Annual County Health Rankings Highlight Racial Disparities

Lilo H. Stainton | March 19, 2018 | Health Care
Among the report’s more unsettling findings: Black babies were more than 40 percent more likely to die prematurely than their white counterparts

black baby
Wealth and health are definitely connected. But race is also a significant factor, with black residents facing health outcomes that lag behind those of white New Jerseyans — often significantly — over the span a lifetime.

Those are among the conclusions of data released last week as part of the annual County Health Rankings, a national report produced by the New Jersey-based Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The findings compare counties across the nation on measures like low birth-weight babies, poor health days, and early death — as well as factors that impact these outcomes, including smoking, education levels, and obesity.

Racial disparities in health have become a growing focus in recent years, and Dr. Shereef Elnahal, the acting commissioner of the state Department of Health, has made it a priority to reduce these gaps, which he called “embarrassingly high” at a recent hearing. “Needless to say, we have much work ahead to improve New Jersey’s public health,” he told the Senate Judiciary committee earlier this month.

Among other things, the 2017 County Health report found that, in New Jersey, Morris, Hunterdon, and Somerset were the three best counties in terms of health outcomes; those three also happen to be the counties with the highest median income levels, with Hunterdon topping the state at nearly $113,700, according to 2016 data from the U.S. Census Bureau.

Income and health outcomes

Cumberland County had the poorest health outcomes, followed by Salem and then Camden counties; Cumberland also had the lowest median income, at just over $49,100, followed by Salem. (Camden ranked 13th in terms of low median income.)

Past rankings show similar, if not identical, results: Hunterdon has held the top healthcare outcome spot for several years, with Morris and Somerset trading second and third positions. Cumberland and Camden typically rank near the bottom, with Atlantic and Essex and Salem counties vying for the third-worst outcomes.

The latest report shows that, statewide, 15 percent of all Garden State youth live in poverty, compared to a national average of 20 percent. But black kids were twice as likely to come from low-income backgrounds in New Jersey, with one in five growing up in poverty, compared to 11 percent of white children. Nearly one-third of Hispanic children live in poverty here.

African-American babies in this state were nearly twice as likely to be born below weight, at 13 percent, versus 7 percent for white and Hispanic infants, according to the report. Black babies were also more than 40 percent more likely to die prematurely than their white counterparts, and nearly 60 percent more likely to die early than Hispanics.

“Communities of color are exposed to many public health risks at rates that far exceed the general population: lead exposure, infant mortality, and maternal mortality are just a few of these risks,” Dr. Elnahal said. “Decreasing these disparities is a top priority for me and the entire department.”

Census findings released last fall showed a significant income disparity between black and white residents in the Garden State, a gap that is larger than the nationwide difference and one that has increased over the past decade. Data from 2016 shows that the median income for blacks (almost $47,700) was, on average, a little more than half that of white residents (nearly $86,400).

Wealth, race, and health

Experts have begun to focus more attention on the connections between wealth, race, and health as part of a growing awareness of how social determents impact wellbeing – factors like poverty, the impact of racism and other stresses, and environmental factors. This is also reflected in New Jersey’s increasing emphasis on tracking and improving public health and in efforts by traditional healthcare systems to add programs that address nutrition, affordable housing, exercise, and more.

“We can’t be a healthy, thriving nation if we continue to leave entire communities and populations behind,” said Dr. Richard Besser, the foundation’s president and CEO. (RWJF is a funder of NJ Spotlight.) “Every community should use their County Health Rankings data, work together, and find solutions so that all babies, kids, and adults — regardless of their race or ethnicity — have the same opportunities to be healthy,” he said.

When compared to nationwide outcomes, New Jersey residents have about the same chance of being born underweight (8 percent), are slightly less likely to report poor or fair health or unhealthy days, and 18 percent less likely to die early.

This may reflect stronger health factors: lower rates of smoking, obesity, and unhealthy drinking, and better access to healthy food and insurance coverage. New Jersey also graduates more high school and college students than is the average nationwide, and has lower levels of violence — all factors that contribute to good health.

However, there are fewer doctors per person here than the national average, and nearly 20 percent fewer dentists per capita; the state does track close to the national norms on diabetes screenings, mammograms, and preventable hospital stays. But other challenges include higher levels of air pollution and housing problems, and longer commutes by car.

In addition, in the Garden State there is significant variation within these averages. Insurance coverage ranges from 5 percent to 15 percent, and there are huge gaps in access to primary-care physicians and other providers. Child poverty ranges from a low of 4 percent to a whopping 27 percent. Low birth weights vary from 6 percent to 10 percent, and adults reporting poor or fair health range from 11 percent to 23 percent.

The County Rankings report also touched on how communities can use this data and other findings to improve public health. The authors urged officials to invest in early-childhood education, which can boost an individual’s economic prospects over a lifetime, expand access to affordable health insurance, and invest in other social-welfare programs.

“Sharing data and trends through reports like the County Health Rankings empowers communities to improve health outcomes and develop solutions to address disparities,” Dr. Elnahal said.