An annual rankings project on Tuesday named Steele County Minnesota's healthiest county, but the report shows some Minnesota counties continue to struggle.
Cass County in north central Minnesota was last in health outcomes for the second year in a row, according to the rankings issued by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
The ranking project, in its third year, measures both health outcomes and health factors. Health outcomes look at measures such as premature death, low birth weight, and the number of days a survey of county residents shows they have poor health. Health factors look at health behaviors, education, economic factors and the environment where people live.
Beltrami County ranked last in health factors, and Cass County ranked 81st out of the 84 counties included in the report. Besides Cass and Beltrami, Mahnomen, Morrison and Mille Lacs counties also landed toward the bottom of both the health outcomes and health factors lists, and rankings from the past two years show little change for the counties in the statewide rankings.
Jamie Richter, director of public health nursing for Cass County, said some of the factors included in the rankings are difficult to control. For example, Cass County has high rates of child poverty and a high unemployment rate — two of many factors that researchers use to determine the health factors rankings. Overall, socioeconomic factors carry a 40 percent weight for the health factors ranking.
"There are things that we can change and there's things we can't change, and we try to focus on the things that we can," said Richter, citing low birth weight as something local health officials can try to improve through prenatal care visits with pregnant women.
Richter said Cass County has also been able to improve residents' access to healthy food. Officials worked with six restaurants to offer healthier menu options and were able to reduce the total number of calories available on the menus. Cass County also did well in the fast food percentage category — only about 14 percent of Cass County's restaurants are considered fast food, compared to nearly half statewide.
The fact that socioeconomic factors were ranked heavily might have helped some counties rank higher. For example, residents of Carver County, which covers several southwestern Twin Cities suburbs, have prospered in recent years compared to other Minnesota counties.
Carver County ranked second in the state in both health outcomes and health factors, but there's still room for improvement, said Marcee Shaughnessy, manager of the Carver County Public Health Department.
"We don't want people to feel like, 'OK, we don't have a problem with obesity, we don't have a problem with lack of activity,'" she said. "We still have those same issues. It's just that that's not the way that this particular ranking was conducted."
Shaughnessy said the county has tried to focus on promoting healthy eating and physical activity, such as a team-based challenge to keep track of how many minutes people spend exercising. It has also offered classes at work sites to encourage people to quit smoking.
But Carver County could do better when it comes to access to recreational facilities and healthy food, Shaughnessy said. And Carver County could face more health challenges in the next two decades as its population is expected to increase rapidly, she said.
State Health Commissioner Dr. Ed Ehlinger said the rankings can help health officials decide what communities need more resources.
"It focuses on some of the health factors and some of the health outcomes that we know we can get evidence-based practices to address those health factors and have some impact on those health outcomes," he said.
Besides Steele, Carver and McLeod counties were at the top of the health outcomes list. But only Carver County landed in the top three for both health outcomes and health factors — Steele was 29th and McLeod was 25th in that category.
Olmsted County ranked first in health factors, and Washington County was third.
"It highlights again the fact that place matters, where you live matters, and that means that what's the economic status, what's the employment status, what's the education status, what is the community investment in itself, is really important," Ehlinger said.
He said that while the rankings can help identify needs, the report isn't as good at identifying which public health initiatives are working. In addition, it's easy for some counties with smaller populations to show big changes in the rankings from year to year, he said.
"I think we need to look at this over a longer period of time to see what the general trend is," Ehlinger said.
Dee Ann Pettyjohn, director of public health in Steele County, said officials there aren't over-celebrating the No. 1 ranking.
"There are some areas where we've improved, some areas where we stayed the same," she said. "With a lot of these things, it might take a generation for outcomes to improve. It's very difficult to measure one year at a time and to get a picture of what's happening."