A new university study ranking California’s counties is leading to some healthy discussion.

“The methodology is interesting,” said Matt Constantine, director of public health for Kern County. “What they are measuring tends to be factors that are not easily quantifiable — for example, measures of environmental quality and ‘built environment.’”

County Health Rankings” was a first-of-its-kind measurement of a variety of health factors by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The university had ranked Wisconsin counties for years, and now has super-sized the ranking protocols nationally.

Overall, California weighs in as the 23rd healthiest state in the union.

The top five counties in health outcomes are Marin, San Benito, Colusa, Santa Clara and San Mateo. The bottom five in outcomes are Yuba, Trinity, Lake, Siskiyou and Del Norte. Health outcomes compiled statistics of mortality, including premature deaths, and morbidity, including self-reported poor health, poor physical and mental health days and percentages of low birth weight.

The tops in health factors are Marin, Placer, Santa Clara, San Mateo and Nevada. The bottom five in health factors are Yuba, Fresno, Imperial, Kern and Tulare. Health factors wrapped in a great diversity of stats, including health behaviors (alcohol and tobacco use, diet and exercise); clinic care (measures of access and quality of care); socioeconomic factors (education, employment, income and community safety); and environmental health measures.

The study gives a broad-brush portrait of a county’s health. But of course a public health department must go more local.

“The report allows people to see how the health of their county as a whole compares to other counties within a state,” said Wendel Brunner, Contra Costa public health director. “What the report doesn’t show are big differences among communities within counties.”

Contra Costa tallied 19th in overall health outcomes and 13th in overall health factors.

Dr. Brunner said the county drills down deeper to examine neighborhood distinctions. For example, a Contra Costa Health Services study created a food retail index demonstrating that many communities have no access to healthy food. A 2005 report showed that some Contra Costa communities suffer disproportionate consequences because of diesel emissions. CCHS data shows that children less than 15 years old living in San Pablo and Richmond have higher hospitalization rates for asthma than children in the county as a whole.

With income levels weighing heavily in the University of Wisconsin rankings, many counties down on the list come from the rural stretches of California.

Poverty means not having the money for preventive health care, as noted by health officials in Madera County, reported in the Fresno Bee.

“The fact that Kern may have a lower income per capita doesn’t necessarily pose a challenge to us,” said Constantine, director of public health for Kern County. “We have some very aggressive methods to get that information to all different types and segments of the population. We have a very active health promotion team with individuals who speak multiple languages.

“We do traditional campaigns with billboards and other advertisements. We also produce our own local TV shows that are run on a public channel and also on some other channels. We have folks who are active in nonprofits and faith-based organizations. We go to them and they come to us. We do Facebook and Twitter, so there are multiple methods to achieve that.”

Diversity of population and low population density make it incumbent on public health officials to be aggressive in outreach campaigns.

“In our H1N1 efforts, we were very successful not only in creating an awareness and creating protective measures that the public needs to take, but in providing useful information for the public about ‘this is how you can help yourself, where you can obtain the vaccine free of charge,’” said Constantine.

He also cited last year’s public information campaign on the West Nile virus.
Constantine said, “We had an active campaign in which we sent individuals to sporting events to find folks receptive to the message” — outdoor activists who might be in harm’s way at risk of contracting the virus from mosquitoes.