RALEIGH — The North Carolina counties where people are healthiest tend to be urban and affluent, while poor, rural counties struggle the most with bad health, according to a study released Tuesday.
Wake, Orange, Union, Mecklenburg and Dare counties lead the state in measurements of so-called health outcomes, which include factors like how long people live and their quality of life, according to the study by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
Ranking last in health outcomes is Columbus County, followed by Robeson, Halifax, Bladen and Edgecombe counties. All five are designated "Tier 1" counties by the state Department of Commerce, meaning they're among those with the highest levels of economic distress in North Carolina. Four of the five healthiest counties are "Tier 3," meaning they're among the least economically troubled, with Dare being designated a "Tier 2" county.
The correlation between economic and physical well-being is not surprising to Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation.
"If you look at the variables that underlie why a county is healthy or less healthy, factors like education, access to health care, the kind of employment opportunities that are available, those track with the wealth of a community," she said Monday.
Wealthier counties also do better when it comes to individual health factors tracked by the report, such as smoking rates, obesity and physical inactivity, the number of children living in poverty and access to primary-care physicians.
Wake County is below the state average in such factors, but also in economic and social factors that may play a role in health. Roughly 77 percent of Wake County residents have at least some college education, compared to 61 percent on average in the state and a national average of 68 percent. In Columbus County, the figure is 52 percent.
Education levels can be a strong indicator of whether people are likely to be healthy, especially when it comes to families, Lavizzo-Mourey said.
"The more education parents have, it's almost as if it becomes a vaccine for the kids," she said.
Behavior that pays off with good health later in life tends to start young, with habits like brushing teeth and having regular checkups by a doctor, said Tom Vitaglione, a senior fellow at Action for Children NC, who was not involved in compiling the report. If those behaviors don't start early in life, it's hard to get into the habit in adulthood.
"It can be done, but children who start off in dire straits have a much harder time overcoming that," he said.
Poverty can also present a more practical barrier to good health, he said: People without health insurance are reluctant to visit a doctor, often delaying until a problem is so serious it requires a hospital stay.
"There's this trait of not addressing health problems until they're right on top of you," he said.
Lavizzo-Mourey said there are encouraging signs, noting that county-level data is starting to be used by community and business leaders to make decisions about ways to encourage better health and to address some of the underlying causes of poor health.