County Health Rankings Show Stark Differences in Premature Death Rates Between Rural and Urban Counties

    • March 16, 2016

Princeton, N.J. and Madison, Wis.—The 2016 County Health Rankings released today compare health differences on a broad range of measures among almost every county throughout the country. The report shows dramatic differences between rural and urban counties on a number of measures, most notably premature death rates. Rural counties not only have higher rates of premature death, but also nearly 1 in 5 rural counties saw rises in premature death rates over the past decade while most large urban counties experienced consistent improvement. 

Rural counties have higher rates of smoking, obesity, child poverty and teen births, and higher numbers of uninsured adults than their urban counterparts. Large urban counties have lower smoking and obesity rates, fewer injury deaths and more residents who attended some college. 

The County Health Rankings, a collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI), compare counties within each state on more than 30 factors that impact health, including such social determinants as education, jobs, housing, exercise, commuting times and more. Over the past seven years the Rankings, available at, have become an important tool for local communities working to build a Culture of Health. 

"The County Health Rankings show how important it is to examine all the conditions that impact well-being and can help families thrive,” said Risa Lavizzo-Mourey, MD, RWJF president and CEO. “Communities around the nation are using the County Health Rankings to drive improvements in education, housing, job training, healthy food options and more, as they work to build a Culture of Health."

The 2016 Rankings Key Findings Report includes several new health-related measures: residential segregation, drug overdose deaths and insufficient sleep. 

  • Residential segregation between African-Americans and whites, a fundamental cause of health disparities, is highest in counties in the Northeast and Great Lakes regions and lowest along the Southeastern seaboard. In areas where African-American and white residential segregation is highest there are typically vast differences in health, well-being, opportunity and quality of life. 
  • Drug overdose deaths have increased 79 percent nationwide since 2002 and are reaching epidemic proportions in parts of the U.S. The highest death rates are in counties in northern Appalachia and parts of the West and Southwest. 
  • 1 out of 3 adults don’t get enough sleep—less than 7 hours a night—with implications for health and productivity. Lack of sleep is tied to higher levels of stress and depression, hypertension, heart and kidney disease, motor vehicle accidents and suicide. The highest rates of insufficient sleep are found in counties in the Southeastern U.S., while the lowest rates are in the Plains states. 

This year’s Rankings data also takes a closer look at health gaps in each state, comparing how the top performing counties stack up against the bottom performing counties on key measures. Enormous differences in health outcomes can exist within a state. 

The Rankings data are only as valuable as the action it inspires and the lives it improves,” said Bridget Catlin, PhD, MHSA, co-director of the County Health Rankings. “Whether it’s addressing health gaps between counties or the concentration of poverty in rural and residentially segregated communities of color—targeting resources to the people and places in greatest need is essential to building a Culture of Health. The Rankings are an important springboard for conversations on how to expand opportunity for all to be healthy.

County Health Rankings & Roadmaps tools, which includes a database of evidence-informed approaches, personalized coaching, and a range of other resources, can assist communities in their efforts to improve health. Visit to learn more. 


About the Robert Wood Johnson Foundation 

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working with others to build a national Culture of Health enabling everyone in America to live longer, healthier lives. For more information, visit www.rwjf.orgFollow the Foundation on Twitter at or on Facebook at

About the University of Wisconsin Population Health Institute 

The University of Wisconsin Population Health Institute advances health and well-being for all by developing and evaluating interventions and promoting evidence-based approaches to policy and practice at the local, state, and national levels. The Institute works across the full spectrum of factors that contribute to health. A focal point for health and health care dialogue within the University of Wisconsin-Madison and beyond, and a convener of stakeholders, the Institute promotes an exchange of expertise between those in academia and those in the policy and practice arena. The Institute leads the work on the County Health Rankings & Roadmaps and manages the RWJF Culture of Health Prize. For more information, visit

Media Contacts

Melissa Blair

Robert Wood Johnson Foundation (609) 627-5937

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