said that physical access to health care remains a challenge for many.

“If you’re living in an area that has very little access to public transportation, for instance, it can be really hard to get to your health care appointments. So it’s not just ‘is this service available?’ It’s also about whether they can get there, what their work status is and what their physical ability is to utilize transportation,” he said.

In response to this perceived need, Dartmouth-Hitchcock Medical Center has been focusing on greater outreach in Sullivan County and northern Grafton County to address disparities in health care availability, Miller said.

He added that while he hopes these measures will make a positive difference in the lives and health of Upper Valley residents, it’s too early to tell exactly how best to respond to the new health rankings.

“This work is really just beginning based on this data that is just now coming out,” he said.

“We can try to remove barriers to health care, which is important to do, but there’s also that other, human component that’s trickier to address. This is important data and a wonderful starting point, but only that — a starting point,” Miller said.

EmmaJean Holley can be reached at eholley@vnews.com or 603-727-3216.