Differences in Health Outcomes within States by Place and Racial/Ethnic Groups

How Do Counties Rank for Health Outcomes?

Health outcomes in the County Health Rankings represent measures of how long people live and how healthy people feel. Length of life is measured by premature death (years of potential life lost before age 75) and quality of life is measured by self-reported health status (% of people reporting poor or fair health and the number of physically and mentally unhealthy days within the last 30 days) and the % of low birth weight newborns.

The green map above shows the distribution of Maryland's health outcomes, based on an equal weighting of length and quality of life. The map is divided into four quartiles with less color intensity indicating better performance in the respective summary rankings. Specific county ranks can be found in your county's Snapshot.

How Do Health Outcomes Vary by Race/Ethnicity?

Length and quality of life vary not only based on where we live, but also by our racial/ethnic background. In Maryland there are differences by race/ethnicity in length and quality of life that are masked when we only look at differences by place. The table below presents the five underlying measures that make up the Health Outcomes Rank. Explore the table to see how health differs between the healthiest and the least healthy counties in Maryland, and among racial/ethnic groups.

Differences in Health Outcome Measures Among Counties and for Racial/Ethnic Groups in Maryland


Healthiest MD County

Least Healthy MD County






Premature Death (years lost/100,000)








Poor or Fair Health (%)








Poor Physical Health Days (avg)








Poor Mental Health Days (avg)








Low Birthweight (%)








American Indian/Alaskan Native (AI/AN), Asian/Pacific Islander (Asian/PI)
​N/A = Not available. Data for all racial/ethnic groups may not be available due to small numbers

Across the US, values for measures of length and quality of life for American Indian, Black and Hispanic residents are regularly worse than for Whites and Asians. For example, even in the healthiest counties in the US, Black and American Indian premature death rates are about 1.5 times higher than White rates. Not only are these differences unjust and avoidable, they will also negatively impact our changing nation’s future prosperity.

Changing the Course in Kansas City

A decade ago, public health officials identified an 8-year gap in life expectancy between the city's White and Black populations. Segregation and discrimination over the past century fueled this disparity, but community residents and city leaders joined forces to tackle tough conversations on race, stem the violence, increase educational opportunities, improve access to care, and ensure economic justice. Today the disparity in life expectancy has been reduced to 6.9 years.

Learn more at rwjf.org/prize.


Differences in Health Factors Within States by Place and Racial/Ethnic Groups

How Do Counties Rank for Health Factors?

Health factors in the County Health Rankings represent the focus areas that drive how long and how well we live, including health behaviors (tobacco use, diet & exercise, alcohol & drug use, sexual activity), clinical care (access to care, quality of care), social and economic factors (education, employment, income, family & social support, community safety), and the physical environment (air & water quality, housing & transit).

The blue map above shows the distribution of Maryland’s health factors based on weighted scores for health behaviors, clinical care, social and economic factors, and the physical environment. The map is divided into four quartiles with less color intensity indicating better performance in the respective summary rankings.

What are the Factors That Drive Health and Health Equity?

Health is influenced by a range of factors. However, social and economic factors, like connected and supportive communities, good schools, stable jobs, and safe neighborhoods, are foundational to achieving long and healthy lives. These social and economic factors also influence other important drivers of health and health equity. Social and economic factors impact our ability to make healthy choices, afford medical care or housing, and even manage stress leading to serious health problems. The choices we make are based on the choices we have.

Across the nation, there are meaningful differences in social and economic factors among counties and among racial/ethnic groups. Even within counties, policies and practices marginalize many racial and ethnic groups, keeping them from resources and supports necessary to thrive. Limited access to opportunities is what creates disparities in health, impacting how well and how long we live.

How Do Social and Economic Opportunities for Health Vary in Maryland?

Social and economic factors vary depending on where we live and by our racial/ethnic background. The following four data graphics illustrate differences among counties and by racial/ethnic groups in social and economic opportunities for health in Maryland. These graphics show that it is important to explore differences by place and race/ethnicity in order to tell a more holistic story about the health of your community.

This report explores state-wide data. To dive deeper into your county data, visit your county Snapshot.

Consider these questions as you look at the data graphics throughout this report:

  • What differences do you see among counties in your state?
  • What differences do you see by racial/ethnic groups in your state?
  • How do counties in your state compare to all U.S. counties?
  • What patterns do you see? For example, do some racial/ethnic groups fare better or worse across measures?

Spartanburg County Closing the Gap

Community leaders in Spartanburg County, SC took a good hard look at their data in 2008 and discovered they had the worst teen birth rate in the whole state. Deciding to face this issue head on, they brought together teens, providers, parents, and partners to create solutions - a warm welcoming teen center, accessible and respectful reproductive health care, and open discussions about sexuality. Recent data show improvements - rates have receded by 50% from 2010 to 2016 for all 15-19 year olds. And while disparities in teen births among racial/ethnic groups in SC continue, the gap has closed for teen births among Black and White females in Spartanburg County (in 2016, 23.3 per 1,000 and 23.9 per 1,000, respectively).

Learn more at rwjf.org/prize.

