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Deaths caused by motor vehicle crashes are considered in health rankings.

Are 26 Minnesota counties healthier than us?

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Douglas County scored in the upper 30th percentile in a 2013 Minnesota county health ranking. The county comes in at 27 out of 87 counties statewide.

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Carver County in the metro area ranked healthiest. North-centrally located Cass County, which includes much of the Leech Lake Indian Reservation, ranked lowest. Neighboring Todd County ranked 57.

"Of course Douglas County is going to rank higher; we have a younger population," said Douglas County Public Health Director Sandy Tubbs.

Tubbs said the numbers are a representation of a population, not an actual measurement of health status.

The Centers for Disease Control collects data from a national telephone poll, which is one of the sources of data studied for statistics. With so many people opting for cell phones and using the Do Not Call List, the method has changed the demographic range used in years past. Also, since some counties have a higher senior citizen population, their responses to questions on topics like morbidity (how healthy people feel) would be different than that of a county with younger residents, like Douglas.

"You have to put it all in context," Tubbs said.

National rankings have been provided for the past four years by the University of Wisconsin Population Health Institute. The Minnesota Department of Health stated that local public health departments already measure health in communities. The County Health Rankings report can be used to identify problem areas in different regions and aid in prevention.

"By reporting on the overall health of people in each county, we can begin to understand how individual health is affected by where people live," said Dr. Ed Ehlinger, Minnesota Commissioner of Health. "The rankings remind us that we live in communities, and that if our community is healthy, we're more likely to be healthy ourselves."

Criteria used to determine rank fall into two categories, health outcomes and health factors. Health outcomes include rate of death before the age of 75, percent of people who report being in fair or poor health and the number of low birth-weight infants. There were 324 premature deaths in the county and 174 babies born with low birth-weights.

Health factors are behavior, clinical care, social and economic factors and physical environment.

Douglas County scored higher than the state average in poor or fair health, adult smoking, adult obesity, physical inactivity and excessive drinking. They were also more likely to be uninsured. Douglas County has 3,121 uninsured residents, according to the report.

Tubbs said Douglas County Public Health focuses on making positive changes in preventable risk factors like tobacco use, alcohol consumption and obesity. Health outcomes are basically a measure of what has already occurred and cannot be prevented, she explained.

There were 37 deaths attributed to motor vehicle crashes (many occurred outside of the county), 36 cases of chlamydia (used to measure quantity of sexually transmitted infections) and 156 teen births last year.

The county has a higher high school graduation and college attendance rate compared with other counties in Minnesota. Statewide, low birth-weights, unemployment, children in poverty and children in single-parent households were lower in Douglas County. There are also fewer fast food restaurants than the state average.

Todd County scored higher than state averages on poor or fair health, adult smoking, adult obesity, physical inactivity, being uninsured, unemployment and children in poverty. There are 3,072 uninsured people in Todd County, according to the report.

Deaths attributed to motor vehicle crashes totalled 41. There were 19 recorded chlamydia cases and a teen birth rate of 203 reported last year in Todd County.

There were fewer than the state average low birth-weight babies born, 124, and fewer children in single parent households. Excessive drinking and fast food restaurants were below average. High school graduation and college were also lower than state norms.

Ehlinger said local public health leadership is one reason why Minnesota consistently ranks as one of the healthiest states in the nation overall. However, the County Health Rankings report does not compare states side by side.

There are 50 community health boards in Minnesota. Douglas, Pope, Stevens, Grant and Traverse counties form the Horizon Community Health Board. Horizon is one of 21 multi-county or city-county boards in the state.

Tubbs emphasized that although Douglas County may have a higher overall ranking than the other Horizon counties this year, a lot of those counties scored better in individual categories. The numbers also fluctuate from year to year and it takes time for a change to be noticeable once a problem area has been addressed.

Being part of a regional health board provides flexibility to provide better services for all the counties included, Tubbs said. Douglas County is larger and has a lot of resources, which increase the ability to recruit qualified physicians to the area. Residents of the five counties often travel to Douglas to receive care not offered in their hometowns.

"It's a win, win for everybody," Tubbs said.

HEALTH BOARD FUNDING

Horizon has benefitted from a two-year $125,000 Robert Wood Johnson Foundation grant that will allow the health board to explore efficient ways to integrate the individual health departments. Tubbs said the foundation also assists with Internet technology support.

Douglas County has been fortunate to retain some Statewide Health Improvement Program (SHIP) funding this year. During the first two years of SHIP, $47 million was available. In fiscal years 2012-2013, the amount available dropped to $15 million. Tubbs said when that cut occurred, SHIP funding became a competitive grant.

Governor Mark Dayton has proposed a budget increase up to $40 million for SHIP next year.

HORIZON COUNTIES

County health rankings (out of 87, with 87th being the lowest) for the five counties that make up the Horizon Community Health Board:

27th Douglas

54th Pope

61st Stevens

66th Grant

84th Traverse

BEHAVIORS CONTRIBUTING TO HEALTH FACTOR RANKINGS

Minnesota Douglas County Todd County

Crash deaths 3,749 37 41

Chlamydia cases 14,630 36 19

Teen birth rate 33,283 156 203

Uninsured 468,857 3,121 3,072

A complete list can be found at www.countyhealthrankings.org.

DeyCrystal Dey Crystal Dey is a staff reporter for the Echo Press. Originally from Minnesota's Iron Range, Dey worked for newspapers in North Dakota, Florida and Connecticut before returning to her home state to join the Echo Press in October 2011. Dey studied Mass Communications at Minnesota State University Moorhead with an emphasis in Online Journalism. Follow Staff Reporter Crystal Dey on Twitter at @CrystalDey_Echo.

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Crystal Dey

Crystal Dey is a staff reporter for the Echo Press. Originally from Minnesota’s Iron Range, Dey worked for newspapers in North Dakota, Florida and Connecticut before returning to her home state to join the Echo Press in October 2011. Dey studied Mass Communications at Minnesota State University Moorhead with an emphasis in Online Journalism. Follow Staff Reporter Crystal Dey on Twitter @Crystal_Dey.

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