County rankings give insight into Colorado health disparities

County Health Rankings & Roadmaps released its annual County Health Rankings this week, for which the program aggregates data on over 30 health-related factors in counties across the U.S.

The program, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, based its 2019 rankings on measures that fall into two broad categories: “Health Outcomes” and “Health Factors.”


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Rankings for Health Outcomes are based on quality of life (using measures like the percentage of adults who report fair or poor health and the percentage of adults with diagnosed diabetes) and length of life (using measures like child mortality, years of potential life lost before age 75 per 100,000 people, and life expectancy).

Health Factors rankings are based on four categories of measures, each with several data sources: Health Behaviors, Clinical Care, Social and Economic Factors, and Physical Environment.

In other words, Health Outcomes “represent how healthy a county is right now,” and Health Factors “represent those things we can modify to improve the length and quality of life for residents,” according to the program’s website.


Image: County Health Rankings & Roadmaps


Douglas County came out on top for both Health Outcomes and Health Factors. Costilla was the lowest-ranked county for Outcomes, alongside a cluster of other low-ranking counties in Southern Colorado. Bent was the lowest-ranked county for Factors — again, it joined several other counties mostly in the surrounding area.

In general, Colorado’s report shows that health across the state varies by county and race/ethnicity.

Health outcomes in Colorado


Image: County Health Rankings & Roadmaps


For example, 11 percent of White respondents, overall, reported poor or fair health. That percentage was higher in every other racial/ethnic group, the biggest contrast being that 30 percent of American Indian/Alaskan Native respondents reported poor or fair health.

And in the highest-ranking county for Outcomes — Douglas County — there were 3,500 years lost before age 75 per 100,000 people (indicating premature death). In the lowest-ranking county for Outcomes — Costilla County —  that stat was over three times higher.


Image: County Health Rankings & Roadmaps


According to the report, the discrepancies indicate that American Indians/Alaskan Natives, as a group, are less healthy than those living in the lowest-ranking county. And Asians/Pacific Islanders are healthier than those living in the top-ranked county.

That’s consistent with the report’s conclusions nationwide:

“Across the US, values for measures of length and quality of life for Native American, Black, and Hispanic residents are regularly worse than for Whites and Asians. For example, even in the healthiest counties in the US, Black and American Indian premature death rates are about 1.4 times higher than White rates.”

Health Factors in Colorado


Image: County Health Rankings & Roadmaps


The factors influencing health, again, vary greatly among counties.

One example: In Douglas County, 10 percent of adults smoke and 4 percent of the population under age 65 is uninsured. And, there’s one primary care physician per every 1,460 people.

Meanwhile, in Bent County, 21 percent of adults smoke, 12 percent of the population under age 65 is uninsured, and the population-to-primary-care-provider ratio is 5,860:1.

In Costilla County, 43 percent of children live in poverty, a percentage that’s trending upward. And in Douglas County, 3 percent of children live in poverty.

Among racial/ethnic groups, child poverty rates range from 9 percent to 22 percent.

To look deeper into individual counties, demographics, and measures, explore the program’s interactive model.

Housing and health

The program emphasized the intersection of housing and health in this year’s Key Findings Report and individual State Health Reports.

On a national level, the Key Findings Report says that 11 percent of households spend more than half their income on housing costs, amounting to “severe housing cost burden.” That burden, in turn, impacts health.

“Housing is central to people’s opportunities for living long and well. Nationwide, housing costs far exceed affordability given local incomes in many communities,” the state report reads. “As a result, people have no choice but to spend too much on housing, leaving little left for other necessities.”

In Colorado, 14 percent of households spend over half their income on housing costs. As of 2017, the report says 61 percent of the 150,000 Colorado children in poverty were living in a household that spent over half of its income on housing.

The report also found that, across the country, places with more residential segregation of Black and White residents have higher rates of severe housing cost burden.

To address the issues raised by this report, the program’s website features a What Works for Health database and a Take Action Center. The database includes over 400 strategies, each rated for its evidence of effectiveness, while other tools for people seeking guidance on next steps are available via the Take Action Center.