Wake County ranks number one in the state for overall wellness. Yet, just one county to the north, Granville residents rank sixty-eighth.
The report is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and it assesses wellness in nearly all the nation's 3,000-plus counties.
Wake and Orange counties ranked healthiest based on lifespan, exercise habits, medical access and similar factors. Union, Watauga, and Mecklenburg counties round out the state's top five.
Columbus, Halifax and Robeson counties were ranked lowest because of high rates of smoking, obesity, premature death, and teen births.
Rural counties made their strongest showing in the category of environmental factors, such as clean air, clean water, and access to healthy foods. That top-five list includes Lee, Lenore, Dare, Pasquotank and Perquimans counties.
The rankings compare counties within each state. They're based on data from vital statistics and government health surveys. In many cases, several years of data are used to calculate rankings. Factors include premature deaths - people dying before age 75 of preventable diseases; self-reported health status; and the percent of low birth-weight babies. Other measures include obesity rates, unemployment, high school graduation rates, and pollution.
"Affluent suburbs tend to have higher paying jobs, often in the cities, whereas rural communities often are dealing with loss of businesses" and declining populations of young people, who tend to be healthier, said Dr. Patrick Remington, a researcher at the University of Wisconsin's Population Health Institute.
Residents of rural communities also tend to have less education, less access to healthcare, and higher rates of substance abuse and smoking - all factors that contribute to the rankings.
Still, counties encompassing big cities aren't immune. Wyandotte County, Kansas learned that when the researchers released their widely publicized first county health rankings report last year.
The county includes Kansas City and boasts two major medical centers, which officials figured would mean a top ranking. But Joe Reardon, mayor and CEO of Kansas City and county government, said the county's listing - 96th out of 98 in Kansas - was a wake-up call. It prompted several meetings with county authorities, local institutions, and citizens, resulting in plans for more urban grocery stores and public works projects that aim to make sidewalks and roadways safer and more usable for pedestrians and bicyclists.
Richard Sewell, a health policy specialist at the University of Illinois at Chicago, praised the report for including a wide array of important measures that affect health.
"It's a call to action" that leaders beyond the medical realm pay attention to, Sewell said.
James Marks, director of the Robert Wood Johnson Foundation's health group, said last year's report resulted in an impressive amount of action in many counties that fared poorly. With annual rankings planned in the future, he said the reports likely will spur real improvement in Americans' health.
Already, prompted by last year's report:
· Jason Cook, an outreach pastor at Center Point United Baptist Church in Lincoln County, W.Va., started a wellness program to encourage parishioners to become more active, eat more healthy foods and lose weight. Overall, 18 people signed up and have lost nearly 250 pounds since January, Cook said.
· The chamber of commerce in Jackson, Tenn., in Madison County, is using health scores to help attract businesses to relocate in the area. Companies are asking about the region's health, said Kyle Spurgeon, chamber president. The county fared better than the statewide average on some measures including the number of college graduates and primary-care doctors, in both reports. It slipped in other areas on this year's report.
· LaSalle County, Ill. authorities are continuing with recent programs to distribute nicotine patches to smokers and increase awareness to school officials about diabetes and obesity, said county health department spokeswoman Jenny Barrie. The report emphasized the need to do so, she said.
· Authorities in central Michigan, where the lowest-ranked counties are located, created a "We Can" initiative to improve health measures including obesity, inactivity and poor nutrition. Monthly brainstorming sessions have been held involving officials from local health departments, mental health agencies, colleges and elsewhere, and a working plan is expected to be developed in April, said Mary Kushion, health officer for the Central Michigan District Health Department.
"We really do have a common theme and a common mission" Kushion said. "We know that we are much better prepared and able to address the issues than we were" last year.
See how counties in North Carolina stack up at http://www.countyhealthrankings.org/north-carolina
AP Medical Writer Lindsey Tanner contributed to this report