Study measures health factors in N.H. counties

When it comes to public health, Hillsborough County does poorly with controlling teen birth rates, does OK with getting people into college and does quite well when it comes to having a lot of grocery stores and farmers markets.Those may seem like unorthodox measures for medical officials to contemplate, but they are part of a new survey on the nation’s health, released Feb. 17 by a collaboration between the Robert Wood Johnson Foundation, a nonprofit group that concentrates on health issues, and the University of Wisconsin Population Health Institute.“One of the key things in this particular type of study is that it shows that where we live matters to our health,” said Dr. Jose Montero, director of public health for the state. “Social and economic factors – some people don’t realize how much they impact or correlate to health.”The most attention-grabbing aspect of the survey is that it ranks every county within each state by overall “health outcomes.”In New Hampshire, Grafton County was tops, perhaps due to the presence of Dartmouth College and the Dartmouth-Hitchcock Clinic and their related socioeconomic benefits, while Coos County was last, likely a reflection of its high poverty rate and associated habits (it has, by far, the state’s highest rate of adult smoking, for example) and a scattered population that is often far from health care.Montero downplayed the ranking aspect, noting that small differences can exist between No. 1 and No. 2, or No. 9 and No. 10, “just like in the Olympics.” He also pointed out that with 28 different factors measured, virtually every county does better in some areas than even its highest-ranking neighbors.

Nontraditional measuresEach county is ranked within the state on how healthy people are, based largely on annual surveys given to around 5,000 people, and how long they live. They also are ranked on key factors that affect health such as: smoking, obesity, binge drinking, access to primary care providers, rates of high school graduation, rates of violent crime, air pollution, liquor store density, unemployment rates and children living in poverty.The data are gathered from sources including Dartmouth’s Atlas Project, a 15-year-old examination of health-care practices across the United States; the Behavioral Risk Factor Surveillance System, which in New Hampshire involves roughly 5,000 telephone surveys a year; and Census Bureau surveys and data.While some of those factors are traditional public health measures, others are not. For example, “access to healthy foods” is a measure of the number of grocery stores with more than four employees – a measure that avoids most convenience stores, which tend to sell a high proportion of junk food and cigarettes – plus farmers markets and farm stands, which are much more likely to sell fresh produce.Joan Ascheim, chief of the bureau of policy and performance management in the Division of Public Health, said that while the state can hardly build grocery stores, but it can urge small stores to sell healthier foods, providing a “Healthy Heart” certificate as recognition.“We talk with people who have convenience stores, say ‘Can you sell more fresh produce?’” Ascheim said. “People are open to that.”That is an example of ways that officials hope surveys like this can improve public health.“We hope that local and regional communities use this to see what is really impacting and affecting them,” Montero said. “They can rally around looking at solutions – not just what the state is going to come and do, but what is happening in my own community, my own county, and how do we prioritize these things.”