Health rankings show where county needs to improve

When it comes to local residents’ health, Johnson County seems to be moving backward.

In recently released rankings of the healthiest communities in the U.S., the county slotted 140 places lower than in 2018. The county scored worse this year in categories such as community vitality, equity, economy and housing.

In the food and nutrition section, the county was significantly worse than last year.

Immediate conclusions are difficult to make when looking at the different rankings, because each ranking uses different data and a different methodology to come to its results, local health officials say. Those who work within the community to improve overall wellness are unsure if the lower ranking is the result of Johnson County getting more unhealthy, or other counties improving at a faster pace.

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But all agree that work remains when it comes to our health.

"We can tell people to stop smoking and get exercise and eat healthy all day. But if they’re not in an environment where they can get healthy foods or transportation or safe, walkable communities to be active in, it’s not going to happen," said Erin Slevin, community wellness coordinator for Purdue Extension Johnson County and a member of Partnership for a Healthier Johnson County.

Throughout Johnson County, programs have been launched to improve the overall health of the community.

Classes and resources to help people quit smoking are always available, and officials have worked to crack down on youth smoking and vape use. Free community health fairs have focused on ensuring expectant mothers have access to prenatal care, and that they are as informed as possible in ways to keep their babies safe. Special programs help moms-to-be quit smoking for the health of their babies.

Local residents can use federal food assistance at farmers markets to buy fresh produce and healthy food even as they struggle with poverty.

Efforts such as these have had an impact on the community, Slevin said.

"For so many years, a lot of groups focused on individual behaviors, which are still really important in providing direct education such as quitting smoking and eating healthier," she said. "But I think we have to look at the environment around them, and that’s where we’re trying to take a step forward and look at the policies and systems around the individual."

Still, according to one nationwide ranking, the county appears less healthy.

The Healthiest Community rankings are compiled by U.S. News and World Report in partnership with the Aetna Foundation, an independent charitable and philanthropic affiliate of CVS Health. Researchers examined more than 3,000 counties across the country, ranking each in 81 metrics in 10 categories such as population health, economy, housing and environment.

The goal of the collaboration is to see how counties can learn from each other to minimize chronic disease, keep people out of the hospital, provide access to health care and lower costs, according to the report’s website.

Researchers worked with the University of Missouri Center for Applied Research and Engagement Systems to collect and analyze data from the Centers for Disease Control and Prevention, the Institute for Health Metrics and Evaluation, the U.S. Census Bureau and the Environmental Protection Agency.

Categories such as population health, education, equity and economy were weighted more highly.

This year, Johnson County was ranked 387th in the nation, compared to 247th in 2018.

"It is very discouraging to see the county drop in rank because it seems we have a healthy community, but there are pockets where it is not good," said Nancy Voris, tobacco program coordinator at Partnership for a Healthier Johnson County.

The most glaring weakness in the county’s rankings came in the health and nutrition area. Local residents had fewer local food outlets and fewer fruit and vegetable purchases than national averages. Johnson County’s population had a greater prevalence of obesity and diabetes than national averages, though its rates did drop slightly from 2018.

Nutrition has been a focal point for local health officials.

Programs have helped introduce local produce and other projects into school lunches. Partnership for a Healthier Johnson County has developed initiatives such as supporting the community garden project at Needham and Webb elementary schools in Franklin, and ensuring that vendors at the Franklin Farmers Market can accept the federal food assistance.

For the past two years, the county has hosted a local food summit to gain input from residents about their interest in local food, inform them about the local food system and emphasize the impact it can have.

A forthcoming smartphone app will allow people to find produce or other healthy food near them. Organizers are planning to form a local food council as well.

"We want to look at food access, the local food system and outreach and education for people," Slevin said. "We have a wonderful county and wonderful community with people who care. There are great things going on everywhere. Now we need to figure out how to tie these things together."

In the rankings, Johnson County was also below national averages in the rate of preventable hospital admissions, prevalence of heart disease and smoking rate. Partnership for a Healthier Johnson County has been focused on education at local schools, smoking cessation classes and targeting vaping and e-cigarettes.

