You may have an idea how healthy your town or city is, but what about your county? An annual set of reports is now available ranking the health of almost every U.S. county, and it shows that grocery stores and schools can be more important than doctors in keeping people well.
"Although healthcare is really important, much of what influences health happens outside the doctor's office, including education, income, access to healthy foods, places to exercise and smoke-free air," said Bridget Booske, senior scientist at the University of Wisconsin Population Health Institute in Madison.
Booske is also deputy director of County Health Rankings, a project done in collaboration with the Robert Wood Johnson Foundation.
One purpose of the reports is to help counties understand what influences people's health as well as to determine how long they will live.
The lowest-ranking counties had certain characteristics in common when compared to the high-ranking counties, such as lower high school graduation rates, more than twice as many children living in poverty, far fewer grocery stores or farmer's markets and higher rates of unemployment.
ABC News looked at the five most populous states and which counties ranked highest (healthiest) and lowest (unhealthiest):
With many state and local governments in a financial bind, implementing widespread health initiatives is a challenge. But experts say there are low-cost ways to start making a difference.
"The most important single intervention is to get people to stop smoking. Of all the controllable causes of illness, that is the most significant. This does not have to be a costly effort," said Robert Field, professor of health policy and management at the Drexel University School of Public Health in Philadelphia. He was not involved with the rankings. "It can involve public education, enforcement of laws against sales to minors, and higher taxes on cigarettes."
Counties can save money in the long run by focusing on prevention.
"A lot of focus is on health care dollars, but we spend more than 95 percent of health care dollars on treating people once they're sick, and most diseases that affect people are entirely preventable," said Booske.
The relationship between health and economic growth is complicated. Some experts say people's physical health can affect a county's fiscal health because of more lost work days and lower productivity, but others say high unemployment is the bigger factor in driving the economy.
"Better health is welcome but it does not drive growth," said Ted Marmor, professor of public policy and management at the Yale School of Management in New Haven, Conn. "In short, the implications of better health are exaggerated in economic terms, however important in individual and family terms."
Last year's rankings, the first of the annual reports, spurred some counties into action. On the County Health Rankings web site, there are stories of what some local governments did after finding out their counties ranked low in their states.
In Wyandotte County, Kan., the mayor of Kansas City, Kan., created a Healthy Communities Initiative and got business leaders and other officials involved in the effort.
"The County Health Rankings were a call to me to say, 'You're not going to be the best community you can be if you don't focus on the health of your community,'" Kansas City Mayor Joe Reardon said.
Public health experts say part of community health initiatives should include better primary care.
"Most illness can be treated or prevented through regular routine medical care, before major interventions are needed. A good primary care provider will also educate patients about healthy lifestyle habits," said Field.
"Laws and policies are our most effective tool in improving the health of communities. Policies that improve the economy, create jobs, support education, et cetera," said Dr. Daniel Blumenthal, associate dean for community health at Morehouse School of Medicine in Atlanta. "Also important are those laws and policies directly related to health, such as smoking restrictions and requiring fast-food restaurants to post calorie counts."
In addition, experts say healthier behaviors should start in schools.
"This can include healthy meals, fewer vending machines, and opportunities for exercise. Starting good habits at a young age can have large long-term rewards."
Another set of rankings will be done next year, and then funding for the project runs out. After that, Booske said the Foundation will launch a new program that offers grants to 14 communities around the country to help improve the public's health.