Three years after researchers at the University of Wisconsin's Population Health Institute released their first national county health ranking study for the Robert Wood Johnson Foundation, people in Carbon and Schuylkill, it would seem, have been climbing up the ladder to better lives.

The study, which looks at what is making people sick or healthy, looks at 25 factors that include health behaviors such as tobacco use, diet and exercise, alcohol use, sexual activity; access to care, and the quality of that care; education, employment, income, family and social support, community safety; and environmental quality. The study also factors in the length and quality of life.

In 2010, Carbon ranked 56th and Schuylkill 60th out of Pennsylvania's 67 counties. This year, Carbon County had climbed to 42nd place, and Schuylkill to 53rd.

While the numbers look good, they may not be an accurate indication of the counties' health, says one local physician.

A LONG CLIMB

While Carbon and Schuylkill county residents' well-being improved, they still lag behind state averages, according to the County Health Rankings.

Over the past three years, Carbon County residents have improved in a number of categories, according to the County Health Ranking. In 2010, 16 percent of residents were in poor or fair health, as compared to the state's average of 14 percent. By 2013, that ranking had dropped to 13 percent for county residents.

The motor vehicle crash death rate dropped from 23 deaths in 2010 to 19 in 2013, still well above the state averages of 13 and 12, respectively, according to the study. The numbers of people who lack insurance dropped from 15 percent to 13 percent. The number of premature deaths dropped from 8,328 to 7,339, still above the state averages of 7,465 and 6,973, respectively.

However, the number of children in poverty rose slightly, from 18 percent in 2010 to 19 percent in 2013.

In Schuylkill County, most factors improved as well.

In 2010, 18 percent of residents were in poor or fair health, as compared to the state's average of 14 percent. By 2013, that ranking had dropped to 16 percent for county residents.

The motor vehicle crash death rate dropped slightly, from 23 deaths in 2010 to 22 in 2013. The numbers of people who lack insurance rose slightly, from 11 percent to 12 percent. The number of premature deaths dropped from 8,652 to 7,852. Also, the number of children in poverty rose, from 16 percent in 2010 to 19 percent in 2013.

However, in both counties, smoking, obesity and heavy drinking have either increased or stayed at about the same levels.

MAKING REAL CHANGES

While it appears that Carbon and Schuylkill made progress, they may have simply moved up in the rankings because they were displaced by other counties sinking, said Blue Mountain Health System's Dr. Ken Sharp of Lehighton.

"If you are doing relatively poorly at something, but everybody else is doing worse than you, it doesn't mean you're doing better. It still means you're doing poorly. We moved up in the ranking, but I think it's more because other counties moved down.

The important message to take from the County Health Rankings, is that many of the markers are factors that are well within each person's control.

Sharp noted that while Carbon and Schuylkill improved in some areas motor vehicle crash death, teen birth rate, and violent crime rates other areas worsened.

For example, residents are still "smoking and drinking excessively. And that's not moving in the right direction," he said.

Further, some markers, including obesity and physical activity have not changed.

"There are certainly factors we can do something about," Sharp said. "There are some things we can't do anything about, environmental things that are tough to regulate. We have to rely on other people to keep the water clean for us, and keep the air clean for us. But some things we need to do on our own. In some of the areas that we as individuals have control over, we're not doing better."

Stopping smoking, curbing alcoholic drinks, and keeping weight to normal levels would result in improvements to overall health, he said.

Resources are available to help alcoholics begin recovery. Hospitals offer smoking cessation programs, and healthy food options are just as available in local supermarkets as junk foods. People can decide for themselves whether they and their children will spend a sunny afternoon parked on the sofa or going for a walk.

But a person has to want to change a behavior in order to be successful.

"You have to have that mindset that this is what you're going to do," Sharp said.

ABOUT THE STUDY

The 2013 County Health Rankings study found that, nationally, rates of premature deaths are at the lowest level in 20 years. However, people in the unhealthiest counties are dying prematurely at more than twice the rates of those in the healthiest counties.

Nationally, the 2013 study found that child poverty rates have not improved since 2000, with more than one in five children living in poverty. It also found that violent crime has decreased by almost 50 percent over the past two decades.

The counties where people don't live as long and don't feel as well mentally or physically have the highest rates of smoking, teen births, and physical inactivity, as well as more preventable hospital stays, the study found.

Also, teen birth rates are more than twice as high in the least healthy counties than in the healthiest counties, and access to health care remains an important factor.

Also this year, the Rankings include residents' access to dentists, as well as primary care doctors. Residents living in healthier counties are 1.4 times more likely to have access to a doctor and dentist than those in the least healthy counties, according to the Robert Wood Johnson Foundation.

The rankings study includes a "Roadmaps to Health" component. The Roadmaps offer a number of steps communities can take to improve the health and well-being of residents, and offer opportunities to apply for Roadmaps to Health Community Grants.

The grants, managed by Community Catalyst, a national consumer health advocacy organization, support two-year state and local efforts to improve health and well-being by way of teamwork among education, business, policymakers, and community and health care organizations.

"The County Health Rankings can be put to use right away by leaders in government, business, health care, and every citizen motivated to work together to create a culture of health in their community," said Dr. Risa Lavizzo-Mourey, Robert Wood Johnson Foundation president and CEO. "The Rankings are driving innovation, unleashing creativity, and inspiring big changes to improve health in communities large and small throughout the country."

The study can be accessed at www.countyhealthrankings.org.