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 (percent 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 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. 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, and among racial/ethnic groups.

Differences in Health Outcome Measures among Counties and for Racial/Ethnic Groups in Florida

 

Healthiest FL County

Least Healthy FL County

AI/AN

Asian/PI

Black

Hispanic

White

Premature Death (years lost/100,000)

5,700

17,500

5,800

3,300

9,600

4,500

7,900

Poor or Fair Health (%)

11%

24%

21%

11%

19%

26%

16%

Poor Physical Health Days (avg)

3.4

4.6

3.9

2.0

3.7

3.6

4.0

Poor Mental Health Days (avg)

3.4

4.6

6.4

2.0

3.5

3.1

4.2

Low Birthweight (%)

7%

10%

7%

9%

13%

7%

7%

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

    

Health Outcomes

This graphic compares measures of length and quality of life by place (Health Outcomes ranks) and by race/ethnicity. To learn more about this composite measure, see the technical notes below.

Taken as a whole, measures of length and quality of life indicate:

  • American Indians/Alaskan Natives are most similar in health to those living in the middle 50% of counties.
  • Asians/Pacific Islanders are healthier than those living in the top ranked county.
  • Blacks are most similar in health to those living in the least healthy quartile of counties.
  • Hispanics are most similar in health to those living in the healthiest quartile of counties.
  • Whites are most similar in health to those living in the middle 50% of counties.

Across the US, values for measures of length and quality of life for Native American, 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 1.4 times higher than White rates. Not only are these differences unjust and avoidable, they will also negatively impact our changing nation’s future prosperity.

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 health factors based on weighted scores for health behaviors, clinical care, social and economic factors, and the physical environment. Detailed information on the underlying measures is available on our website. 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 and How Does Housing Play a Role?

Health is influenced by a range of factors. 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 interact with other important drivers of health and health equity. For example, housing that is unaffordable or unstable can either result from poverty or exacerbate it. When our homes are near high performing schools and good jobs, it’s easier to get a quality education and earn a living wage. When people live near grocery stores where fresh food is available or close to green spaces and parks, eating healthy and being active is easier. When things like lead, mold, smoke, and other toxins are inside our homes, they can make us sick. And when so much of a paycheck goes toward the rent or mortgage, it makes it hard to afford to go to the doctor, cover the utility bills, or maintain reliable transportation to work or school.

How Do Opportunities for Stable and Affordable Housing Vary in your state?

Housing is central to people’s opportunities for living long and well. Nationwide, housing costs far exceed affordability given local incomes in many communities. As a result, people have no choice but to spend too much on housing, leaving little left for other necessities. Here, we focus on stable and affordable housing as an essential element of healthy communities. We also explore the connection between housing and children in poverty to illuminate the fact that these issues are made even more difficult when family budgets are the tightest.

What can work to create and preserve stable and affordable housing that can improve economic and social well-being and connect residents to opportunity?

A comprehensive, strategic approach that looks across a community and multiple sectors is needed to create and preserve stable, affordable housing in our communities. The way forward requires policies, programs, and systems changes that respond to the specific needs of each community, promote inclusive and connected neighborhoods, reduce displacement, and enable opportunity for better health for all people. This includes efforts to:

Make communities more inclusive and connected,
such as:

  • Inclusive zoning
  • Civic engagement in public governance and in community development decisions
  • Fair housing laws and enforcement
  • Youth leadership programs
  • Access to living wage jobs, quality health care, grocery stores, green spaces and parks, and public transportation systems

Facilitate access to resources needed to secure affordable housing, particularly for low- to middle-income families, such as:

  • Housing choice vouchers for low- and very low-income households
  • Housing trust funds

Address capital resources needed to create and preserve affordable housing, particularly for low- to middle-income families, such as:

  • Acquisition, management, and financing of land for affordable housing, like land banks or land trusts
  • Tax credits, block grants, and other government subsidies or revenues to advance affordable housing development
  • Zoning changes that reduce the cost of housing production

For more information about evidence-informed strategies that can address priorities in your community, visit What Works for Health.

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?

This report explores statewide data. To dive deeper into your county data, visit Use the Data.

   

Children in Poverty

Poverty limits opportunities for quality housing, safe neighborhoods, healthy food, living wage jobs, and quality education. As poverty and related stress increase, health worsens.

  • In Florida, 21% of children are living in poverty.
  • Children in poverty among Florida counties range from 9% to 47%.
  • Child poverty rates among racial/ethnic groups in Florida range from 13% to 33%.

   

Severe Housing Cost Burden

There is a strong and growing evidence base linking stable and affordable housing to health. As housing costs have outpaced local incomes, households not only struggle to acquire and maintain adequate shelter, but also face difficult trade-offs in meeting other basic needs.

  • In Florida, 18% of households spend more than half of their income on housing costs.
  • Across Florida counties, severe housing cost burden ranges from 8% to 27% of households.
  • Severe housing cost burden ranges from 14% to 26% among households headed by different racial/ethnic groups in Florida.

   

Homeownership

Homeownership has historically been a springboard for families to enter the middle class. Owning a home over time can help build savings for education or for other opportunities important to health and future family wealth. High levels of homeownership are associated with more stable housing and more tightly knit communities.

  • In Florida, 65% of households own their home.
  • Homeownership rates among Florida counties range from 52% to 90% of households.
  • Homeownership rates among racial/ethnic groups in Florida range from 44% to 73%.

Credits

Credits

Suggested citation
University of Wisconsin Population Health Institute. County Health Rankings 2019.
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
Anne Roubal, PhD, MS

Research Assistance

Courtney Blomme, RD
Keith Gennuso, PhD
Elizabeth Pollock, PhD
Joanna Reale
Matthew Rodock, MPH

 

With contributions from our CHR&R team including:
What Works for Health
Community Transformation
Operations
RWJF Culture of Health Prize

This work could not be done without our partnerships with
The Centers for Disease Control and Prevention for providing us with key health indicators
Burness for supporting our communication efforts
Forum One for website design and support

This work is possible thanks to a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute