Where We Live Matters: County-Level and Community-Level Health Indicators

April 2014

Spring is here! We have warmer weather, we’ve celebrated National Public Health Week (April 7-13) and we have exciting data to look forward to. As the last of the snow melts and we step outside into our neighborhoods, April is a great time to discuss the role our communities play in our overall health and wellbeing. At the end of March, the 2014 County Health Rankings were released, revealing how each county in each state ranks on the factors that influence health as well as health outcomes. In addition to the local community data we provide, Public Health Management Corporation’s (PHMC) Community Health Data Base (CHDB) team serves as the state team lead for the Pennsylvania County Health Rankings. This article uses data from the Robert Wood Johnson Foundation and University of Wisconsin’s County Health Rankings as well as data from the Southeastern Pennsylvania Household Health Survey, and the US Census to examine the ways that where we live, learn, work and play are tied to our opportunities to be healthy.

Statewide Data for Pennsylvania
The County Health Rankings draw on data from thirteen different sources to determine each county’s rank. Health factor rankings consider clinical care, the physical environment, health behaviors and the social and economic factors that have an impact on our health. Health outcome rankings address mortality and morbidity, that is, how long we live and how healthy we are. In general, counties that rank higher on health factors also rank higher on health outcomes. In some cases, however, we see a county that ranks high on health outcomes with a lower rank on the factors that influence health. This may be a leading indicator of a risk that can be addressed.

In Pennsylvania, the top five counties for health outcomes for 2014 were Union, Chester, Centre, Cumberland, and Montgomery (Figure 1), while the top five for health factors were Chester, Montgomery, Centre, Cumberland and Bucks Counties (Figure 2). The counties that fell at the bottom of the rankings for outcomes were Philadelphia, Forest, Fayette, Greene, and Sullivan, while those at the bottom for factors were Philadelphia, Fayette, Forest, Cameron, and Green. There is some overlap, between outcome and factor rankings, but it’s not a perfect match. In top-ranked Chester County, rankings were lower for some physical environment factors, things like driving alone to work and long commutes, each of which can impose health risks and serve as a barrier to healthier behaviors. Philadelphia, ranked at the bottom of the state overall, was number one in the state for clean drinking water.

Southeastern Pennsylvania – US Census
The five-county area where PHMC fields the Southeastern Pennsylvania Household Health Survey (Bucks, Chester, Delaware, Montgomery and Philadelphia) includes counties ranked at the top, in the bottom and in the middle. Using local data from the US Census, we can zoom in and see that where we live within the county matters as well.

• In high-ranked Chester County, there are communities with more resources and those with fewer resources: in the city of Coatesville, the 2013 Median Household Income was $37,017, while in Birmingham Township it was $157,077.
• Employment status related directly to resources, both financial as well as access to care. In Montgomery County, the unemployment rate in Schwenksville is 12.7%, while in Skippack Township and Jenkintown Borough, both in Montgomery County, the unemployment rate is 3.3%.
• Educational attainment is a key predictor of future income, and within counties there is wide variation. In Yardley Borough, Bucks County, 1.4% of adults have less than a high school diploma while in Telford Borough, Bucks County, that number is far higher, at 18.7% of adults.
• The demographic breakdown of a community can play a significant role in the needs of that area as well. In Thornbury Township, Delaware County, 28.7% of the population is under the age of 18, while in the same county, in Media Borough, the percentage of the population represented by children is half of that, at 14.1%.
• For those for whom English is not their primary language, resources and services need to be tailored to meet the needs of the community. In Philadelphia, four in ten North Philadelphia residents (40.0%) speak Spanish at home, while in Lower South Philadelphia 1.8% speak Spanish at home.

Southeastern Pennsylvania Household Health Survey
PHMC’s Southeastern Pennsylvania Household Health Survey provides a unique perspective on community-level population health data within counties. With a sample of 10,000 residents, the survey provides insights into the health of children and adults at the neighborhood level, allowing for exploration of the differences in health factors and health outcomes between communities.

In Bucks County, which generally rated well for health outcomes, adults in the lower part of the county were nearly twice as likely as those in the central part to describe their health as fair or poor (18.4% as compared with 9.6%). Adults in the south most part of Delaware County were three times as likely to be in fair or poor health as those in the west (17.8% as compared with 6.2%) (Figure 3).

Within the city, health factors vary widely from neighborhood to neighborhood. Inequalities in access to resources can have wide-ranging impacts on long-term health.
In North Philadelphia, 17.8% of adults have a difficult time finding fresh produce in their neighborhoods, while in the Lower Northwest and Lower Far Northeast 3.8% of adults have the same difficulty (Figure 4).

The County Health Rankings and Roadmaps draws nationwide attention to the role of place in health and wellbeing. With the release of this year’s Rankings it is clear that no county is perfect and each could take steps to improve opportunities for health for all residents. Narrowing the focus and reviewing neighborhood-level data within counties using the Southeastern Pennsylvania Household Health Survey, it is obvious how widely varied communities are within counties, and how important local-level data are in supporting local-level initiatives.

For more information about the findings presented in this article, please contact Rose Malinowski Weingartner at This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it..">.

To download this article as a PDF, click here.