The 2016 County Health Rankings Include New Measures and Reveal Dramatic Health Differences Between Rural and Urban Counties

photo-1456428746267-a1756408f782The County Health Rankings, a collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI), are an easy-to-use snapshot that compares counties within states on factors that affect health. Over the past seven years the Rankings, available at, have become an important tool for communities to pinpoint areas to focus on and improve the health of their residents.

In this year’s Rankings we see the dramatic differences between the health of rural and urban counties. Rural counties not only have higher rates of premature death, but nearly 1 in 5 rural counties saw rises in premature death rates over the past decade while most large urban, small metro, and suburban counties improved. Rural counties have higher rates of smoking, obesity, child poverty, and teen births, and higher numbers of uninsured adults than their urban counterparts. With smaller populations, fewer businesses, and lower tax bases, rural areas have challenges offering their residents as many opportunities, such as good jobs, health care, and quality education, as their urban counterparts.

The 2016 Rankings also include several new health-related measures: residential segregation, drug overdose deaths, and insufficient sleep.

  • The health of blacks suffer when they live in highly segregated neighborhoods. In areas where African-American and white residential segregation is highest there are typically vast differences in health, well-being, opportunity, and quality of life. Evidence-based strategies to improve residential segregation include ensuring low-income Americans have access to safe affordable housing and financing, ensuring wages that enable people to take care of themselves and their family, and improving access to healthy food and reliable public transportation.
  • Drug overdose deaths have increased 79 percent nationwide since 2002 and are reaching epidemic proportions in parts of the U.S. The highest death rates are in counties in Northern Appalachia and parts of the West and Southwest. Strategies to address drug overdose deaths include tracking prescriptions, dispensing and safe disposal of drugs, increasing access to naloxone, (a prescription drug that reverses overdoses caused by opioids), and offering non-violent offenders options like treatment instead of jail time.
  • Sleep is an important part of a healthy lifestyle and 1 out of 3 adults don’t get enough. Lack of sleep (or getting less than 7 hours of sleep a night) can cause stress, loss of productivity, depression and accidents while driving. To improve insufficient sleep rates, communities can restrict light and noise during nighttime hours, primary care doctors can ask patients about sleep patterns, and schools can shift the school day by delaying start times especially for middle and high school students.

The Rankings, these new measures, and the contrast in health between urban and rural counties can serve as calls to action to leaders in local communities. Not only does the County Health Rankings & Roadmaps program provide data, but we also offer tools and on-the-ground assistance to communities who want to improve health.

Community Coaches, seven of whom are NNPHI employees, work with local leaders to identify areas for progress, bring partners from different sectors together and enhance community capacity.

Recipients of the RWJF Culture of Health Prize provide inspirational and instructional stories for how to move health forward.

To learn more about coaching and web-based guidance to improve health, including What Works for Health, a database of more than 360 evidence-informed approaches that communities can explore, visit

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