Researchers used the data to devise each county’s “health factors” score based on several areas: health behaviors, clinical care, social and economic factors, and physical environment. They then applied a model to calculate how the health factors data influenced the counties’ average mortality and morbidity.
The model places a greater weight—40%—on the impact of social and economic factors than on the effect of either health behaviors (30%) or clinical care (20%).
“Having health insurance and access is important to people’s health, but there are a lot of things that influence people outside the doctor’s office,” said Bridget Booske, senior scientist at the University of Wisconsin Population Health Institute and deputy director of the County Health Rankings.
The study’s website includes a County Health Calculator that compares states and counties, and features a slider tool that allows users to see how many deaths could be averted if a state had a higher percentage of residents with a higher level of education or income.
For example, the calculator shows that Mississippi, the state with the lowest percentage of residents with what researchers define as “basic income,” would have more than 2,500 fewer deaths a year if it reached New Hampshire’s 80% rate of basic income.
New Hampshire, which also has an above-average percentage of college-educated residents, consistently ranks high in health-related studies because of its relatively wealthy, educated and homogenous population, said Joan Aschiem, bureau chief with the New Hampshire Division of Public Health Services.
“Where you live matters—socio-demographic factors impact you the most,” Aschiem said. “What impacts you the least is the one-on-one visit with your doctor,” she said.
Dr. Gary Sobelson, a family physician and the past president of the New Hampshire Medical Society, said that the medical world has known about the health impact of social and economic factors for decades and that “preserving health has nothing to do with the medicine we practice or the drugs we prescribe—it’s the people who come to us.”
While pediatricians have the power to make interventions very early with health education, in practice on adults, “you realize you’re just bailing out the ocean of illness,” Sobelson said.
However, the idea of directing money toward community resources the study identified as impacting health—such as parks, recreational facilities and other “built environment” areas—is a hard sell for income-strapped Mississippians, said Mendal Kemp, director of the Mississippi Hospital Association’s Center for Rural Health.
“If you develop a bike track, but you don’t have a bicycle—what good is that going to do?” Kemp said.
While he attested that poverty and unemployment beget higher rates of obesity and alcoholism in Mississippi communities, Kemp said healthcare providers can use every available dollar for treating elderly and chronically ill patients who need help now.