Income Inequality, Social Factors Help Determine Statewide Health Rankings

Andrew Kitchenman | March 26, 2015 | Health Care, Maps
Hunterdon County tops NJ list, while Cumberland is last in annual report intended to spark local efforts to improve community health

The income status of New Jersey residents appears to be a major driving force in their health, with wealthy Hunterdon County again topping the annual County Health Rankings report, while low-income Cumberland County ranked last when it came to health outcomes.

But this year’s report for the first time is considering income inequality within counties, which is intended to guide efforts on the local level to improve residents’

The report ranks every county in the state according to two main components: health outcomes and the factors that contribute to those outcomes. Half of the outcomes calculation is based on “premature death,” or the number of years of potential life lost before age 75. The other half is based on self-reported health status, the number of days that people report poor physical or mental health, and the percentage of babies born with low birth weights.

The second ranking combines 30 factors that influence a person’s health. They include the share of the adult population that smokes, access to clinical care, percentage of the population that’s uninsured, as well as social and economic factors like the rate of unemployment and violent crime and the physical environment, such as the amount of air pollution.

For each of the areas that are measured, the report includes a list of policies that social scientists and other experts believe can lead to improved health. For example, the report lists 15 different policies that can be used to reduce smoking.

Many New Jersey counties had similar rankings compared with last year, although Essex County improved the most, rising three slots, with a drop in violent crime and the share of residents without insurance helping to drive the improvement.

Income inequality has been a major focus of recent political debates, but its role in driving poor health outcomes led to its inclusion as a factor in the rankings this year. The rankings also added a measurement of “social associations,” which were defined as the number of memberships that residents had in local organizations ranging from bowling leagues to civic associations to churches.

The sixth annual rankings are a joint project of the Plainsboro-based Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

While the ranking of countywide health outcomes may draw the most attention, the goal of the report is to focus the attention of government, business, and community organizations on improving the factors that contribute to health.

Dr. John R. Lumpkin, foundation senior vice president, said income affects health in numerous ways.

“It affects choices in housing, education, childcare, food and so many other things. All of these things have a direct link to how healthy we are and how long we live,” he said.

Essex County had the most unequal incomes, based on the measurement used in the report. Sussex County had the most income equality.

While discussions about income inequality can be politically fraught, Lumpkin said local leaders can focus on the health implications without focusing on the political arguments.

“Recognizing that people in poorer communities don’t have access to fruits and vegetables, you can change that without changing their income. They don’t have access to places to exercise. Again, you can change that,” he said.

The report also lists ways to reduce income inequality, with increasing the earned income-tax credit topping the list of policies that are supported by social science.

The other new factor, social associations,, was included for multiple reasons, Lumpkin said.

“We know that to the extent that people are isolated, their risk of death goes up. and this is why friendship and social connectedness, whether it be through the church or community groups or something that’s being done by the city council, senior programs, has a big impact,” he said, adding that there’s evidence that when people connect and work together, the entire community become healthier.

Lumpkin noted that all counties can find areas to improve, and can track progress over time. For instance, Somerset County was ranked second among counties statewide in the overall health-outcomes rankings, but ranked last in how the physical environment affects health, due to a high level of water-quality violations and relatively long commutes.

The rankings include new factors every year as evidence grows about the factors that influence health. Jan O’Neill, a University of Wisconsin associate researcher and a program community coach, said the rankings program is always looking for county-level health data. She is part of the team that helps develop the rankings.

The announcement of the report in the Statehouse yesterday brought together the array of leaders that the program is intended to reach, from legislators like Sen. Joseph F. Vitale (D-Middlesex) and Assemblywoman Donna M. Simon (R-Hunterdon, Mercer, Middlesex and Somerset) to business representatives and clergy.

Natalie Menza, manager of health and wellness for ShopRite owner Wakefern Food Corp., said a ShopRite program to employ more than 100 nutritionists in its stores was an example of how businesses can improve the health of their communities.

Lumpkin linked the rankings to the foundation’s overall mission of building a culture of health, where “the health choice becomes the easy choice, where you walk into a food store and the first thing you see is the produce.”

The program also is expanding its community-coaching program, in which trained experts link local leaders with tools they can use to improve health. New Jersey, as the home of the foundation, will be the only state in the country with a single coach dedicated to serve all communities in the state. The other 49 states will be served by a total of 10 coaches.

Toni Lewis, the New Jersey community coach, said she’d use the ranking to start conversations with community leaders, helping them set priorities for improving health.

“We believe we’re going to see a lot of innovative and great stories coming out of New Jersey that we can share across the nation,” Lewis said.

Disclosure: The Robert Wood Johnson Foundation provides funding for NJ Spotlight’s health coverage.