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More Americans are dying prematurely across the U.S.

Introduction

The County Health Rankings & Roadmaps program helps communities identify and implement solutions that make it easier for people to be healthy in their neighborhoods, schools, and workplaces. Ranking the health of nearly every county in the nation, the County Health Rankings illustrate what we know when it comes to what is keeping people healthy or making people sick and how the opportunity for good health differs from one county to the next. Supporting a call to action, the Roadmaps show what we can do to create healthier places for everyone to live, learn, work, and play. The Robert Wood Johnson Foundation collaborates with the University of Wisconsin Population Health Institute to bring this program to communities across the nation.

Summary of Key Findings

Now in its eighth year, the County Health Rankings continue to bring revealing data to communities across the nation.

  • More Americans are dying prematurely, notably among our younger generations
    • Premature death rates rose across urban and rural community types and racial/ethnic groups in 2015. Premature death has consistently been highest in rural counties and among American Indian/Alaskan Native and black populations.
    • In recent years, premature death increased most among those ages 15–44.
  • Drug overdose and other injury deaths heavily influenced the rise in premature death
    • Drug overdose was by far the single leading cause of premature death by injury in 2015 and contributed to the accelerated rise in premature death from 2014 to 2015.
    • Large suburban metro counties went from having the lowest to the highest rate of premature death due to drug overdose within the past decade.
    • For those ages 15–24, an increase in drug overdose deaths was part of the equation, but more deaths due to motor vehicle crashes and firearm fatalities also played a role in the accelerated rise in premature death.
  •  A focus on opportunities for youth and young adults
    • Disconnected youth (a new measure this year) are youth and young adults ages 16–24 who are not in school and not working, and represent untapped potential to strengthen the social and economic vibrancy of local communities. In 2015, there were about 4.9 million youth – or 1 out of 8 – not in school or working.
    • Youth disconnection is most prevalent among American Indian/Alaskan Native, black, and Hispanic youth. Rates of youth disconnection are higher in rural counties than in urban counties. Places with high levels of youth disconnection have higher rates of unemployment, child poverty, children in single-parent households, teen births, and lower levels of educational attainment – all barriers to a successful transition from youth to healthy adulthood.

More Americans Are Dying Prematurely Across the U.S.

The County Health Rankings measure the health of communities by examining how long people live and how healthy they feel. Rather than examine overall death rates, we look at deaths that occur among people under age 75. These deaths are considered premature because loss of life prior to age 75 is often preventable.

Years of Potential Life Lost (YPLL) before age 75 is the measure of premature death used in the Rankings. More years of life are lost when deaths occur among younger age groups. Learn more about YPLL.

Key Findings

  • After years of improvement, premature death rates began to rise steadily in 2012 and then accelerated from 2014 to 2015 (representing a 1 percent increase).
  • In 2015, more than 1.2 million people died prematurely –this was 39,700 more people than in the previous year.
  • There are significant disparities in who is most affected by premature death. Premature death has consistently been highest among American Indians/Alaskan Natives and blacks. In 2015, these groups experienced a higher rate of years of life lost than other racial and ethnic groups.
  • Rural counties continued to have the highest premature death rates, followed by smaller metro areas, carrying on the trend we first reported in the 2016 Key Findings Report.
  • Premature death rose in 2015 across the full range of racial and ethnic groups and community types.

Younger Generations of Americans Are Dying Prematurely

To further understand the accelerated rise in premature death, we looked at which age groups and causes of death were contributing to the increase from 2014 to 2015. We found that younger generations are losing their lives too soon and the largest contributor was an increase in injury deaths.

Injury deaths can be intentional, including homicides and suicides, or unintentional, meaning they were unplanned events, such as drug overdoses, motor vehicle crashes, falls, or suffocation.

Key Findings

  • Eighty-five percent of the increase in premature death (YPLL) was due to more deaths among youth and young adults ages 15–44.
  • From 2014 to 2015, a rise in injury deaths contributed substantially (more than 70 percent) to the increase in premature death (YPLL).
  • Looking at the number of deaths across the age groups of 15–44, unintentional injury deaths, homicides, and suicides have increased in recent years.
  • Early deaths due to chronic conditions such as cancer, heart disease, and HIV have decreased over the past decade.
  • Trends among the leading causes of death hold true across all community types, particularly the recent increase in unintentional injury deaths and suicides.

Drug Overdose and Other Injury Deaths Influenced the Rise in Premature Death

Drug Overdose is a Major Contributor to the Rise in Premature Death Across the U.S.

The U.S. continues to experience an epidemic of drug overdose deaths. From 2000 to 2015 more than half a million people died from drug overdoses, the majority (55 percent of these deaths) occurring from 2009 to 2015. While injury deaths due to drug overdoses, motor vehicle crashes, and firearms have consistently been leading contributors to premature death, as indicated in the graphic, drug overdose was by far the single leading cause of premature death by injury in 2015.

