Where You Live Shouldn’t Determine How Healthy You Are (But it Can)

Your health shouldn’t be determined by where you live, but two new reports show that where you live, learn, work and play have a major impact on how healthy you are and how long you live. Disease rates and factors that influence health vary dramatically from neighborhood to neighborhood and region to region—and funding for public health and disease prevention programs also vary significantly from community to community and state to state.

The third annual County Health Rankings and Roadmaps, released earlier this month by the Robert Wood Johnson Foundation and the University of Wisconsin School of Medicine and Public Health, ranks the healthiest and least healthy counties in every state, based on key factors that influence health such as education rates, income levels and access to healthy foods and medical care. The report’s findings illustrate how much health is impacted outside of what happens in the doctor’s office.

In counties where people live longer and have a better quality of life, there are lower rates of smoking, teen births, preventable hospital stays, unemployment, children in poverty and violent crime, and higher levels of physical activity, education, social support systems and access to primary care physicians. The report found:

  • Excessive drinking rates are highest in the northern states;
  • Rates of teen births, sexually transmitted infections, and children in poverty are highest across the southern states;
  • Unemployment rates are lowest in the Northeast, Midwest, and Central plains states; and
  • Motor vehicle crash deaths are lowest in the Northeast and upper Midwest states.

The County Health Rankings and Roadmaps help counties understand things they can do to improve health and help them build “roadmaps” to give people in their communities the tools they need to make healthier choices easier.

Our organization, the Trust for America’s Health, also issued our annual Investing in America’s Health: A State-By-State Look at How Federal Public Health Dollars are Spent last month, and we also found that disease rates—funding for disease prevention programs—are very different across the states.

For instance, diabetes rates range from a high of 12.2 percent in Alabama to a low of 5.9 percent in Alaska and Colorado, and hypertension ranges from a high of 34.8 percent in Mississippi to a low of 20.5 percent in Utah. Nine of the 10 states with the highest rates of diabetes are in the South and all 10 of the states with the highest rates of hypertension are in the South.

The Investing in America’s Health report found that federal funding for disease prevention and public health from the U.S. Centers for Disease Control and Prevention averaged out to $28.28 per person in fiscal year (FY) 2011—and ranged from a per capita low of $14.20 in Ohio to a high of $51.98 in Alaska. State funding also varies significantly state to state. Some of this is due to the structure of state governments, but it also reflects the investment that states decide to make in improve health. We found that the median amount in state FY 2010-2011 for public health equaled $29.80 per person, with ranges from a low of $3.42 per person in Nevada to a high of $153.17 per person in Hawaii.

The report also found that funding for disease prevention and public health has been severely cut at the state and local level in recent years, while it has remained basically flat at the federal level.

The budget for CDC has decreased from a high of $6.62 billion in 2005 to $6.12 billion in 2011. Forty states decreased their public health budgets from FY 2009-10 to FY 2010-11, and 30 of these states decreased budgets for a second year in a row and 15 for three years in a row. The budget cuts are resulting in major program cuts and job losses. Combined state and local public health job losses total 49,310 since 2008.

The Investing in America’s Health report features a series of stories from communities around the country about how they are taking action to help improve health—such as how Travis County and Austin City in Texas are working to limit tobacco use to how Dane County, Wisconsin is making healthy, locally-grown food more available in their community to improve health.

However, despite some very promising efforts and success stories, overall the Investing in America’s Health report concludes that without a sustained and sufficient investment in prevention and public health, the differences in disease rates will not be significantly changed.


All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.


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