Carbon County may be a great place to live, with strong families and neighbors who pitch in to help one another, but a snapshot of the county's well-being reveals it's not the healthiest place to live in Pennsylvania, according to a study recently released by the Robert Wood Johnson Foundation.

In fact, according to a foundation-sponsored study done by the University of Wisconsin's Population Health Insititute, Carbon County ranks among the 17 unhealthiest of Pennsylvania's 67 counties in terms of quality and length of life.

Researchers used five measures to assess the level of overall health or "health outcomes" by county: the rate of people dying before age 75; the percentage of people who reported being in fair or poor health; the number of days people reported being in poor physical health; number of days in poor mental health; and the rate of low-birth weight infants.

Researchers then looked at factors that affect people's health within four categories: health behaviors, clinical care, social and economic factors, and physical environment.The rankings show that people who live in healthier counties tend to have higher education levels, are more likely to be employed, have access to more health care providers, and have more access to healthier foods, parks and recreational facilities.

The higher the rank, the healthier the county. Carbon County and neighboring Schuylkill are both ranked low on the list.

Smoking, obesity, lack of access to health care and car-crash deaths are among the primary weights that sink both counties to the bottom, according to the study.

The study ranked counties by two categories: health outcomes (the length and quality of life) and health factors (behavioral, clinical, social/economic and environmental). Health outcomes measures how healthy a county is; health factors are what influence its health.

The study looked at smoking, drinking, eating habits, rates of violent crime, high school graduation rates, the numbers of children living in poverty and access to health care, among other factors.

Out of 67 counties, Carbon County ranked 56th in health outcomes and 62nd in health factors. The county ranked 62nd in the length of life (mortality), and 41st in quality of life (morbidity). Schuylkill ranked 60th in health outcomes and 60th in health factors. The county ranked 64th in the length of life (mortality), and 40th in quality of life (morbidity).

About 11 percent more people die before age 75 in Carbon County than the state average. In Schuylkill, the rate is about 16 percent higher.

Carbon County ranked 64th in health behaviors (smoking, diet/exercise, alcohol use and risky sex). It ranked 57th in the accessibility and quality of health care and 46th in social/economic factors (education, employment, family and social support and community safety).

Schuylkill County ranked 61st in health behaviors. It ranked in the accessibility and quality of health care and 50th in social/economic factors.

"These rankings demonstrate that health happens where we live, learn, work and play. And much of what influences how healthy we are and how long we live happens outside the doctor's office," Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, said in a news release. "People, no matter where they live, should have the best possible opportunity to be healthy.

What to do?

Dr. Julie Willems Van Dijk, a researcher with the Population Health Institute, urges people to use the rankings as motivation to change.

"I've talked to folks who say this is scary. But I think it's scarier to not know" the facts, she said. Armed with the facts, she said, "people are empowered to work together (to change)."

She encourages people to gain momentum for that change through a variety of avenues, but especially through local public health agencies.

"Hospitals are often key players in leading community collaborative efforts," Van Dijk said.

Officials at Blue Mountain Health System and St. Luke's agreed.

"The results of the survey were not a huge surprise to us," said Lisa Johnson, spokeswoman for Blue Mountain Health System, which has hospitals in Lehighton and Palmerton. "The hospitals of the Blue Mountain Health System are always reviewing the health trends of our patients and the residents of our community."

Johnson addressed some of the study points.

"In terms of accessibility and quality of health care, the Blue Mountain Health System recognized the fact that Carbon County is underserved in accessibility to health care. The health system made a decision to actively recruit physicians to Carbon County specifically to address this issue. In the last three years, the health system has been able to recruit physicians and surgeons to our area including a family practice physician who specializes in the care of older adults. This is directly in relation to Carbon County's high geriatric population. In fact, the health system believes there is room for additional family practice physicians in the region," she said.

"The staff of the health system has worked diligently to improve the quality of care at our hospitals. In fact, the Gnaden Huetten Memorial Hospital received a deficiency-free survey from the Pennsylvania Department of Health in 2008 and the Palmerton Hospital just completed a Joint Commission survey in November 2009 and received outstanding results. Also, the Summit Nursing and Rehabilitation Center received outstanding scores from a recent Pennsylvania Department of Health Survey.

Blue Mountain Health System encourages residents to develop better health habits, she said.

"Our efforts to help the community improve its health range from community education programs and health fairs to fitness programs and free drive-thru seasonal influenza vaccinations. As part of the Centers for Medicare and Medicaid Services Core Measures, we provide smoking cessation education to patients that smoke or use smokeless tobacco, especially those who have heart conditions. We also offer a variety of exercise programs through our Health Works Health and Fitness Center, many of which are specifically designed for the senior population. We also now offer weight loss surgical options, as well as provide nutrition counseling for those who are struggling with obesity. The BMHS Healthy Smiles, Happy Kids Dental Van is now the dental home for more than 1,700 children in need of dental care," she said.