"You have to take these rankings with a grain of salt. There are so many different organizations and different information they’re using," said Ryan Skora, lead health and wellness coach at Johnson Memorial Health. "You have to dive into it more."

Partnership for a Healthier Johnson County, housed at Johnson Memorial Health, has been working with other area hospitals to address health needs that they’re seeing everyday.

Franciscan Health focuses its community health initiatives on areas such as infant and maternal health, childhood trauma and toxic stress, and behavioral health and substance health, said Kate Hill-Johnson, administrative director of community health improvement at Franciscan Health.

The hospital system also looks closely at nutrition and physical activity.

"I tend to think in terms of root causes. I would not say that diabetes and obesity are the big problems, I think physical activity and nutrition are the causes of those problems," Hill-Johnson said.

Research has shown that the root of many of a community’s health and social problems stem from adverse childhood experiences — traumas that have a tremendous impact on future violence, both as being a victimization and a perpetrator, as well as lifelong health and opportunity.

As Franciscan Health was putting together its needs assessment for the area, they found that what’s happening in family units plays a big role in current and future wellness, Hill-Johnson said.

"It’s easy to find data about health outcomes, but we need to keep going to where root causes start, either poor behaviors or risk factors. That’s how we get ahead of health and preserve health, long term," she said. "If we can prevent bad things from happening in childhood that contribute to poor behavior and help people overcome that trauma, we can get to healthier communities."

The drop in the Healthiest Communities rankings is discouraging to those looking to improve overall county health. But even within the lower overall ranking from 2018, Johnson County scored well in a number of areas.

In categories such as a people without health insurance, availability of primary care doctors and adults with no leisure-time physical activity, the county scored better than the averages of Indiana, the U.S. and other urban, high-performing counties.

The county still ranked in the top 13 percent of counties overall across the U.S., and was the fifth-healthiest in Indiana, behind only Hamilton, Boone, Hendricks and Hancock counties.

Other assessments of the community have showed progress.

In a recent Ball State University report, the Community Asset and Inventory Rankings, compared the county in 2018 to data from 2012, and graded in different areas such as education, health and economy. The county scored an A or B grade in each category.

But just because the county scores well in Indiana does not mean that it’s healthy, Hill-Johnson said.

"Indiana, as a state, is very unhealthy. When a county ranks high in a health indicator, they’re still ranked high in a lowly ranked state," she said.

[sc:pullout-title pullout-title=”At a glance” ][sc:pullout-text-begin]

Johnson County Health

Life expectancy

Johnson County: 78.6 years

Indiana: 77.7 years

U.S.: 79 years

Smoking rate

Johnson County: 17 percent

Indiana: 19.6 percent

U.S.: 15.6 percent

Cancer prevalence rate (per 100,000 people)

Johnson County: 434.7

Indiana: 447

U.S.: 436.4

Adults in poor or fair general health

Johnson County: 13.2 percent

Indiana: 16.5 percent

U.S.: 16.3 percent

Medicare beneficiaries with depression

Johnson County: 20 percent

Indiana: 19.2 percent

U.S.: 17.5 percent

Population with no health insurance

Johnson County: 7.8 percent

Indiana: 9.5 percent

U.S.: 9.9 percent

Poverty rate

Johnson County: 9.3 percent

Indiana: 15 percent

U.S.: 15.1 percent

Unemployment rate

Johnson County: 2.9 percent

Indiana: 3.5 percent

U.S.: 4.4 percent

Obesity prevalence

Johnson County: 29.1 percent

Indiana: 32.5 percent

U.S.: 28.4 percent

Diabetes prevalence

Johnson County: 9.3 percent

Indiana: 10.4 percent

U.S.: 9.2 percent

Unsafe drinking water exposure

Johnson County: 0 percent

Indiana: 2.2 percent

U.S.: 5.3 percent

— Information from the 2019 U.S. News and World Report Healthiest Communities rankings