Health outcomes have long varied significantly among New Jersey’s 21 counties, and experts say it is no surprise that COVID-19 has taken a greater toll on communities traditionally home to less healthy populations.
In fact, some of the counties near the bottom of the latest County Health Rankings & Roadmaps report, an annual public health resource funded by the Robert Wood Johnson Foundation and created by the University of Wisconsin Population Health Institute, have some of the highest COVID-19-related death rates in New Jersey, according to an NJ Spotlight News review of state data.
The 2021 rankings, released Wednesday, depend on data through 2019 that predates the coronavirus pandemic. But in several cases the findings align with the impact COVID-19 has had on New Jersey’s counties.
Passaic and Essex counties — ranked 14th and 17th, respectively, in the 2021 report — have recorded the highest county-level COVID-19 fatality rates, according to state figures. Salem and Cumberland counties — ranked 20th and 21st this year — have the seventh- and eighth-highest death rates, despite being located in a region that was not as hard-hit by the virus as north Jersey.
Poor health and COVID-19
While he did not review the NJ Spotlight News findings, Bob Atkins, director of the New Jersey Health Initiatives, a Robert Wood Johnson Foundation project, said associations between poor health outcomes and outsize pandemic impacts should not be surprising. COVID-19 has clearly had a disproportional effect on Black and brown communities, where individuals are more likely to have preexisting conditions that make them vulnerable to the virus, work in frontline jobs that put them at greater risk for exposure and live in crowded, multi-generational situations that exacerbate spread.
“Those at the bottom of the hill are always getting rolled over,” Atkins said. “COVID has really just exposed the inequities. Everything bad that can happen is going to happen most in the places that are most distressed.”
In addition, several New Jersey counties consistently shown in the report to have the healthiest populations are less impacted by COVID-19 deaths, the state data shows. Hunterdon County, ranked second for health outcomes in the new report, has the state’s lowest county-based death rate for the disease. Morris County, ranked No. 1., has the 14th-highest death rate; Somerset County, ranked third, is currently 11th on the list of COVID-19 fatality rates.
Tracking social determinants of health
The Robert Wood Johnson Foundation launched the county health-rankings report over a decade ago to focus greater attention on social determinants of health — things like poverty, education and exposure to violence that experts say shape wellness even more than medical care. In recent years, annual reports have highlighted specific factors, like racism and housing, that are particularly influential.
“The idea was, if we’re going to have a healthier society, we can’t just have this conversation that involves health care systems and physicians and nurses and public health,” Atkins, a nurse, explained. “We have to have a conversation that really involves where we work and where we live. We have to talk about schools,” he said, plus a host of other factors that are outside the traditional health care industry.
“All these things are connected to how long we live and how healthy we’re going to be,” Atkins said. “This is why ZIP codes matter.” Research has shown average lifespan can differ greatly between communities just a few miles apart — like Trenton and Princeton — as a result of these social determinants of health.
The rankings consider factors like access to medical care, parks and healthy food; smoking and other personal habits; and statistics on crime, disease and mortality, among other things. High school completion was added as a new ranking factor for 2021, Atkins said, and broadband access — now a critical link to school, doctors and more — was also considered.
The results have varied little in recent years, with Morris, Hunterdon, Somerset and Bergen counties generally ranked at the top of the list and Cumberland, Salem, Camden and Atlantic counties at the bottom. Essex, Gloucester, Cape May and Passaic counties tend to be low on the list as well.
Mapping unhealthy communities
The report includes two highly similar maps, one illustrating the rankings and the other reflecting health factors, or the elements that influence population health. These include measurements of human behavior, clinical care, and social and environmental influences. According to the report, these factors “are an estimate of the future health of counties” when compared to others in New Jersey.
The rankings are designed to help government and community leaders pursue effective policy changes, Atkins said, not to spark regional competition. The more that data can be localized, the more useful it is to this process, he noted. The pandemic also underscored the critical need for public health services and access to accurate information, he added, giving this work particularly urgency now.
“We need to talk about, ‘How do we build resiliency?’” Atkins said, “Because we’re going to have another pandemic. We’re going to have another Superstorm Sandy.”
2021 rankings of New Jersey counties by health outcomes:
- Cape May
— The Robert Wood Johnson Foundation is a funder of NJ Spotlight News.