In Northern California and across the nation, wealth seems to translate into good health, a comprehensive new report affirms.
But the factors behind that trend are complicated, public health experts said following the release of the report Tuesday by the University of Wisconsin and the Robert Wood Johnson Foundation.
The report ranks counties across the nation based on a wide variety of factors including premature death, smoking and drinking, and access to healthy foods and medical care. In California, Marin tops the list of healthiest counties, followed by Santa Clara, San Benito, Placer and San Mateo.
What do the counties have in common? A relatively high mean household income, according to U.S. census figures.
The five counties ranked as having the poorest health are relatively rural and poorer: Trinity, Del Norte, Siskiyou, Tehama and Lake. Sacramento County ranked 31st of 56 counties. (Two of California's smallest counties were not included in the study because no data were available.)
"Wealth is an extremely powerful factor," said Dr. Stephen McCurdy, professor and director of the UC Davis master of public health program. "There is a plethora of research showing that, for almost any health condition you can name, persons higher on the wealth scale do better than those below them."
Why? Wealthy people and their children are more likely to live in safe neighborhoods, afford healthy food, have health insurance and access to top doctors and hospitals, as well as more leisure time that allows them to engage in healthy activities such as exercise, McCurdy and others said. They also are far less likely to smoke cigarettes, a habit strongly linked to cancer, heart disease and stroke.
"The net effect of all of these advantages, summed through a lifetime, is that morbidity and mortality tend to be greatly reduced among the wealthy," McCurdy said.
Some communities have been able to overcome a relative lack of wealth, noted Patrick Remington, associate dean for public health at the University of Wisconsin School of Medicine.
"We do see exceptions," including border communities in Texas with residents who have lower average incomes but closer family ties and other support systems that are key to maintaining health, Remington said in a conference call with reporters.
The data released Tuesday also make it clear that "even the healthiest counties have areas where they can improve," he said.
The report, which culled information from a variety of sources including the Centers for Disease Control and Prevention, the Department of Education and the census, is designed to give communities "a template, a kind of Polaroid photograph" of public health, said Remington. Organizers hope the rankings will stimulate projects that will encourage healthy living.
Seemingly small projects can lead to real lifestyle change, particularly for people in underserved areas, said Chip Johnson, mayor of the city of Hernando in Mississippi.
Johnson said data from the rankings, first published three years ago, helped spur his city to launch anti-smoking programs, new bike paths, community basketball camps for kids and farmers markets targeted toward people in lower-income areas.
"It's the small things that build to a culture of health," he said.
Dr. Marc Schenker, professor and director of the Center for Occupational and Environmental Health at UC Davis, cited Yolo County as a community that has embraced a healthy lifestyle.
"Yolo might not be a wealthy county, but the largest town, Davis, is strongly influenced by the university, perhaps out of proportion to our income," Schenker noted. "Witness efforts to increase bicycling, healthy eating and other public health measures" that residents have embraced, he said.
Yolo finished seventh-healthiest among the 56 counties studied in California. Among other things, the data show, Yolo citizens have a far lower smoking rate, fewer babies born at low birth weight and fewer uninsured people compared with the state at large.
Sacramento County, by contrast, has a higher rate of premature death, more smokers and a higher rate of obesity than the state overall.
Some of Sacramento County's statistics may be skewed by unusually high rates of certain problems, such as infant mortality and sexually transmitted disease, that are occurring in a few urban ZIP codes, said Dr. Olivia Kasirye, Sacramento County's public health officer.
Kasirye said the county, working with community groups, has begun digging into the data with an eye toward attacking those issues.
"We are going to conduct further analysis, look at strategies and develop an action plan," she said.