What Communities Can Do to Create Opportunity and Health for All

This report shows some of the differences in opportunity for people in Maryland based on where they live and their race or ethnicity. But how can you turn this information into action? Below are some evidence-informed approaches to consider as your community moves forward:

Invest in education from early childhood through adulthood to boost employment and career prospects

  • Strengthen parents’ skills, including ways to foster children’s learning and development in home and community settings
  • Undertake policy initiatives to improve pre-K-12 education in the classroom, school, district, or state level, focusing on raising school attendance and high school graduation rates
  • Implement community and school-based supports that will improve access to and quality of early childhood care and education, beginning in infancy
  • Offer alternative learning models and technology to help students develop social and work-ready skills
  • Support higher education opportunity for all through college application assistance and financial aid

Increase or supplement income and support asset development in low income households

  • Increase public and private sector wages and offer benefits for low-income earners through living wages and paid leave
  • Expand eligibility for earned-income tax credits and increase credit amount
  • Assist parents by expanding refundable child care tax credits and increasing child care subsidies

What Works for Health

To learn more about specific strategies that can support your work, visit What Works for Health, a living resource of evidence-informed policies and programs to make a difference locally. You can search for policies and programs that have been tested or implemented in communities like yours, or adapt strategies that have been tested elsewhere but seem like a good ‘fit’. You can also learn about each strategy’s likely impact on disparities. Visit What Works for Health.

Ensure that everyone has adequate, affordable health care coverage and receives culturally competent services and care

  • Make health care services accessible and available in community, school, and clinical settings, including medical, dental, vision, mental health care, and long-term care
  • Increase access to sex education and contraceptives in school, clinic, and community settings
  • Increase patients' health-related knowledge via efforts to simplify health education materials, improve patient-provider communication, and increase literacy
  • Provide culturally-sensitive care coordination and system navigation, including language interpretation and care tailored to patients’ norms, beliefs, and values

Foster social connections within communities and cultivate empowered and civically engaged youth

  • Establish positive relationships among youth and adult mentors and provide youth with leadership opportunities in schools, community groups, and local governments
  • Create safe places to convene, such as community centers, with activities, programs, and supportive technologies for all ages and abilities
  • Support information sharing, collaboration, and networking to inform decision-making using social media and in-person approaches

Communities Driving Local Change

We can work together to reshape the policies, programs, and practices that have marginalized some and, without action, will perpetuate health disparities. We can create environments where people are treated fairly, where everyone has a voice in decisions that affect them, and where all have a chance to succeed.

The 35 RWJF Culture of Health Prize winners are prime examples of making this a reality. Here are links to examples of how several communities are cultivating a shared belief in good health for all.

Moving With Data to Action

County Health Rankings & Roadmaps offers a range of community supports including data, evidence, guidance and stories to support communities moving from awareness to action.

  • CHR&R provides a snapshot of a community’s health and a starting point to explore ways to improve health and increase health equity. Use the Data will help you learn more about the data and find other sources as you begin to assess your needs and resources and focus on what's important.
  • Our Partner Center helps changemakers in all sectors make connections and leverage collective power to put ideas into action. 
  • Our Action Center provides step-by-step guidance to help communities assess their needs, drive local policy and systems changes, and evaluate the impacts of their health improvement efforts. Our team of community coaches are available to communities across the nation to guide local collaborations and individuals to accelerate learning and action.

Guidance in the Action Center focuses on areas like:

  • Working together is at the heart of making meaningful change. When people share a vision and commitment to improve health, it can yield better results than working alone. CHR&R’s Work Together guide can help you build and sustain partnerships that reflect the diversity of your community. Together you can identify the challenges and solutions that can make a difference.
  • Taking time to choose policies and programs that have been shown to work and that are a good fit for your community will maximize your chances of success. CHR&R’s Choose Effective Policies & Programs guide can help you explore and select strategies to address priority issues.
  • Once you have decided what you want to do, the next step is to make it happen. CHR&R’s guide to Act on What’s Important can help your community build on strengths, leverage available resources, and respond to unique needs.
  • What you say and how you say it can motivate people to take the right action at the right time. CHR&R’s Communicate guide can help you to develop strategic messages and deliver those messages effectively.

Technical Notes and Glossary of Terms

2018 Rankings for this state



Suggested citation
University of Wisconsin Population Health Institute. County Health Rankings 2018.
Report Authors

University of Wisconsin-Madison
School of Medicine and Public Health
Department of Population Health Sciences
Population Health Institute

Marjory Givens, PhD, MSPH
Amanda Jovaag, MS
Julie Willems Van Dijk, PhD, RN, FAAN

This publication would not have been possible without the following contributions:

Research Assistance

Courtney Blomme, RD
Keith Gennuso, PhD
Elizabeth Pollock, PhD
Joanna Reale
Jennifer Robinson
Matthew Rodock, MPH
Anne Roubal, PhD, MS
Alison Bergum, MPA
Lael Grigg, MPA
Bomi Kim Hirsch, PhD
Jessica Rubenstein, MPA, MPH
Jessica Solcz, MPH
Kiersten Frobom


Centers for Disease Control and Prevention: National Center for Health Statistics
Dartmouth Institute for Health Policy & Clinical Practice
Measure of America

Outreach Assistance

Kate Kingery, MPA
Kitty Jerome, MA
Kate Konkle, MPH
Raquel Bournhonesque, MPH
Ericka Burroughs-Girardi, MA, MPH
Aliana Havrilla, MPIA
Antonia Lewis, MPH
Karen Odegaard, MPH
Justin Rivas, MPH, MIPA
Attica Scott, MS
Jerry Spegman, JD
Janna West Kowalski, MS
Astra Iheukumere, MPA, MBA
Carrie Carroll, MPA
Olivia Little, PhD
Devarati Syam, PhD

Communications & Website Development

Forum One
Kim Linsenmayer, MPA
Matthew Call
Komal Dasani, MPH
Lindsay Garber, MPA
Samuel Hicok
James Lloyd, MS

Robert Wood Johnson Foundation