County Health Rankings continue to show largest shifts in the middle rankings, familiar names at the top and bottom

The chart next to the map shows the spread of health outcomes scores (ranks) for each county (green circles) in Kentucky. It shows the size of the gap between ranked counties, is most cases small.
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By Melissa Patrick
Kentucky Health News

The latest County Health Rankings report for Kentucky shows little change in the top and bottom quarters of the standings, with most of the bigger shifts among counties in the middle.

The rankings measure health outcomes, gauged by life expectancy and measures of quality of life; and health factors, such as access to physicians and areas to exercise, tobacco use, children living in poverty, violent crime, long commutes and other environmental factors. The report is issued by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Because the shifts in rankings for most counties are so small that they are statistically insignificant, the researchers have placed counties in four groups of 30 counties each, called quartiles. The rankings are meant to be viewed more as a general categorization of a county’s health status, rather than making specific comparisons with counties that are relatively close in the rankings.

Top of snapshot for Adair County, first in Kentucky’s alphabetical list

The report’s website has a snapshot of data for each county that includes county-level data for each of the measures.

In health outcomes, 17 of the 120 counties moved up at least 10 notches since last year, and another 14 moved down at least 10. In health factors, 13 counties improved and 10 dropped at least 10 notches.

The bottom quartile for both health outcomes and factors continues to be made up almost entirely of Appalachian counties. The only exception for health outcomes is Fulton County, a poor county in the Mississippi Delta at the state’s western tip. The exceptions for health factors are Fulton County and Grayson County, in west-central Kentucky.

Oldham and Boone, two of Kentucky’s wealthiest counties, continue to be the top two in health outcomes, as they have been since 2011. No. 3, Spencer County, has ranked either third or fourth since 2016. Woodford County ranked fourth this year, moving up from the 14th spot in last year’s rankings and Fayette County ranked fifth, moving up from 10th.

Oldham and Boone are also the top two counties in health factors, and have been since 2015. They have been in the top five since 2011. Woodford, Campbell and Scott are ranked third, fourth, and fifth, respectively, for the second year in a row.

Breathitt, Owsley and Perry counties, in that order, hold the bottom three spots for health outcomes again this year, followed by Clay and Floyd. All are in the East Kentucky Coalfield. The bottom five counties for health factors are Clay, Owsley, Wolfe, Breathitt and McCreary, all in the coalfield.

Some counties show big changes

Green County was the only county to move at least 10 slots to put it in the top quartile for health outcomes. It rose 13 notches, to 27th. The last time it was in the top quartile was in 2017, when it ranked 19th.

Taylor and Mason counties saw the greatest gains in health outcomes this year, both moving up 19 places. Taylor moved up to 38th, from 57th; and Mason moved up to 46th, from 65th.

Two counties dropped more than 10 slots to land them into the bottom quartile for health outcomes. Russell, is now 93rd, down from 77th last year; and Elliott is 101st, down from 81st.

Crittenden County saw the greatest drop in health outcomes this year, falling 26 notches, to 64th from last year’s 38th spot. It also dropped 16 slots in health factors, to 88th.

Todd and Christian counties also saw big drops in outcomes, each falling 19 spots. Todd moved to 65th, from 46th; and Christian moved to 70th, from 51st.

Changes in health factors

Henry County was the only county to move at least 10 spots into the top quartile for health factors, moving up 11 notches into 27th. No county shifted by 10 or more spots into the bottom quartile for health factors.

McLean County saw the greatest gain in health factors, moving up 18 notches to 38th, from 56th last year. It moved down 16 slots in outcomes, to 89th, from 73rd.

Map shows the health-factor quartile for each county; column at right 
shows the size of the gaps between ranked counties is small.

Four counties moved up 15 spots in health factors, including Bracken, to 45th; Metcalfe, to 66th; Trigg, to 32nd; and Boyd, to 44th.

Owen County saw the biggest drop in health factors, falling 26 spots, to 60th from last year’s 34th spot. It moved down four spots for outcomes, to 39th.

Marion County also showed a big drop in health factors, moving down 20 spots to 55th, from 35th. It moved down four slots for outcomes, to 54th.

The report challenges Kentucky counties to take this data and turn it into action, and offers resources to do that on the “Take Action To Improve Health” section of its website. The report says it “illustrates what we currently know when it comes to what is keeping people healthy or making them sick and shows what we can do to create healthier places to live, learn, work and play.”