The Robert Wood Johnson Foundation is out today with its fifth annual ranking of the health of nearly every county in the nation, and while a lot of the report won't, unfortunately, surprise you, some of it will make you think about healthful living in a different way.

Housing, for example, isn't the first thing that comes to mind when we consider how to stay healthy. But the new study reports that 19 percent of the housing in the United States is overcrowded, lacks adequate facilities for cooking, cleaning and bathing or is just too expensive for its occupants to afford.

This problem is most severe on the east and west coasts, in Alaska and in parts of the south. In the worst case, 69 percent of the housing in Wade-Hampton County, Alaska, has at least one of those problems; in the best case, just 3 percent of Fallon County, Montana housing is sub-standard.

The availability of mental health counseling is another new, and illuminating, measure of the factors that go into overall health. While more people will be getting health coverage under the Affordable Care Act, it won't do them much good if they can't find providers. The report shows that, on average, there are 1,620 people for every mental health provider (defined as psychiatrists, psychologists, licensed clinical social workers, counselors, and advanced practice nurses who specialize in mental health care). In one county, that figure is as low as 72 to 1, but in another, it reaches a rather staggering 55,969 people for every provider.

Not surprisingly, the availability of mental health providers in the healthiest counties is 1.3 times higher than it is in the least
healthy counties. Bridget Catlin of the University of Wisconsin's Population Health Institute, who helped prepare the report, noted that there is just one child psychiatrist to serve the entire northern half of the Badger State.

Predictably, and sadly, unhealthy counties are still those where poverty is high, level of educational attainment is lower, inactivity is higher, smoking is more prevalent and access to healthful foods is more limited than in healthy counties.

The report notes some developments that do provide hope: teen birth rates are by down almost 25 percent since 2007; the rate of preventable hospital stays declined about 20 percent between 2003 and 2011; smoking by adults dropped about three percent, to 18 percent, from 2005 to 2012; more people are completing at least some college; physical inactivity rates are decreasing and violent crime is down by 50 percent over the last 20 years.

But rates of obesity and sexually transmitted infections are up, and the Great Recession did, of course, lead to higher unemployment and more children living in poverty.

"It continues to surprise me, the big differences we see [between counties]," Catlin said. "We know that from state to state there are differences. But within states there are two-fold differences in how long people are living."