And once again Johnson County, the state’s most affluent and highly educated county, is also its healthiest, reflecting how socioeconomic factors such as income levels, education, jobs and affordable housing determine health outcomes.
The 2018 rankings, compiled by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, show that where you live is at least as important as access to affordable health care when it comes to determining how well and how long you live.
“You have this paradox of having the top and bottom counties next to each other in a part of the same metropolitan area. To me, it’s one of the best case studies one could find to show why where you live matters,” says Dr. Gianfranco Pezzino, a senior fellow at the Kansas Health Institute in Topeka.
“Ironically, KU Med Center is based in Wyandotte County, and I know they’re working really hard to improve the health in their communities," Pezzino says. "But once again, just having good health care is not enough to make a healthy community and the gap between those two counties is really a big reminder of that.”
Matt Trujillo, a program officer with the Robert Wood Johnson Foundation, says the trends reflected by the Wyandotte County data are not unique.
“We see data that represent things that are happening throughout the country,” Trujillo says. “With things like low birth weight, childhood poverty, we’re seeing some of these factors that are consistent across multiple counties and across the country. Kansas and Wyandotte County are no different there.”
The rankings for nearly every county in the United States are based on health outcomes, as measured by how long people live and how they subjectively feel. It's also based on health behaviors (for example, diet and exercise, alcohol and drug use, and tobacco use), social and economic factors (education, employment, income, family and social support), the physical environment (air and water quality, housing and transportation), and clinical care.
Taking all those factors into account, Wyandotte County ranked No. 99 out of the 103 Kansas counties measured (two counties were not included). Only Republic, Morton, Labette and Woodson counties fared worse. Republic is in north central Kansas, Morton is in the southwest corner, and Labette and Woodson are in the southeast corner.
This is the ninth year the rankings have been published. Once ranked at the bottom, Wyandotte County has taken extensive measures to undo that lowly status. But health experts note that population health can’t be turned around on a dime, and the county still lags when it comes to health behaviors and social and economic factors.
Wyandotte still comes in dead last among the state’s counties when it comes to smoking, adult obesity, drinking, teen births and sexually transmitted infections. It also rates last when measured by education levels, children in poverty, income inequality and violent crime.
“Certain health factors used in the county health rankings, such as unemployment, percent of children in poverty, high school graduation rate, and percent of children in single-parent households, are factors that cannot be fixed overnight, or even in a few years,” Terry Brecheisen, director of the Public Health Department for the Unified Government of Wyandotte County/Kansas City, Kansas, said in a statement.
“Health rankings change slowly, and health improvement may take decades, but we are not waiting around for nothing to happen. We are taking action.”
Brecheisen pointed to a community health assessment undertaken last year that will be used to map out steps to improve health in the county over the next three to five years. The Unified Government will focus on four broad areas, Brecheisen said: safe and affordable housing; access to medical, dental, and mental health care; violence prevention; and education and jobs.
“These four improvement areas may seem outside the traditional realm of health, but it shows the complexity of factors that affect the community’s overall health and well-being which are all measured by the county health rankings,” Brecheisen said.
Wesley McKain, supervisor of the healthy communities division of the health department, says the rankings serve a useful role by highlighting some of the county’s health disparities by race and ethnicity, providing guidance for policymakers.
For example, the data show that 46 percent of black children in Wyandotte County live in poverty, compared with 40 percent of Hispanic children and 17 percent of white children. They also show that 13 percent of black newborns have low birthweights, compared with 7 percent of white newborns and 6 percent of Hispanic newborns.
“The ways that those are going to change is not just by providing better healthcare,” McKain says. “They're going to change by the the way we apportion public resources in Wyandotte County. “It's going to take some pretty significant kind of policy level changes for those to get better. And so I think this provides good data for having those types of conversations.”
Trujillo, of the Robert Wood Johnson Foundation, cautions that Wyandotte County’s relative ranking may have remained static because, while it has improved in some areas, other counties have improved at the same time.
But like Brecheisen of the Unified Government’s health department, he says that turning the tide will take a long time.
“This is a big ship to turn and so what it will require is patience, and it will require having a long-term goal,” Trujillo says. “So even though we may not see progress in the short term, that doesn’t mean that there won't be progress in the long-term.”
One example is Wyandotte County’s childhood poverty rate, which stands at 24 percent, compared with 14 percent statewide. Trujillo says ensuring that children have access to quality early-childhood education and that their parents have access to good, paying jobs would be among the long-term steps the county could take to improve its population’s health.
“When we get people – all people – involved, not just policymakers but community members, and we start having conversations and we start taking action on a multitude of different factors, that’s when we'll see progress,” Trujillo says. “So it's all about getting everyone involved in recognizing everyone has a role to play in improving their communities.”
Pezzino, of the Kansas Health Institute, points out the data don’t account for recent initiatives in Wyandotte County, such as the construction of new walking paths and the effort to attract grocery stores that sell fresh fruit and produce.
“Even though they have made a lot of efforts to improve their socioeconomic factors and all the other built environment factors that are linked to health, if anything it’s just a reminder that these are big issue and it takes time to address them and resolve them,” Pezzino says.
Dan Margolies is a senior reporter and editor for KCUR. You can reach him on Twitter @DanMargolies.