New County Health Rankings report shows same counties at top and bottom, but many have shown moves in the rankings this year

By Melissa Patrick
Kentucky Health News

The fifth annual County Health Rankings report shows that some Kentucky counties have made great improvements in their rankings over the last five years, while others have significantly dropped or remained stuck at the bottom.

The report estimates each county’s overall health outcomes (length and quality of life) and its overall health factors (determinants of health). These categories are broken down into eight different areas that are measured and calculated to rank each county relative to the other counties in the same state.

communities can use the data “to see how they compare to other Kentucky
counties on several health dimensions,” said Susan Zepeda, president/CEO of the Foundation for a Healthy Kentucky. “We hope local leaders will use
this information to identify both health challenges and policy opportunities.” The foundation operates a complementary data
website,, with detailed information on each county’s health status.

The last five years have shown some great improvements in the health outcomes and health factors in some of Kentucky’s counties. The factors used in the rankings have changed somewhat over the years, some statistical modeling is involved, and statistical differences among closely ranked counties are so small that they may not be significant.

Thus, the rankings should be viewed more as a general categorization of a county’s health status than be used to make specific comparisons with counties that are relatively close in the rankings. To emphasize that, the University of Wisconsin‘s Population Health Institute, which compiles the data, groups counties in quartiles, or fourths of the whole. Kentucky has 120 counties, in quartiles of 30.

McLean County (ML on the map, southwest of Owensboro) is the only one that showed major improvement in both measures, moving up to 45th now from 85th in health outcomes, and up to 51st now from 79th in health factors.

Other counties that showed the most improvement in health outcomes are Hickman, moving up to 56th from 95th; Grant, moving up to 58th from 89th; Elliott, moving up to 66th from 93rd; and Simpson, moving up to 27th from 54th.

A video on Grant County is part of this year’s national presentation, also funded by the Robert Wood Johnson Foundation. To watch it, click here.

Grant County was spotlighted because community members used its low ranking as a motivation for improvement. One goal of the project is to provide specific health information to counties that can be evaluated and used to improve their health status.

The counties that showed the most improvement in health factors are Bracken, moving up to 40th from 74th; Meade, moving up to 49th from 83rd; Hart, moving up to 62nd from 91st; and Graves, moving up to 42nd from 73rd. Four other counties, besides McLean, moved up 28 spots in this category: Union (to 43rd from 71st), Marion (to 36th from 64th), Christian (to 66th from 94th) and Carlisle (to 21st from 49th).

Because the rankings are relative, within the state, as many counties must move down as move up, and some counties have shown significant drops in the last five years.

Morgan and Carlisle counties both plummeted 48 spots in the rankings for health outcomes over the five-year period. Morgan fell from 14th to 62nd and Carlisle dropped from 25th to 73rd. These counties were followed by Bath, moving from 67th to 99th; Harrison, from 47th to 77th; and two that dropped 29 spots: Union, which fell from 45th to 74th, and and Robertson, which went from 57th to 86th.

Larger drops were seen in health factors. Fulton County showed a whopping 61-place decline in the last five years, from 48th to 109th. Robertson dropped to 91st from 37th; Lincoln dropped to 95th from 45th; Harrison dropped to 50th from 16th; and Clinton dropped to 89th from 60th.

The top and bottom counties in the rankings have showed very little variation over the last five years. This year the top five counties for health outcomes are: Oldham, Boone, Shelby, Calloway and Scott. The top five for health factors are Oldham, Woodford, Boone, Fayette and Scott.

All five are some of the state’s wealthiest and most educated counties, and the five at the bottom are some of the poorest and least educated.

The bottom five counties for health outcomes this year are Lee, Breathitt, Wolfe, Floyd and Perry, at 120th. The bottom five for health factors are Leslie, Magoffin, Wolfe, Martin and Clay, at 120th. These overlapping groups of counties form a contiguous area in the middle of Eastern Kentucky.

Year-to-year changes are subject to more statistical doubt, but some counties showed big movements in their rankings form last year. Carlisle County showed the single greatest drop in health outcomes, dropping 29 spots, from 44th to 73rd. Adjoining Harrison County dropped 22 spots in health outcomes, moving from 55th to 77th. Trimble County dropped 26 spots in health factors, moving from 21st to 47th.

It will be interesting to watch Bracken County, whose improvement of 30 spots to 40th from 70th this year might reflect in better health outcomes in the future.

Morgan County is also one to watch. Its dismal health factors scores over the last five years, ranging from 96th to 111th, may have contributed to a drop in health outcomes, from 14th in 2010, to 23rd 2011, to 29th in 2012, to 69th in 2013 and to 62nd in 2014.

The downward trend in Nelson County’s health-factor ranking, from 25th in 2013 to 46th in 2014, is also worth watching to see if this will reduce its consistently high ranking in health outcomes, ranging from 17th to 25th over the last five years.

The report uses data from the federal Centers for Disease Control and Prevention‘s Behavioral Risk Factor Surveillance System, which constantly surveys Americans about their health. Because of small sample sizes for small counties, their figures are calculated through statistical modeling and comparison with counties of similar demographics.

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