Key Findings

  • Premature deaths due to drug overdose have risen over the past decade with an accelerated rate in recent years. In comparison, trends show reductions in premature death due to motor vehicle crashes, and little progress in trends involving firearms and all other injury methods. But, recent data also suggest an increase in premature death due to these methods of injury.
  • Premature death due to drug overdose increased across community types, with large suburban metro, smaller metro, and rural counties having the highest rates.
  • Large suburban metro counties went from having the lowest to the highest rate of premature death due to drug overdose within the past decade.
  • Premature death due to drug overdose was highest among whites (778 years of potential life lost per 100,000) and American Indian/Alaskan Natives (736 years of potential life lost per 100,000) in 2015.

How Did We Select These Strategies?

Evidence-informed strategies included in this report represent those that have demonstrated consistently favorable results in robust studies or reflect recommendations by credible experts supported by early research. To learn more about evidence-informed strategies that can make a difference, visit What Works for Health.

Taking Action to Address the Drug Overdose Crisis

How Can Drug Overdose be Prevented?

Manchester Recovery Community Center

Communities can take action to address the overdose crisis. Evidence suggests that tracking prescriptions, increasing access to naloxone, and offering non-violent offenders options like treatment instead of jail time can all make a difference.

Ensuring appropriate dispensing and disposal of drugs and offering legal immunity for those who act in good faith to summon emergency services during an overdose (i.e., Good Samaritan laws) can also improve outcomes.

Communities Taking Action

Responding to a sudden rise in drug overdose deaths, Manchester, NH built partnerships and a broad approach to solutions, including an innovative initiative where people addicted to drugs may go to any of Manchester’s fire stations and are directed to treatment without fear of being arrested. In the first 10 months of the Safe Station program there were over 1,300 visits. Twelve people came in on Father’s Day. “They wanted to get better to be with their kids,” said Mayor Ted Gatsas. Since the Safe Station Program began, 70 percent of participants have entered into treatment. To learn more, visit www.rwjf.org/prize.

For Younger Americans, a Rise in Injury Deaths Contributed to More Early Deaths

For youth and young adults ages 15–24, drug overdose deaths impacted this age group, but more lives were lost due to other forms of injury death.
In 2015, these injury deaths most commonly occurred due to motor vehicle crashes and firearms, followed by drug overdoses.

Key Findings

  • Unintentional injuries, suicides, and homicides have consistently been the leading causes of death among 15–24 year olds.
  • Compared to drug overdose deaths, there were more than three times as many injury deaths due to motor vehicle crashes and firearms among youth and young adults ages 15–24 in 2015.

Taking Action to Prevent Early Deaths Due to Injury

Reducing the number of lives lost too soon requires a comprehensive approach to complex, often related issues.
Below are a number of evidence-informed approaches that communities across the country are employing. Communities are working together toward:

  • Preventing and mitigating childhood and youth exposure to neglect, abuse, and violence, and promoting safe, stable, and nurturing families through efforts like early childhood home visiting and intimate partner violence prevention.
  • Creating safe spaces for dialogue among youth about mental health and suicidal behavior to prevent self-harm through school-based social and emotional instruction.
  • Improving and expanding access to quality mental and behavioral health services for at-risk children and adults to reduce their risk of suicide and harm to others.
  • Reducing access to lethal methods of self-harm through safe storage of, and careful access to, medications and firearms.
  • Preventing crime and violence within schools and neighborhoods, and supporting community-based outreach and partnership with law enforcement.
  • Encouraging and enforcing safe motor vehicle travel, especially to reduce alcohol-impaired and distracted driving, and modifying the built environment to improve traffic safety.

To learn more about evidence-informed strategies that can make a difference, visit What Works for Health.

Injury Deaths Vary by Community Type and Race/Ethnicity

Key Findings

  • Youth and young adults living in rural areas had the highest rates of injury death due to suicide or unintentional injuries, while those living in urban areas had the highest rates of homicide but lower rates of injury death overall.
  • Youth and young adults in rural areas died from unintentional injuries at more than twice the rate of those in urban areas who died as a result of homicide (41 vs. 18 deaths per 100,000).
  • Among white and Hispanic youth and young adults, most injury deaths were unintentional. Among Asian/Pacific Islanders and blacks, a greater share of injury deaths were due to suicide and homicide.
  • The rate of injury death was highest among American Indian/Alaskan Native (96 deaths per 100,000) and black (79 deaths per 100,000) youth and young adults, and lowest among Asian/Pacific Islanders (23 deaths per 100,000) in 2015.

A Focus on Opportunities for Youth and Young Adults

How we shape our communities has a meaningful impact on how long and how well we live. For each stage of life, but especially for children and youth, a person’s chance of lifelong health and well-being is largely determined by the opportunities they have.

New Measure: Disconnected Youth

This year, we added a measure of disconnected youth, defined as those ages 16–24 who are not in school and not working. These years represent a critical stage in an individual’s journey toward independence, self-sufficiency, and civic engagement in adulthood.

