Rowan County Health Rankings – 2023

County Health Rankings….How did Rowan County Fare in the 2023 release?

In March, as they have done every year since 2003, the University of Wisconsin Population Health Institute published the county health rankings for each state. Funded by the Robert Woods Johnson Foundation, the extremely complicated process includes ranking every county in each state. In North Carolina, we have 100 counties, so a ranking of 1 would be best in the state and the ranking of 100 would be the worst. Counties are ranked in two categories, Health Outcomes, which is length and quality of life and Health Factors, which is determinates of health. For the 2023 ranking, Rowan County ranked 64^th in Health Outcomes and 66^th in Health Factors. This is very frustrating for the multitude of folks in our county who have worked diligently to improve the health of Rowan County, and deserves a much closer look. With access to available data back to 2011, we see that the best Rowan County has ever ranked was 54^th for Health Outcomes in 2012 and again in 2021 and 51^st for Health Factors in 2014. (see chart)

So what causes our ranking to be what it is? The devil is in the details, or in this case the devil is in the data. Comparing counties based on rankings is a futile exercise because there isn’t a way to control for the tremendous amount of variables across a state. Additionally, the factors measured often change from year to year, are measured differently over time, and lag behind in data. For the 2023 ranking, some of the data is from all the way back to 2011. I’ll give you a little bit deeper dive to show you what I mean about the details.

First, Health Outcomes is made up of two factors – Length of Life and Quality of Life. Length of Life, which accounts for 50% of this score,  is measured by premature death. Premature death is defined by loss of years due to death before age 75.

Rowan scored same as last year and is similar to the state average and 59^th in county rank.

Quality of Life makes up the remaining 50% of Health Outcomes, and is derived from scores assigned from answers to a subjective telephone survey. The survey is from 2020 and is called the Behavioral Risk Factor Surveillance System(BRFSS). It is only conducted with those above age 18 and is done through landline or cell phone. The survey has the respondent answer their own evaluation of whether they have poor or fair health, number of poor physical health days,  and number of poor mental health days. Additionally, the percent of low birthweight births between 2014-2020 is added in from Vital Statistics and a Health Outcome score is derived.

Rowan Improved from last year, and scored similarly to the state average and 68^th in county rank

The second part of the rankings is Health Factors and this is where it gets extremely complicated. Health Factors include Health Behaviors (30%), Clinical Care (20%), Social &Economic Factors (40%), and Physical Environment (10%). Under each of these categories are numerous measures, and you can quickly see how every component of our lives impacts our scores, with how good the healthcare in our county is having little impact on our score.

HEALTH BEHAVIORS included the following:

• Tobacco Use (adult smoking as reported in the BRFSS)
• Diet and Exercise as measured by Adult Obesity, Food Environment Index, Physical Activity, Access to Exercise, Food Insecurity, and Access to Healthy Foods (per the BRFSS survey)
• Alcohol and Drug Use as measured by Excessive Drinking, Alcohol Impaired Deaths, and Drug overdose deaths
• Sexual Activity as measured by the incidence of chlamydia infection, and teen births.

In these factors there was no change for Rowan in Tobacco Use, although we are still higher than the state; We increased in adult obesity from 35% to 36% – state average is 34%; we improved slightly in the Food Environment Index to near state average; we improved greatly in physical inactivity to 25% from 30% but the state average is at 22%  and Access to Exercise from 61% to 70% with a state average of 75%. Note that the majority of this data is from the BRFSS survey

Rowan’s County rank was 61 for Health Behaviors

Many organizations, spearheaded by Healthy Rowan, have put tremendous energy into trying to impact these health behaviors. Tobacco Use was once measured by whether municipal and county parks and recreation banned smoking from their facilities. Rowan was successful in making parks “no tobacco use”, however the model for county health rankings has since changed the way that is measured to simply what is attested in the survey. Much work continues and is needed with diet and exercise and Alcohol and Drug Use. Programs like Rowan Moves and our Post Overdose Response Team continue to work in these areas. However, as you can see from the data, it often takes more than five years to see any changes.

CLINICAL CARE makes up only 20% of the Health Factors score and includes both Access to Care measures and Quality of Care. Access to Care measures include percentage of uninsured, number of primary care physicians, dentists and mental health providers and other primary care providers per population.