Johnson touted Carbon County's health assets.

"Carbon County has so many resources that lend themselves to improving our community's health. From walking/hiking trails, lakes and nature parks, our area provides wonderful opportunities, many of which are free of charge, for residents to improve their physical activity levels. There are many local farmers with fresh produce stands as well as grocery stores that offer a wide variety of produce for residents to increase their fruit and vegetable intake. We have all the ingredients to improve the health status of Carbon County and making the change to a healthier lifestyle, which includes preventive medicine, is a personal commitment and one in which the Blue Mountain Health System is there to help make that change possible," she said.

The area's poor economic status directly impacts health, said Dr. Bonnie Coyle, director of Community Health for St. Luke's Hospital & Health Network.

"Health status is found to be highly linked to economic status meaning the higher the unemployment rate and the poorer the area, the lower the health status. As a result, studies have shown that rural areas and inner city areas generally are lower in health status than more suburban areas," she said.

"At St. Luke's, we are developing and implementing a proactive, coordinated Community Health Network strategy for the Carbon and Schuylkill counties. We have identified five main areas of focus including access to care; child and adolescent health/maternal and child health; health promotion/chronic disease prevention and control; health disparities reduction; community health advocacy and awareness.

"While these challenges are great, the staff at our St. Luke's Miners Memorial Hospital campus has established programs in place and are taking these programs to the communities we serve so that it is easier for residents to access care," Coyle said.

St. Luke's Miners Health Center's Kim Otto, certified registered nurse practitioner, spoke to the challenge of providing access to health care in rural areas and how St. Luke's is encouraging residents to improve their health.

"Eastern Schuylkill and Western Carbon counties are designated as medically underserved areas, meaning the area has a low number of health care providers and specialists. This means access to care is reduced which contributes to the health status of our community," she said. "In identifying this problem, we have established two St. Luke's Miners Health Centers, one in Nesquehoning (Carbon County) and one in Hometown (Schuylkill County), in response to this need. We are increasing access to care by establishing a third Health Center in McAdoo. The staff at our Health Centers provide care to people of all ages who need it, when they need it. We provide wellness check ups, immunizations, sick visits among other services.

"Our St. Luke's Sports & Rehabilitation centers, which offer wellness programs to achieve long-term weight loss, weight management and good nutritional habits. These facilities are located in Lehighton, Jim Thorpe, Nesquehoning, Coaldale, Mahanoy City, West Penn, Weatherly and Blakeslee," Otto said.

"We have received a community outreach grant, which supports our goal of building educational programs in the communities. Utilizing this grant, we are working in partnership with community agencies to build a strong foundation in promoting wellness and providing education on diabetes, obesity and exercise. In addition, we are providing specialty services through telemedicine to increase the availability of services and specialties to the area," she said. "The health care providers who work in our counties everyday are at the forefront of our efforts."

Van Dijk urged people to look at the positives in the study. For example, Carbon County has a good rate of high school graduation and a lower violent crime rate than the state average. More of its residents have access to healthy food and both Carbon and Schuylkill counties have less Chlamydia, a venereal disease, than the state average.

"You can look at those areas where you're doing the worst, and say 'what can we do about that'? And you can look at the better rankings, and ask 'what are we doing right in this area that we can apply to other areas' where we are doing poorly," she said.

"It's also important for residents to see this as a snapshot – not the be-all and end-all of health information. This is the starting point, not the ending point. It's really important for people to get together and look at study... look at all the indicators and think about the details."

For example, in areas where the smoking rate is higher than the state average might want to look closer at who is smoking and aim prevention programs at that group.

"Think about what programs or policies you can continue or initiate to have an impact on those problem areas," she said.

The solutions don't have to cost money, she said.

Van Dijk suggested posting signs in businesses encouraging people to take the stairs instead of the elevator, and to take walking breaks instead of smoking breaks.

The study

The study, which is the first of its kind to rank the health status of counties in all 50 states, was launched about a year ago, Van Dijk said.

The Robert Wood Johnson Foundation asked for the study after seeing a smaller study done by the Population Health institute. That study looked only at Wisconsin counties. Van Dijk said the data used to reach the conclusions was gathered from a variety of sources.

"We gathered the data from a number of federal agencies," she said.

The agencies included the Centers for Disease Control in Atlanta, Ga., and the U.S. Census. The information-gathering took about a year, she said.

Researchers used the latest data available for each county, ranging from 2000 to 2008.

Researchers said they hope the study will prompt action.

"For the first time, people have a tool to help identify what is making people in every county unhealthy," says Patrick Remington, M.D., M.P.H., associate dean for public health at the University of Wisconsin School of Medicine and Public Health. "We hope this kind of checkup will mobilize community leaders to take action and invest in programs and policy changes that make their counties healthier places to live."

On the Web: http://www.countyhealthrankings.org/pennsylvania [2]