Douglas County ranked the eight healthiest county in Kansas for the third year in a row in 2016.

Kansas City, Kan. ? Seven years in to an effort to improve its poor showing on statewide surveys of resident health, Wyandotte County continues to rank near the bottom. The county ranked very last, No. 101, in 2016.

But county leaders point to improvements in smoking rates, the teen birth rate and other measures to argue that the trend is in the right direction.

“We feel like there’s been a lot happening over the last two to three years and we are really beginning to move the needle,” said Jerry Jones, executive director of the Community Health Council of Wyandotte County. “While the rankings are always good to show what’s in front of us, we also know really good work is happening and we need to press on.”

The northeast Kansas county has consistently ranked last or nearly last since 2010 when the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute began the rankings. This year Wyandotte County came in last in rankings based on nearly 40 factors, including premature deaths, obesity, poverty, housing stock, income equality and access to exercise.

The work to improve began in 2009, when the Kansas Health Institute issued its own statewide rankings and Wyandotte County was last. That prompted county officials to launch a multipronged approach involving private, public, religious and government leaders.

The 2016 rankings are based on data collected before 2014, meaning they don’t show recent efforts, such as a push since 2013 to sign up residents for health care under the Affordable Care Act, which reduced the rate of uninsured county residents from 26 percent to 18 percent.

Mark Holland, mayor of the Unified Government of Wyandotte County and Kansas City, Kan., said the health effort led in part by his predecessor, Joe Reardon, has grown to include more than 100 community partners and eight teams using about $8 million in direct and indirect grants. Efforts include improving access to fresh food, providing more biking and walking trails, addressing a lack of affordable housing, expanding education offerings and increasing access to health care.

Jones said the county is seeing an increase in diabetic screenings and the percentage of adult smokers — 23 percent — is the lowest it’s been in five years. He also noted the county’s ranking for teen birth rate improved from 85th to 73rd between 2012 and 2016.

Poverty is the underlying cause for the county’s health challenges, said Holland, who noted the top-ranked county in Kansas, Johnson County, is the state’s wealthiest and is adjacent to Wyandotte County, which is one of the poorest. Douglas County has ranked eighth-healthiest in the state for three years in a row.

“We just decided we are not going to wait for poverty to be fixed before we start taking aggressive steps to improve things and to help our residents make better health choices,” he said.

Another focus is to persuade uninsured residents to take advantage of health care and education programs provided by safety net medical clinics rather than delaying health care until they need an emergency room. That can be difficult because their clients face obstacles such as lack of transportation and money, said Catherine Rice, spokeswoman for the Saint Vincent and Duchesne health care clinics in Wyandotte County and Leavenworth.

“Our patient base, oftentimes their health is not a priority,” Rice said. “They’re worried about keeping the lights on, putting food on the table, everyday things that others take for granted. We want to look at the whole person and to educate them that in order to keep the lights on and take care of the kids, you have to take care of yourself.”