Quality of Care includes preventable hospital stays, mammograms, and flu vaccination. This score is particularly bothersome because it is only measured in those over 65. For the preventable hospital stays the data is from 2020 (Covid year!) and is measured by counting anyone over 65 who had a hospital stay for diabetes, COPD, asthma, hypertension, dehydration, bacterial pneumonia or a urinary tract infection. The model explains that all of these conditions should be treated as an outpatient. The mammogram measure is only for women ages 65-74 who received a mammogram, and the flu vaccine was also counted only for adults over 65 during 2020.

Rowan actually dropped to the state average of uninsured, but double the state average in shortage of primary care physicians per population. Preventable hospital days stayed at just the state average, but mammogram rates dropped below the state to 42%. Flu vaccination stayed at the state average.

Rowan’s county rank was 46 for Clinical Care

SOCIAL AND ECONOMIC FACTORS, making up the largest portion of the score, are likely the most controversial and include Education, Unemployment and Income.

Education incorporates high school completion and graduation, amount of college education, 3^rd grade reading scores and school funding, among others. Unemployment is a straightforward statistic, but Income uses many factors to create a measure such as children in poverty, income inequality, gender gap pay, median household income, and living wage for our county. Of interest, the living wage for a single adult in Rowan county is $16.06 per hour, and changes according to number in household, etc.

For education, Rowan raised the high school completion rate but fell short on 3^rd grade reading level scores, but the measure used was 2018. A great deal of work has been done in our county since 2018, especially with the proliferation of Apseed and other efforts to improve reading. Apseed is a tablet reading learner designed especially for early childhood and is provided free to each newborn, in head start centers and many other areas of our county. A brainchild of Greg Alcorn, this strategy is one that we are anxious to measure the effect of over time.  This will continue to be a lagging indicator. Rowan County showed an increase in children in poverty to 24% with a state average of 18%, and also a lower than average median income.

Family and Social Support was largely survey measured and included number of children in a single parent household, number of memberships in social associations (think church, Civitan’s, etc.) residential segregation, child care cost burden, and availability of child care centers.

Rowan improved the score for this category to closer to the state average, but the entire child care cost and availability, which was measured in 2021 has continued to be challenging post COVID from a staffing standpoint. As of this writing, I am told that all child care centers in Rowan County have a waiting list.

The final group under the messy Social and Economic Factors category is Community Safety. This is measured by Injury deaths from 2016-2020, homicides, suicides, death from firearms, motor vehicle deaths and 2019 juvenile arrests. As you can see from the dates, work in this area will take a long time to show up in the data.

The state average conglomerate score is an 82, and while Rowan’s score didn’t worsen, it is still 114 and lower scores are better! Crime prevention has been a major focus of county and city leaders and will continue to be needed into the future.

Rowan’s county rank for the Social and Economic category was 62

PHYSICAL ENVIRONMENT is the next category measured and makes up 10% of our score. This is an area that has gotten a lot of folks riled up. There are only two measures and include Air and Water, and Housing and Transit.

For Air and Water, the air quality is measured by the Air Pollution Particulate Matter system. This is a nationwide system that uses readings from air monitors. A beef of Rowan county is that we have two of these in southern Rowan and no one can explain why. Cabarrus has only one, and some counties have none. This is a pass/fail score, and we have historically performed poorly. With respect to Water, this is also a pass/fail and you fail if you get ANY finding of poor water quality from the EPA at any time in the year. Our measurement year was 2021.

Senator Carl Ford has introduced a bill to address the fact that Rowan is unfairly punished in this score by having two monitors, and the bill is moving through the legislature at this time.

Finally, Housing and Transit is scored using measures of “severe housing problems”, long commutes to work alone, traffic volume, homeownership, severe housing cost burden and broadband access in the home.

Rowan measures fairly close to the state average in most of these categories, but when you add in the air and water scores Rowan scored 96 out of 100 counties overall on these measures for Physical Environment.

While we can take issue with what is measured, when it is measured, and how it is measured, reviewing the data from the annual county health rankings can provide two major insights:

• Health rankings for a county are not about a person’s physical or mental health or the healthcare system as we traditionally think. They incorporate a multitude of measures that when viewed together paint a picture of our county from education to income levels to physical environment. As such, it is obvious that multiple parties must understand the data and their respective role in working toward improvement. To improve poverty levels, we must have good jobs, which means recruiting business and industries who pay well, and who want to be in a county with good schools, low crime and safe air and water. All of this requires us constantly working together and not in silos.

• The data may be a bit frustrating and we may discount certain things, but it can also serve as a compass for us to focus our energy as a community to strive toward Rowan County as a great place to live, work and play.

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