Hidden disparities in the County Health Rankings
By Charlie Mandile and Colin Cureton
*Update: This story was published as a guest column in the April 3, 2013 Northfield News.
The Robert Wood Johnson Foundation in collaboration with the University of Wisconsin Population Health Institute recently published the County Health Rankings report. The report ranks the health of nearly of every county in the nation using a variety of measures that affect health such as health outcomes, health behaviors, clinical care, social and economic factors, and physical environment. The results are in, and Rice County is ranked in the top 25% of healthy counties in Minnesota. So, here in Rice County we should pat ourselves on the back and call it a day, right?
Not so fast. Minnesota as a whole ranks among the highest in overall health and quality of life in the nation. However, Minnesota also has some of the highest disparities in wealth, health, education, and employment outcomes between White and non-white residents. In a state with some of the highest disparities in the nation, Rice County is home to some of the highest disparities in Minnesota.
Using data from the U.S. Census Bureau’s American Community Survey (i), we created a simple ratio to compare the percentage of Latinos in poverty and the percentage of Whites in poverty for all Minnesota counties (ii); the higher the ratio, the higher the inequality.
In terms of income inequality between White and Latino residents, Rice County is among the State’s worst 20%. Amongst non-metro counties, Rice County’s White poverty rate (8.4%) is in the State’s lowest quartile. In stark contrast, Rice County’s Latino poverty rate (34.8%) is in the State’s highest quartile, even including the metro. In other words, the Latino poverty rate in Rice county is more than 4 times the rate for Whites. Among greater Minnesota counties with Latino populations greater than 1,500, this is the highest disparity for any county in the State. Rice County is a very unequal place.
Public health research (and common sense) confirms a strong relationship between low income and poor health outcomes. Whether it is low-cost low-quality food, unhealthy living environments, or differential access to health care, poverty leads to poor health. Given this well-known trend, it is reasonable to suggest that Rice County’s Latinos are less healthy, perhaps very much less healthy, than its Whites.
With the highest disparities in poverty and health, how can Rice County be in the top 25% of the County Health Rankings? The simple answer is that the report masks these disparities by using data for counties on the aggregate. Such averages hide the gross disparities in our communities. To use another stark example, the “healthiest” county in Minnesota, according to the County Health Rankings is Carver County. However, this metro county has the second-highest disparity in poverty rate in the state, where the Latino poverty rate is over six times that of Whites. Thus, the County Health Rankings report’s “healthiest” county is our State’s most unequal.
In closing, health is inescapably multi-dimensional and we can’t afford to gloss over its complexities. Furthermore, our tools must reflect our challenges. The County Health Rankings is a massive undertaking, but we must go further. In Minnesota, one of the most unequal states in the country, we need tools that account for the health of all Minnesotans. Health happens locally. Thus it is good to compare counties, but we should also compare neighbors. We must challenge ourselves to go beyond the surface and look at the complex local challenges in front of us.
Charlie Mandile is executive director of HealthFinders Collaborative, and a graduate student at the University of Minnesota School of Public Health. Colin Cureton is a community health researcher and Applied Economics graduate student at the University of Minnesota.
i. We used 5 year estimates instead of 3- or 1-year estimates because it was the most recent available data for all 87 Minnesota counties.
ii. The ratio: (percent of Latinos in poverty)/(percent of Whites in poverty)
See below for various representations of the American Community Survey Data for Minnesota. Data available at American FactFinder, U.S. Census Bureau website.
The tabs along the bottom sort various column headers.
See also: County Health Rankings & Roadmaps