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Health rankings follow the money

By David Gulliver
2/17/2010 © Health News Florida

Florida’s affluent and retiree-laden coastal counties tend to be healthiest, and the poor and rural counties in the state’s north-central region and around Lake Okeechobee its least healthy, according to a first-ever nationwide study released this morning.

The study, from the Robert Wood Johnson Foundation and the University of Wisconsin, is essentially a report card on the health of counties. 

It looks both at the factors that influence a community’s health -- such as obesity, smoking, and access to doctors and health insurance -- and at the outcomes, such as mortality rates and people’s perception of their health. A Health News Florida analysis found a strong statistical correlation between the preventive measures and the outcomes.

There was also a correlation between health outcomes and money. Collier County, home to wealthy enclaves of Naples and Marco Island, ranked first for health outcomes. St. John’s County, home of St. Augustine, led in healthy lifestyles.

Union County, west of Jacksonville, had the worst outcomes; Hendry County, near Lake Okeechobee, had the least-healthy lifestyles.

That was no surprise to Dr. Kevin Sherin, director of public health for Orange County health department and a nationally-recognized expert in the field.

“It is economics,” he said. “People who have jobs, who have access to healthy food, who have access to care, who have an understanding about how lifestyle affects their health -- doesn’t it make intuitive sense that they would be healthier?”

“If you don’t have a job, chances are, you won’t be in as good health.”

The strong-performing coastal counties, like Collier, St. John’s Sarasota, Charlotte, Palm Beach and Broward, all benefit from having heavy concentrations of retirees who have guaranteed health care access via Medicare.

Those residents also are likely have what Sherin called “medical literacy” -- the ability to understand their medical conditions, their doctors’ directions and how lifestyle choices affect them.

Sherin said that in Florida’s tourism and service industries, workers tend to be transient and less likely to have insurance or consistent primary care.

He noted the low-ranked counties were some of the poorest in Florida, like Union and Bradford in the rural north, and Glades and Okeechobee, with heavy populations of migrant workers. Those counties also tend to have more people who speak only Spanish, Creole or other languages.

But communities can take steps to combat those problems, Sherin said. In Orlando, capital of Florida’s tourism industry, the Primary Care Access Network has provided medical care to some 120,000 people who lack insurance. (Editor's note: The name of the network was misstated when this article was originally published.)

The study considers the quality of hospital care in a community, but puts twice as much weight on levels of education, employment, income and social services. Sherin praised the study’s inclusion of a community’s air quality and the number of grocery stores, fast-food outlets and liquor stores.

He said communities could improve their health outcomes by concentrating on the underlying factors: increasing access to smoking-cessation programs and to grocery stores, and developing parks and exercise opportunities.

The best communities would coordinate those opportunities, such as having sidewalks that lead from residential areas to parks and shopping. “If people could walk to grocery stores, you’d have less traffic and less air pollution,” Sherin said.

Communities also could improve infants’ health and reduce childhood obesity by encouraging breastfeeding at home and in workplaces, he said.

“The take-home message is, we need to have healthy, safe communities,” he said.

The study’s authors did not provide nationwide rankings and discouraged comparing counties in different states, because they may collect and report data in different ways.

For overall and sub-category rankings, and maps of counties’ performance, go to

-- David Gulliver is founder of Sarasota Health News.