The 2017 County Health Rankings have been released, and the prognosis for our area is … not so great.

Out of the 67 counties in Pennsylvania, Carbon ranked 54, Monroe ranked 53, and Schuylkill ranked 64, placing each in the lowest quarter for overall health outcomes. Lehigh County fared slightly better at the rank of 40, with Northampton in the top quarter at 15.The County Health Rankings are a program of the Robert Wood Johnson Foundation, which funds a number of initiatives based on creating a "Culture of Health." The Rankings analyze various statistics under two categories, health outcomes and health factors.Health factors analyze health behaviors, like drug and alcohol use, clinical care including access to care, social and economic factors such as income and education, and the physical environment's factors including air and water quality, all of which can determine health outcomes. Health outcomes measure the overall length and quality of life within a county.So, what ails us?"Obesity, mental health and chronic illnesses such as diabetes are three of the main points," Lisa Johnson, vice president of public relations and marketing at Blue Mountain Health System, said. "Comparatively, all three counties have higher than state average in the uninsured, access to primary care physicians, dentists, and mental health providers, and obesity rates."Carbon's analysis showed that about 35 percent of Carbon and Schuylkill residents have a body mass index, which measures body fat based on height and weight, over 30. A BMI over 30 indicates obesity.Figures for the five counties regarding current smokers in the population all fell around 17 percent, with Schuylkill with 18 percent. All five counties showed that 18 percent of their population engaged in excessive or binge drinking.Johnson said that Northampton's higher health outcome ranking is likely linked to access to health care providers, and the means to get to them."The ratio for primary care physicians for all three counties is nearly double than that of Northampton's," she said of Carbon, Monroe and Schuylkill. "There are other factors, such as transportation issues, for the three counties that contribute to accessing care."Dr. Robert Motley, Lehigh Valley Health Network's chair of community health, said that the area's history and current stagnation could be contributing to the problem. More unemployment, along with limited or nonexistent health benefits for those that are employed, can seriously affect one's capability to maintain their health."These are, for the most part, all rural counties. If you look at them over the last generation, they were all in the Slate Belt. As that industry has reduced, you're seeing counties that are a little more depressed," Motley said.And when an area is more economically depressed, proactive healthy choices will often suffer."Lower socioeconomic status seems to be associated with poor dietary choices, either due to a lack of knowledge of better nutrition choices or unwillingness to change dietary habits. Nonnutritive snacks and sweetened drinks are two dietary habits that stand out to me as major contributors in overall poor health and obesity," said Rhianna Cenci, nutritionist at Kinsley's ShopRite in Brodheadsville.A prescription for educationDespite the bleak results, it is possible to turn our numbers around. Education, especially at an early age, is integral to establishing a healthy lifestyle."In general, education is a key factor to improving anyone's overall health," Johnson said. "For example, if you have been diagnosed as a diabetic, a Diabetic Education class provides a wealth of knowledge in how best to manage your blood sugar. Continuing to educate yourself in new management techniques and treatments is imperative to the management of the disease."Weatherly Area School District nurse and Wellness Council facilitator Rebekah McFadden has been working to promote good health habits from day one of kindergarten through high school graduation."We coordinate all sorts of health promotion and disease prevention activities in all three of our schools during the school year. This is a great group of people, and we have been able to provide some pretty cool activities over the years," McFadden said.Highlights of the district's health promotion initiative have included a physical activity program sponsored by Geisinger, where students were engaged in exercise games with the Nintendo Wii and Microsoft Xbox video game systems. The 2015 Drug and Alcohol Expo was hosted at Weatherly Middle School, and the district has held numerous anti-smoking campaigns, such as Kick Butts Day and the Great American Smoke Out.Learning about the nutritional content of what you eat can go a long way toward making significant healthy changes as well."The biggest change for most people would be reading and understanding the nutrition facts label," Cenci said. "This is foreign to a lot of people, and hard to understand with a lot of factors to consider. The nutrition facts are a useful tool ready at your fingertips, as long as you are able to interpret the information provided."Gradual changes can lead to big resultsWhen it comes to making the effort to improve, the key is to hone your strategy to fit your body and personality. Working with a nutritionist can be helpful for those who are struggling with a good diet. Simply consulting with a personal fitness trainer and a doctor can lead to more productive and healthy exercise habits. No matter what, though, most experts recommend that introducing small, gradual alterations to your repertoire is the best route to success."Some people can quit their eating habits 'cold turkey,' but it is more common to gradually ease out of bad dietary habits. Gradual changes are more likely to become a sustainable lifestyle change, rather than a one month fad," Cenci said.The same strategy also applies to exercise. You don't necessarily have to join a gym and rack up hours with a personal trainer, though, as even small activities can have their benefits."The way we try to help is to engage members of the community," Motley said, pointing out projects like community gardening clubs. Activities like these can provide some light physical activity, with the added benefits of promoting socialization, and maybe even producing some healthy produce.Overall, most health experts recommend staying ahead of the curve as the best method to sustaining good health. Building up to a good state of health is a victory in and of itself, but maintaining positive habits over the long haul is the key to success."Looking to improve overall health can seem like a daunting task," Cenci said. "Start with making one small change at a time, beginning with either diet or exercise. Remember to be proactive about your health, not just reactive to a diagnosis."StatisticsOverall rank for health outcomes, out of 67Carbon: 54Monroe: 53Schuylkill: 64Northampton: 15Lehigh: 40Overall rank for health factors, out of 67Carbon: 56Monroe: 37Schuylkill: 51Northampton: 21Lehigh: 26Adults who report poor or fair healthCarbon: 13 percentMonroe: 17 percentSchuylkill: 14 percentNorthampton: 14 percentLehigh: 17 percentAdults with a body mass index equal to or great than 30Carbon: 35 percentMonroe: 29 percentSchuylkill: 35 percentNorthampton: 29 percentLehigh: 30 percentAdults who are current smokersCarbon: 17 percentMonroe: 17 percentSchuylkill: 18 percentNorthampton: 17 percentLehigh: 17 percentAdults who binge drink or drink alcohol excessivelyCarbon: 18 percentMonroe: 18 percentSchuylkill: 18 percentNorthampton: 18 percentLehigh: 18 percentAdults age 20 and over who report no leisure time physical activityCarbon: 23 percentMonroe: 26 percentSchuylkill: 28 percentNorthampton: 25 percentLehigh: 22 percentAdults under age 65 who do not have health insuranceCarbon: 11 percentMonroe: 12 percentSchuylkill: 11 percentNorthampton: 9 percentLehigh: 11 percent