People living in least healthy counties twice as likely to have shorter lives

The fifth edition of the County Health Rankings continues to show that where an individual lives matters to his or her health. Large gaps remain between the least healthy counties and healthiest counties. For instance, the least healthy counties have twice the death rates and twice as many children living in poverty and teen births as the nation's healthiest counties.

A collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, the County Health Rankings allow each state to see how its counties compare on 29 factors that impact health, including smoking, high school graduation rates, unemployment, physical inactivity, and access to healthy foods. The rankings are available at

The rankings provide county-to-county comparisons within a state; this year's rankings also show important national trends:

• Teen birth rates have decreased about 25 percent since 2007.

• The rate of preventable hospital stays decreased about 20 percent from 2003 to 2011.

• Smoking rates dropped from 21 percent in 2005 to 18 percent in 2012.

•  Completion of at least some college increased slightly from 59 percent in 2005 to 64 percent in 2012.

This year's report features the following new measures:

• Housing:  Almost 1 in 5 households are overcrowded, pose a severe cost burden, or lack adequate facilities to cook, clean, or bathe. These problems are greatest on the East and West coasts, Alaska, and parts of the South.

• Transportation: More than three-quarters of workers drive to work alone and among them 33 percent drive longer than a half hour each way. Driving contributes to physical inactivity, obesity, and air pollution.

• Food Environment: People in many parts of the country face food insecurity (or the threat of hunger) and limited access to healthy foods, especially in counties in the Southwest, across parts of the South, and the western U.S.

• Mental Health: Amid growing attention to mental health care, the availability of mental health providers in the healthiest counties in each state is 1.3 times higher than in the least healthy counties. The West and Northeast regions of the country have the best access to mental health providers.

•  Injury Related Deaths: The third leading cause of death in the U.S., injury death rates are 1.7 times higher in the least healthy counties than in the healthiest counties. These rates are particularly high in the Southwest, part of the Northwest (including Alaska), and the East South Central, and Appalachian regions.  

• Exercise Opportunities: Access to parks or recreational facilities in the healthiest counties is 1.4 times higher than in the least healthy counties.

"The County Health Rankings show us how health is influenced by our everyday surroundings—where we live, learn, work, and play," said Bridget Catlin, PhD, MHSA, director of the County Health Rankings. "The County Health Rankings often provide the spark for businesses, community planners, policy-makers, public health, parents, and others to work together for better health."

The County Health Rankings is part of the County Health Rankings & Roadmaps. The program includes the Roadmaps to Health Action Center which provides local leaders with tools, step-by-step guides, and stories to help communities identify and implement solutions that make it easier for people to live healthy lives. The program also includes the annual RWJF Culture of Health Prize, which celebrates communities who are harnessing the collective power of leaders, partners, and stakeholders to build a culture of health.

This year's Prize winners and the call for 2014-2015 prize applications will be announced in June at the Aspen Ideas Festival, Spotlight: Health.

Report urges inclusion of patients and families in clinical, design, delivery and policy development

Enabling patients and families to be respected partners in health care — from the exam room to the policy arena — is essential if the U.S. health care system is to continue to make progress in patient safety. That is the central message of a report released by the National Patient Safety Foundation's Lucian Leape Institute.
"Safety Is Personal: Partnering with Patients and Families for the Safest Care" advocates for patients and families to be active partners in all aspects of their care, as well as in health care design and delivery and in policy development and research efforts. The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health care.

Significant evidence is mounting in support of patient engagement as a vital contributing component of safe care. The report calls for targeted education and training for health care clinicians and staff to give them skills to better engage patients in decisions and management of health problems and to redesign processes and systems to facilitate patient and family partnerships.

While firmly placing the responsibility for patient safety on health care providers and organizations, the report also urges patients, families, and the public to view themselves as full and active members of the health care team.

"Many of the barriers to meaningful patient and family engagement can only be overcome if leaders and clinicians support them in becoming confident and effective partners," said Susan Edgman-Levitan, PA. "With this report, we hope to influence health leaders and practitioners to act on the evidence and knowledge we already have." Ms. Edgman-Levitan, a member of the NPSF Lucian Leape Institute and the lead author of the report, is also executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital.

The report is the product of two roundtable meetings with representatives of patient advocacy organizations, health systems, research organizations, and industry. Personal stories of safety lapses punctuate the report and bring the issue into focus.