Princeton, N.J. and Madison, Wis.—For nearly a decade, the County Health Rankings have shown that where we live makes a difference in how well and how long we live. This year, our analysis shows that meaningful health gaps persist not only by place but also by race and ethnicity. These health gaps are largely influenced by differences in opportunities that disproportionately affect people of color, such as access to quality education, jobs, and safe, affordable housing.
This year’s report shows some troubling trends. For example, after nearly a decade of improvement, we are seeing more babies born at low birthweight (8.2% in 2016, a 2% increase from 2014)—low birthweight is a key indicator of quality of life for mothers and babies. A pattern of disparity by race in low birthweight can be seen across the nation, with poor birth outcomes more likely among blacks. Compared to white babies, black babies are twice as likely to be born at low birthweight and about twice as likely to die before their first birthday.
“We can’t be a healthy, thriving nation if we continue to leave entire communities and populations behind,” said Richard Besser, MD, RWJF president and CEO. “Every community should use their County Health Rankings data, work together, and find solutions so that all babies, kids, and adults—regardless of their race or ethnicity—have the same opportunities to be as healthy as possible.”
The County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI), compares counties within each state on more than 30 health-influencing factors such as education, jobs, and access to quality health care. The Rankings are available at www.countyhealthrankings.org.
One of the connections this report illuminates between race and place is that segregated communities of color are more likely to be cut off from investments that promote good schools, affordable housing, and other opportunities for health. The U.S. has a long history of racism and discriminatory policies and practices that have limited the opportunities of people of color in choosing where to live, including practices like denying housing loans to people of color. Poor health exists in places segregated from opportunity. Decades of research show that residential segregation is a fundamental cause of health disparities in the U.S. This year’s report shows blacks in more segregated counties fare worse in rates of child poverty, infant mortality, and high school graduation than those in less segregated counties.
“As an organization committed to improving health and well-being, we can’t tolerate the reality that some American’s don’t have the same opportunity to be healthy because of where they live, how much money they make, or the color of their skin,” said Besser. “As a nation, we will be healthier and stronger together when we remove barriers to opportunity for everyone in America.”
This year’s Rankings explores important trends happening among the nation’s children and youth:
- Teen Births: There are strong ties between poverty and births among teens. Teen birth rates have been declining across community types and racial groups for more than a decade, with most recent data showing a U.S. rate of 27 per 1,000 females, ages 15-19. Hispanic teens have seen the most improvement in birth rates, falling from 77.7 to 31.9 births per 1,000 females—ages 15-19, from 2006 to 2016. Black and American Indian/Alaskan Native teens have also seen notable improvements. Teen birth rates are highest among counties in the Southwest and Southeast as well as parts of Appalachia, the Mississippi Delta, and the Plains regions. These regions have seen little change over the last decade, while the East and West Coasts have seen improvements.
- Children in Poverty: Poverty limits opportunities and increases the chance of poor health. Today, 1 in 5 children grow up in poverty. Available data show that, for the majority of U.S. counties, child poverty rates for American Indian/Alaskan Native, black, or Hispanic children are higher than rates for white children, and these rates are often twice as high.
“The time is now to address long-standing challenges like child poverty and residential segregation,” said Julie Willems Van Dijk, PhD, RN, director of County Health Rankings & Roadmaps. “This year’s Rankings are a call to action to see how these persistent health gaps play out locally, take an honest look at their root causes, and work together to give everyone a fair shot at a healthier life.”
The Rankings website also features What Works for Health, a database of nearly 400 evidence-informed strategies to support local changemakers as they take steps toward building healthy communities. Each strategy is rated for its evidence of effectiveness and likely impact on health disparities. The Rankings’ Take Action Center and Community Coaches also provide valuable guidance for local leaders and community partners to move with data to action. Visit www.countyhealthrankings.org to learn more.