Losing weight, quitting smoking and tackling alcohol abuse are tough to do, says Dr. David Russo, who works at Blue Mountain Health System's Palmerton Hospital.

Those battles can be close to insurmountable, so it's crucial to educate children away from overeating and unhealthy eating, smoking and drinking. More education, he believes, just may help people avoid getting fat or becoming hooked on nicotine or alcohol.

That's especially important in our area, because Carbon, Schuylkill and Monroe counties all have higher rates of smoking, obesity, inactivity and traffic crash deaths than the state averages, according to a study by the University of Wisconsin Population Health institute with the Robert Wood Johnson Foundation.

The study tracks public health by measuring health outcomes and health factors.

"For a long time now, the conversation has focused only on health care. And while health care is important, our research tells us that much of what affects our health happens outside of the doctor's office. The Rankings tell us that where we live matters to our health," said Angela Angela R. Russell, MS, Community Engagement Lead for County Health Rankings, University of Wisconsin Population Health Institute.

"The Rankings tell us where counties are doing well and where there are opportunities for improvement. We want the Rankings to be a call to action to leaders across the nation so that they can make local changes to improve the health of their school, neighborhood, workplace, city, town or county," she said.

"In addition, the Rankings tell us that improving the health of a community is everyone's responsibility. We all need to work together to find solutions such as working to improve high school graduation rates, providing more walking paths, promoting affordable access to healthier foods, or enacting smoke-free laws," Russell said.

According to the Rankings findings, all three counties have a long climb to reach the pinnacle of good health.

Where we are now

Rankings, released in April, looked at health factors, which include behaviors (such as smoking, obesity, inactivity and excessive drinking); clinical care (access to doctors, whether or not a person has health insurance, and whether they have access to mammograms and diabetic screening); social and economic factors (levels of education, poverty, employment, and violent crime rates); physical environments (air quality, access to recreation and healthy foods).

Health factors help to determine health outcomes: how long people tend to live, the quality of their lives, the numbers of premature deaths, the numbers of poor physical or mental health days, and poor or fair health.

There are 67 counties in Pennsylvania. Carbon County ranked 49th in terms of health outcomes, and 61st in health factors, with only Cameron, Armstrong, McKean, Forest, Fayette and Philadelphia faring worse. Schuylkill County ranked 57th in health outcomes, and 59th in health behaviors. Monroe County ranked 36th in health outcomes and 50th in health behaviors.

The study showed that Carbon County residents have a higher number of poor mental health days than the state average (4.2 per 100,000 people as opposed to the state average of 3.6). More Carbon County residents also smoke (31 percent of adults compared to the state average of 21 percent). The county also has slightly more obese and sedentary people than the state average.

Carbon residents have a higher number of fatal traffic accidents – 22 per 100,000 people compared with the 13 per 100,000 state average, but have a much lower rate of sexually transmitted infections: 63 per 100,000 as opposed to the state average of 346 per 100,000.

Schuylkill County residents have a higher rate of premature deaths than the state average (8,164 to the state's 7,284), and more people living with poor to fair health, with more poor physical and mental health days. More Schuylkill residents smoke, are obese and inactive and drink more than the state average.

The number of people dying in Schuylkill traffic crashes is also higher than the state average – 23 per 100,000. Like Carbon, however, Schuylkill residents with sexually transmitted infections rank lower than the state rate with 110 per 100,000.

Monroe County residents health outcomes followed closely along the state rates. The county does have more residents who drink excessively (26 percent compared to the 18 percent state rate), and more Monroe residents died in car crashes (23 per 100,000 compared to the state rate). The county also has a lower rate – 156 per 100,000 – of sexually transmitted infections than the state rate.

Road map to health

Rankings was done "as a call to action for communities to understand the health problems in their community, get more people involved in improving the health of communities, and recognize that factors outside medical care influence health," according to the study's authors. It is the third such study performed; others were released in 2010 and 2011. Each study used data collected from previous years.

"Ranking the health of counties using not only traditional health outcomes, but also the broad range of health factors, can mobilize action on the part of governmental public health and in many other sectors that can influence and are affected by health," they wrote.

Along with Rankings is a Roadmap to Health, suggesting ways for business, health care, education, philanthropy and investors, government and public health to work together with the community to assess health needs and resources, focus on what's important, choose effective policies and programs, act on what's important, and evaluate those actions.

Russo reiterates that while education is the best prevention, the climb to better health will still be arduous.

"These three things (obesity, excessive drinking and smoking) have been historically the cause of most medical problems," he says.

Smoking, he says, typically starts when people are in their mid-teens.

"These kids, I assume, have had education about the dangers of smoking, so I don't know how on Earth we could change that. We could try more education, but in that age group, peer pressure makes it tough," he says.

As for obesity, Russo says that's an even tougher battle.

"In my opinion, the economic state of the whole country is affecting it. Having both people in the house working ... both my wife and I work, and it's virtually impossible to cook a healthy meal. You resort to takeout, restaurant food, or pre-prepared foods, which have almost no nutritional value," he says.

Russo also believes the availability of processed foods feeds into the high obesity rates.

"They are marketed as healthy, but if you actually read the labels, you'll see they're not. In order to educate young people about that, you have to overcome an almost insurmountable barrage of media that is promoting these things," he says.

"I'm not a big believer in legislation changing these things, either. You can't legislate thinness or exercise. But you can try to educate people, certainly younger people."

For more information on County Health Rankings, go to http:// www.countyhealthrankings.org.