Philadelphians ranked least healthy in state

To be healthy, it helps to be wealthy - or at least not poor.

That was brought home in stark fashion yesterday by a new report that ranks Chester County residents the healthiest in Pennsylvania, and Philadelphians the least healthy. Camden County came out near the bottom in New Jersey.

The findings were not a surprise to health-policy experts, who say factors such as obesity, education, and exposure to crime and pollution - all related to poverty - are at least as important as good medical care for maintaining health.

The report, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin's Population Health Institute, is touted as the first to rank the overall health of every county in the nation. It allows for comparisons on multiple measures at www.countyhealthrankings.org.

Some are within individuals' power to change.

"All health is local, ultimately," said Jennifer Kolker, an assistant professor of health management and policy at Drexel University's School of Public Health. "If you think about smoking and binge drinking and motor-vehicle death rates" - all measures that are part of the report - "you can think, maybe not talking on your cell phone while driving . . . is a good idea."

The study examines more than 3,000 counties, but compares them only within state lines. It provides two rankings, both based on a combination of publicly available data.

The "health-outcomes" ranking relies on five measures of morbidity and mortality - how sick people are and how long they live.

The "health-factors" ranking combines 23 measures in four categories - behaviors such as smoking and diet; clinical measures that affect care, such as access to insurance and diabetes screening; socio-economic factors that include income and crime; and physical-environment issues, such as air pollution and availability of healthy foods.

Relationships between outcomes and health factors show up in state after state. The Bronx borough of New York City ranked dead last in the state on both scales, while affluent Nassau and Westchester Counties were near the top.

In New Jersey, the wealthier northern parts of the state did better on both measures than most of South Jersey, although Burlington County was in the top half on both. Hunterdon County was healthiest, and Camden County, while low, was not the worst - rural Cumberland County was, on both measures.

That pattern was also seen around the country. Large swaths of rural, lower-income Pennsylvania did poorly, while the wealthiest metropolitan counties - Chester, Bucks, and Montgomery - did best. Delaware County was in the vast middle. Philadelphia, which has both sophisticated medical care and high poverty rates, placed at the bottom of both scales.

"It's ironic," said David B. Nash, dean of Thomas Jefferson University's new School of Population Health. The city has "a concentration of all the academic medical centers, of course, but the outcomes are poor because, when you look at a population's health, the measures are not directly related to health care."

The study, which analyzed data collected before the economic downturn, found few differences locally in rates of people without health insurance. Access to care has dominated and stymied health-care debates in Washington. Nash, however, thinks real change would be "much more basic, but much more difficult for our society to get our arms around."

"We have a disease-based system, not a prevention- and wellness-based health-care system," he said. Such a system might pay supermarkets to bring fresh produce into poor neighborhoods and reward doctors for preventing illness, not just treating it.

Nash, who was not involved with the new report, said he hoped it would help inform next week's get-together between President Obama and congressional leaders seeking a breakthrough in health-care legislation.

Patrick Remington, the study's coauthor and an associate dean at the University of Wisconsin School of Medicine and Public Health, suggested that the report could "mobilize community leaders to learn what is making their residents unhealthy" and to take appropriate action.

"Cancer, heart disease, and stroke are all partially attributable to tobacco," said Drexel's Kolker, who was not involved with the study.

"In Bucks County, even, 18 percent of adults are smoking. That's pretty high. And 23 percent are obese. That's pretty high," Kolker said, clicking on the county-by-county snapshots online.

"Any time you get a local community to look at itself, you make some headway."