Metro area counties, cities receive high health ranking despite poor air quality

By Lena H. Sun
Washington Post Staff Writer
Wednesday, February 17, 2010; B02

Fairfax, Arlington and Loudoun are the healthiest counties in Virginia, and Howard, Montgomery and Frederick top the list in Maryland, according to a set of reports to be released Wednesday. The reports rank U.S. counties and cities based on how long people live and how healthy they are.

The three Northern Virginia counties get top marks within the state for overall health, but they compare poorly with other parts of Virginia for air quality. Fairfax ranked 132 -- last among Virginia's counties and cities included in the study -- in that category because of the region's horrendous traffic. Fairfax had 37 unhealthy air quality days in 2005; rural counties such as Craig and Cumberland had none.

In Maryland, Prince George's County ranked 17 out of the state's 23 counties and Baltimore City for overall health, in large part because the rate of people dying before age 75, which is more than twice that of Howard County.

The County Health Rankings (available at are the first reports to rank the overall health of almost every county in all 50 states. The District was not included. The Virginia study did not include Highland County or Lexington.

The health rankings were done by the University of Wisconsin's Population Health Institute and the Robert Wood Johnson Foundation. Researchers rated overall health based on five measures that included the rate of people dying before age 75; the percentage of people who reported being in fair or poor health; and the rate of low-birth-weight infants.

They also gave a separate grade to factors that influence health. Those include: smoking, obesity, binge drinking, access to primary care providers, high school graduation rates, violent crime rates, air pollution levels and liquor store density. Researchers relied on federal health, census and crime data compiled from 2002 to 2008.

Counties and cities are ranked within each state; there is no overall score for which county is the healthiest in the nation. Researchers said they hope public health officials, community leaders and consumers compare their county with others in the state and find ways for improvement.

"Rather than pointing the finger at the least healthy places in the country, which tend to be in the Southeast and Appalachia, this is a Polaroid snapshot that allows every state to look within their own boundaries, down to the county level," said Patrick Remington, associate dean for public health at the University of Wisconsin School of Medicine and Public Health.

"People tend to rank health based on life expectancy," said Jim Marks, a senior vice president at the Robert Wood Johnson Foundation. "But so many things that are important for health are outside the responsibilities of the doctors and hospitals we traditionally think of as public health."

Community interest could increase pressure for change.

"When people move to a neighborhood, they want to know how good are the schools and expect to get some answer," Marks said. "They almost never ask how healthy is this a place to live and raise a family."

It's also to an employer's advantage, he said, to draw from a healthier population so health insurance costs are less.

In general, poorly ranked counties often had multiple factors that affected health. They had two or three times higher rates of premature death, often from preventable conditions. They also had high unemployment and poverty rates and high numbers of liquor stores and fast-food outlets, but few places to buy fresh fruits and vegetables.

The rankings show sharp health disparities even in counties located right next to each other. Prince George's County has higher rates than Montgomery County for smoking, adult obesity, teenage births and unsafe sex, according to the data.

Frances Phillips, Maryland's deputy secretary for public health, said the rankings track closely with socioeconomic factors. "It's no surprise that health follows wealth," she said.

What's not reflected in the report, she said, are state initiatives launched in the last six months to improve health, such as using telemedicine to bring obstetrics specialists to the virtual bedside of at-risk women in Prince George's County.

Howard County edged Montgomery for having the overall best health in Maryland. Howard also ranked highest on three of four main health factors. Howard has fewer uninsured adults, its high school graduation rate (90 percent) is slightly better than Montgomery's (87 percent) and significantly higher than Prince George's county (72 percent).

Peter Beilenson, Howard County's health officer, said the county has been a leader in public health for years, citing anti-smoking ordinances as well as an abundance of parks and walking trails.

At the same time, Howard has a significantly larger percent of obese adults than Montgomery, a factor that put Howard second behind its neighbor in health behaviors.

Beilenson said the reason may be rooted in jobs. Many two-career couples live in Howard and work in Washington. Their commutes may be longer than Montgomery residents, he said, "so people who are driving a lot may not be exercising as well as you think for such a well-educated and well-off community."

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