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Features Health & Wellness Macon County health ranks 16th in the state

Macon County has been ranked 16th in North Carolina for over-all good health in the recently released 2013 rankings. That is three spots below the 2012 ranking of 13th. Despite the small decline, Macon still sits ahead of 84 other counties throughout the state and is ranked fourth in Western North Carolina behind Watauga (3), Henderson (12) and Transylvania (14).

The County Health Rankings and Roadmaps program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The program ranks almost every county in the country.

The purpose behind the County Health Rankings Index is to help communities create solutions that make it easier for people to be healthy in their communities, focusing on specific factors that they believe affect health, such as education and income, whether a person has health insurance and the quality of health care they receive.

The rankings consider a variety of measures that affect health such as the rate of people dying before age 75, high school graduation rates, unemployment, limited access to healthy foods, air and water quality, income, and rates of smoking, obesity and teen births. Based on data available for each county, the rankings are unique in their ability to measure the overall health of each county in all 50 states on the many factors that influence health, and have been used to garner support among government agencies, healthcare providers, community organizations, business leaders, policy- makers, and the public for local health improvement initiatives.

Neighboring Jackson County ranked at 23rd in the state, three spots better than it ranked in 2012. When considering the last four years, a comparison of the two counties tells a different story. From 2010-2013, Jackson County has fallen from 12th to being constantly in the mid 20s. Macon County on the other hand has improved its position significantly since 2010 when it ranked 44th in the state. In the ensuing years, it made progress moving to 34th, 13th, and now slipping just a few spots to 16th. Despite these shifts in numbers, officials note that it is important that those who analyze the study do not compare data from year to year for a county.

“In the past we've kind of cautioned against looking at rankings and comparing them from year to year,” said Becky Barr, Population Health Section Administrator of Macon County Public Health. “You have to look at them within the context of this year only.”

Since some measures are based on small samples, there could be a fluctuation in the numbers that are produced from year to year. The researchers involved with the rankings have tried to develop criteria for managing small numbers, but counties with smaller populations could see unreliable variation in the measures from year to year.

“We encourage these communities to view the rankings as a tool to raise awareness annually of the many factors that affect health,” said the creators of the Rankings and Roadmaps Program. “The rankings are not the best tool for measuring progress from year to year. We encourage communities to develop a specific evaluation plan as part of comprehensive community health improvement planning.”

“We are extremely proud of Macon County for such a high ranking,” said County Commissioner Ronnie Beale. “Hopefully we can sit down and look at the study and find areas that we can improve on even more.”

The results are more than just theoretical outcomes from researchers at a think-tank. According to the Robert Wood Johnson Foundation the county-level estimates based on Behavioral Risk Factor Surveillance System (BRFSS) data are calculated for the County Health Rankings by staff at the Centers for Disease Control and Prevention. Seven years of data were used where possible and estimates represent an average over the seven years. The BRFSS measures in the 2013 County Health Rankings are based on data from 2005-2011. Except for 2011, the public use final weight variable was used to produce estimates. These weights ensure state level estimates that reflect the age-sex-race distributions of the state.

The weights might not always provide accurate county level estimates, particularly when county age-sex-race distributions vary greatly from that of the state. For 2011 BRFSS data, a post stratification weight was calculated using the aforementioned approach for landline respondents only. Other publicly available BRFSS data for 2011 include cellphone respondents and are based on a revised weighting methodology.

The measures used were developed by multiple organizations and then passed on to the researchers for the final study. For example, measures from the National Vital Statistics System and the Behavioral Risk Factor Surveillance System were calculated by the National Center for Health Statistics/ Centers for Disease Control and Prevention. Researchers at the Dartmouth Institute were also instrumental in developing health care quality measures.

The study offers multiple subjects of study such as mortality where Macon ranked 20th, morbidity (12th), health behaviors like teen birth rate, excessive drinking, smoking, etc...(16th). The studies also considered clinical care (23rd), social and economic factors like unemployment rates, violent crime rate, etc.. (40th), and physical environment (16th).

“I just think the the Health Department has done a phenomenal job spreading awareness and conducting the programs they do to help people lead healthier lives,” said Beale. “A lot of it has to do with our free clinic. Some people can't afford insurance and they sure can't afford high medical bills and this helps those people. I hope in the future that we can allot county dollars for the clinic because it really does offer a good service to those who need health care.”


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