WASHINGTON

Ranking of healthiest counties revealed as suburban overdoses soar

Jayne O'Donnell, Frank Gluck and Darla Carter
USA TODAY Network

Corrections and clarifications: An earlier version of this story failed to mention that Kentucky was among the Southern states that expanded Medicaid. It has also been updated to say a rapid increase in deaths among young people ages 15 to 44 led to 85% of the increase in premature deaths.

Premature deaths among those aged 25-44 were way up in 2015, due in large part to a surge of drug overdoses in suburban areas, a report out Wednesday shows.

Young adults learn "mental toughness training" doing carpentry and gardening as part of YouthBuild Louisville. Louisville won a Culture of Health RWJF prize in 2016. 


YouthBuild Louisville is an education, job training and leadership program that provides low-income young adults ages 18-24 opportunities to realize their potential as active community leaders and as part of an educated workforce for Louisville. These photos are from YBL mental toughness training, where the students do carpentry and work in the gardens. Photo by Tyrone Turner/ Robert Wood Johnson Foundation

Drug deaths are also accelerating among 15- to 24-year-olds, but almost three times as many people in this age group died by homicide, suicide or in motor vehicle crashes, according to the new report from the Robert Wood Johnson Foundation (RWJF). A rural and urban divide, along with racial differences, were also evident in the data. Young white adults in rural areas were more likely to die by suicide or overdose, while homicides by firearms were much more common for young black victims.

The report shows "where people live plays a key role in how long and how well they live,” said Risa Lavizzo-Mourey, a physician who is RWJF's CEO.

County rankings

RWJF's county rankings come just days after efforts to overturn the Affordable Care Act failed in Congress, and some experts say the study underscores the importance of continued health coverage. It also coincides with President Trump's proposed $3 billion reduction in Department of Health and Human Services funding, along with his expected announcement of an opioid epidemic commission to examine funding and policy issues, as first reported by Politico.

From 2014 to 2015, 85% of the increase in premature deaths was attributed to a rapid increase in deaths among people aged 15 to 44. The report notes that many issues contributed to the increase, but the drug overdose epidemic is a "clear driver of this trend" among those 25- to 44-year-old.

States including Florida and Kentucky illustrate the pattern.

Of the 30 factors RWJF considered when ranking counties — including housing and education — Breathitt County in eastern Kentucky was ranked dead last in health outcomes and Clay County was last in health factors.

"The eastern Kentucky counties have a lot of problems that they have to overcome, starting with high poverty levels," says Ben Chandler, CEO of the Foundation for a Healthy Kentucky. "We've got a lot of work to do in the eastern part of the state."

In Florida, however, affluent St. Johns and Collier counties remained Florida’s healthiest, while the rural regions continued to suffer some of the highest rates of mental illness, substance abuse, and premature death, the report found. Union County, home to about 16,000 residents and a maximum security prison, ranked last in Florida, while the the largely rural Dixie County near the Florida panhandle had the highest rate of overdose deaths in the state.

Rates of “youth disconnection” — people aged 16 to 24 who are neither working nor in school — are a new addition to RWJF's report. Education and employment are key determinants of health, and the rates of youth disconnection were highest in rural counties, especially in the West and South.

'Largely invisible'

These young people are a "largely invisible" population that represent an "untapped social and economic opportunity," says Marjory Givens, an associate scientist with RWJF's county health program at the University of Wisconsin's Population Health Institute.

Marjory Givens is Deputy Director of Data and Science for the University of Wisconsin Population Health Institute.

It's "easier to prevent" young people from becoming disconnected, she says, than to "try to reengage young people who have dropped out of school or gone without work for some time."

Those living in the South are also far less likely to have health insurance as most southern states did not expand Medicaid under the Affordable Care Act. Since Congress decided not to vote Friday on the ACA replacement legislation, Kansas' state Senate approved a Medicaid expansion bill and Virginia Gov. Terry McAuliffe resumed his push for expansion. Maine voters had already approved placing a measure on the November ballot to consider expansion over the strong opposition of Gov. Paul LePage.

Medicaid covers more than 20% of substance abuse treatment in the U.S. Coverage for addiction treatment "cuts down on costs in a lot of areas, including hospitalization and emergency room visits," says Tom Hill, the National Council for Behavioral Health's vice president of addiction and recovery.

"Kudos to those states for reconsidering how Medicaid expansion might help the general health and well-being of their citizens," says Hill, a former Obama administration official at HHS' Substance Abuse and Mental Health Services Administration. 

Read more: 

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"We believe everyone should have access to affordable health care," says Givens, who is also deputy director of data and science at the Population Health Institute. "We also feel communities can take actions outside of health care that can really influence the health of community.

Taken together, health care and these efforts put people "just that much closer to be able to live long and live well," says Givens.

What's your experience with health in your community? Tell us at healthinsurance@usatoday.com