After dipping out of the top 10 for the first time — to 23rd in 2018 — Douglas County has climbed back to the 17th healthiest county in Kansas this year.

Since the County Health Rankings & Roadmaps began in 2011, Douglas County had never ranked below ninth prior to its drop in 2018.

It’s bounced back a bit in 2019, but the report still notes significant racial and ethnic disparities, as well as high rates of alcohol-related health concerns and sexually transmitted infections compared to the rest of the state. Also, a key measurement largely responsible for the drop in 2018 worsened in this year’s report.

About the report

The annual report, released Tuesday, comes from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. It analyzes data from a range of sources to rank each state’s counties on overall health, and it provides a comparison to the top performers across the United States. Full reports are available at countyhealthrankings.org.

The Kansas Health Institute also looks at the data in the reports county-by-county and provides a report for each county’s statistics over the past several years. Those reports are available at khi.org.

According to the 2019 report, Johnson County ranked No. 1 in Kansas; Riley County, home to Kansas State University, ranked No. 5; and Chautauqua County ranked last, at No. 102.

Equity concerns

The 2019 rankings remind of equity concerns for Douglas County, but those worries are not new to local health leaders.

The Lawrence-Douglas County Health Department has begun initiatives to improve health equity in the area, based on some key findings in the department’s own 2018 Health Equity Report.

In speaking at a Douglas County Commission meeting on Feb. 6, the department’s director of informatics, Sonia Jordan, said she’s “seen the faces of people of various populations around our county when they read (the health department’s) report and they realize that we are failing them.” She said at the time that she and her colleagues are willing to “go pretty much anywhere to talk to anyone about this,” because they believe so strongly in the importance of the message.

Work is underway in that regard: “Primarily, a multi-sector, multi-jurisdiction steering committee in 2018 developed the county’s five-year Community Health Plan that with an encompassing focus on health equity will address: behavioral health, safe and affordable housing, nutrition and physical activity and poverty and jobs,” the department said in a news release this week.

According to the County Health Rankings report, black children in the county are three times as likely to live in poverty as white children. The report says that 12 percent of all Douglas County children live in poverty; broken down by race, it’s 10 percent of white children, 19 percent of Hispanic children and 30 percent of black children.

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Some of the findings in the County Health Rankings are similar to LDCHD’s, such as the percentage of babies born at a low birth weight. The reports use different data sets, but both show that the percentage is significantly higher for black mothers than for those of other racial and ethnic groups, by 4 to 7 percentage points.

Both reports also share statistics on teen birth rates, sourced from different data sets and explained a bit differently. According to the County Health Rankings report, there are nine teen births per 1,000 female Douglas County residents ages 15 to 19. That’s the lowest among counties in Kansas ranked for that measure, far lower than the state average of 28, and lower than top U.S. performers’ rate of 14.

However, that’s another category that shows significant racial and ethnic disparities: The rate among white teens is eight, but it doubles to 16 among Hispanic teens and more than triples to 26 among black teens.

The health department’s report, rather, shows what percentage of all babies born in the county are born to teen mothers. Overall, the county’s number is 4.1 percent; it’s 3.3 percent for white teens, 7.2 percent for Hispanic teens, 10.4 percent for multiracial teens and 10.8 percent for black teens.

Quality of life virtually unchanged after drop

Last year’s drop in the overall rankings had a good deal to do with the report’s quality of life category. In this ranking, Douglas County dropped from 28th to 68th from 2017 to 2018, and dropped again, to 74th, this year.

It includes the percentage of adults reporting poor or fair health; the average number of poor physical health days per month and of poor mental health days per month adults report; and the percentage of infants born at a low birth weight.

From 2017 to 2018, those numbers grew from 12 percent, 3 days, 3.2 days and 6.5 percent, respectively, to 13 percent, 3.4 days, and 3.6 days, with a static 6.5 percent of low birth weights. None budged from 2018 to 2019, except low birth weights, which rose to 6.8 percent.

Statewide averages for each in 2019 were 15 percent, 3.1 days, 3.3 days and 7 percent. According to the Kansas Health Institute, the latter three numbers had a significant negative contribution to the county’s overall score.

Other Douglas County statistics of note

• Percentage of driving deaths with alcohol involvement: This number fell from 27 percent in 2015 to 24 percent, on par with the current state average, in 2017; however, it climbed back up to 30 percent last year and 31 percent this year. Among U.S. top performers, the rate is 13 percent.

• Excessive drinking: On a similar note, Douglas County’s percentage of adults reporting binge or heavy drinking in the past 30 days was 22 percent, or the second highest in the state, behind Riley County’s 23 percent. That’s above the state average of 17 percent and the top U.S. performers’ 13 percent.

• Sexually transmitted infection rate, per 100,000: The county’s number of newly diagnosed chlamydia infections has increased each year since the 2015 rate, 487, to this year’s rate of 575, the third highest in the state behind Wyandotte (804) and Riley (683) counties. The state average is 417.7, and the rate for the nation’s top performers’ is 152.8.

• Percentage of obese adults age 20 and older: According to the Kansas Health Institute’s report, Douglas County’s score of 28 percent was a driver with a strong and positive impact on the county’s ranking. It’s better than the statewide 33 percent — however, it has been trending upward each year, from 23 percent in 2016.

• Premature death: This number is measured in years of potential life lost before age 75 per 100,000 population. Douglas County’s value, 5,420, was better than the state value of 6,944. The county ranked third in the state in that measure, and KHI’s report says it’s another positive driving factor in the county’s overall ranking.

However, it’s another equity concern: the rate was 5,500 for white residents and 6,800 for black residents. Data on other races and ethnicities wasn’t available in the report. It’s also been trending upward each year, from 4,826 in 2015.

New to rankings this year

The 2019 report has added some new categories and significantly expanded another.

Life expectancy has been added to the reports, though it is not included in the overall rankings. For Douglas County, that is 80.4 years, based on data from the National Vital Statistics System.

Also new to the report is the percentage of fee-for-service Medicare enrollees who received a flu vaccination. In Douglas County, that was 56 percent — better than the statewide 44 percent, but also even better than the top U.S. performers’ 52 percent.

The report also now tracks severe housing cost burden, or the percentage of households that spend 50 percent or more of their household income on housing. In Douglas County, that was 18 percent, according to the County Health Rankings, which used American Community Survey five-year estimates.

In previous years, the report included the percentage of female Medicare enrollees ages 67 to 69 who received mammography screenings. In Douglas County, that was 69 percent. However, the 2019 report expands the scope to women ages 65 to 74, and that percentage is 50 — better than the statewide 43 percent and about on par with the top U.S. performers, 49 percent.