Disconnection can have health and economic costs not just for youth, but for their communities. Youth disconnected from opportunity – meaning the chance to advance in school, gain work experience, form relationships, and build social supports in the community – represent untapped potential to strengthen the social and economic vibrancy of our communities.

Key Findings

  • There are about 4.9 million youth and young adults – 1 in 8 – not working or in school. These youth and young adults are disconnected from opportunities to live long and healthy lives.
  • Rates of youth disconnection are highest among American Indian/ Alaskan Native, black, and Hispanic youth.
  • Rates of youth disconnection are higher in rural counties (21.6 percent) than in urban counties (13.7 percent), particularly rural counties in the South and West.
  • Places with high levels of youth disconnection have higher rates of unemployment, child poverty, children in single-parent households, and teen births, and lower educational attainment.

Communities Taking Action

Louisville, KY is helping youth thrive through IDEAS xLab’s Project HEAL which uses art expression to expand hope for the future and fosters youth-led community leadership through initiatives including Photovoice, poetry writing workshops, a kid vision committee with Steam Exchange, and One Poem At A Time. Also, young people are expanding the skills needed for greater career options through YouthBuild. Based on a national model, youth ages 18 to 24 can earn their high school diploma and get training in several career tracks, including construction and environmental design. Since 2000, 88 percent of participants have completed high school, GED, or career certification and 83 percent have entered college or the workforce. Louisville is building power among young adults with valuable professional and educational skills that help them reach their full potential. To learn more, visit www.rwjf.org/prize.

Communities Taking Action

In Miami, FL local residents and businesses banded together with leaders in healthcare, education, and human services to provide a cradle to career support system called the Miami Children’s Initiative. The initiative started with a 29 block impact zone surrounding an elementary and middle school in Liberty City and now includes early-learning centers, after-school and summer programs, and workshops and social and emotional support for parents/caregivers. This initiative has helped improve the local elementary school rating from an F to a B, helped local residents gain employment and, most importantly, provided over 100 parents living in the neighborhood with parenting classes. To learn more, visit www.rwjf.org/prize.

Cultivating Opportunity and Health for Youth and Young Adults

Youth and young adults can thrive when communities engage them as leaders. Employers, educators, and other community leaders can help create new and better opportunities for younger generations by:

  • Increasing community and school-based supports and services that will raise school attendance and high school graduation rates.
  • Offering alternative learning models and training opportunities to help students develop social and work-ready skills that will advance their education and career potential.
  • Providing employment experiences that will help prepare youth and young adults to get and keep good jobs.

The challenges of youth disconnection and child poverty are often linked, and evidence shows that early childhood supports like investments in preschool and kindergarten programming, and childcare subsidies that can help establish safe and financially stable ho mes can make a difference in cultivating opportunity and health beginning in early life stages.

To learn more about evidence-informed strategies that can make a difference, visit What Works for Health.

Communities Taking Action

As part of Menominee Nation’s trauma-informed care model, schools have established safe zones in classrooms where students can focus on developing positive coping skills. Populations that have experienced historical trauma, such as American Indians, suffer from higher rates of premature death, injuries, and social and economic barriers to good health. Addressing the roots of challenging issues with a trauma-informed approach enabled Tribal members to turn around a drop-out crisis. In 2008, fewer than 60 percent of the students who started as freshmen graduated from Menominee Indian High School. In the 2015 to 2016 school year, the graduation rate was 92 percent. To learn more, visit www.rwjf.org/prize.

Credits

Recommended citation

University of Wisconsin Population Health Institute. County Health Rankings Key Findings 2017.

Lead Authors

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

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

Research Assistance

Paige Andrews
Kathryn Hatchell
Melissa Marver
Elizabeth Pollock
Matthew Rodock, MPH
Anne Roubal, PhD
Alison Bergum, MPA
Kiersten Frobom
Lael Grigg, MPA
Bomi Kim Hirsch, PhD
Jessica Rubenstein, MPA, MPH
Jessica Solcz, MPH

Outreach Assistance

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

 
Communications and Website Development

Burness
Forum One
Kim Linsenmayer, MPA
Matthew Call
Komal Dasani
Samuel Hicok
James Lloyd

Data

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

Robert Wood Johnson Foundation

Katrina Badger, MPH, MSW
Abbey Cofsky, MPH
Andrea Ducas, MPH
Michelle Larkin, JD, MS, RN
Jessica Mark, MPH
James Marks, MD, MPH
Joe Marx
Donald Schwarz, MD, MPH
Amy Slonim, PhD
Kathryn Wehr, MPH

Scientific Advisory Group

Patrick Remington, MD, MPH, Chair
Renée Branch Canady, PhD, MPA
Jim Chase, MHA
Maggie Super Church, MSc, MCP
Tom Eckstein, MBA
Kurt Greenlund, PhD
James Holt, PhD, MPA
C. Tracy Orleans, PhD
Ana Diez Roux, MD, PhD
Rebecca Tave Gluskin, PhD
Steven Teutsch, MD, MPH
Trissa Torres, MD, MSPH, FACPM

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