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County health rankings reveal a north-south divide in Minnesota

The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute released their annual County Health Rankings on Wednesday.

The rankings use a variety of sources to compile county-level data on 35 measurements, including quality of life, health behaviors, medical care, and social and economic factors. Each county receives two scores: one for health outcomes (an indication of the current health of the county’s population) and another for health factors (an estimate of how healthy that population will be in the future).

For the first time in the project’s six-year history, the rankings include income inequality as one of the health factors.

Minnesota overall

As it has in past years, Minnesota scores higher than the national average on almost all of the measures. For example, the percentage of babies born in Minnesota with a low birth weight is 6.5 percent, compared to 8 percent nationally. And only 19 percent of Minnesotans aged 20 and older report that they don’t engage in leisure-time physical activity compared to 27 of adults percent nationally. In addition, 14 percent of Minnesota’s children under the age of 18 live in poverty, compared to 24 percent nationally.

On the new measurement — income inequality — Minnesota also did better than the national average, but only slightly. The disposable income of a Minnesota household at the 80th percentile was 4.3 times higher than that of a household at the 20th percentile. Nationally, it’s 4.4 times higher.

Minnesota scored lower than the national average, however, on two health behaviors: the percentage of adults who admit to binge drinking (19 percent vs. 16 percent nationally) and the number of newly diagnosed chlamydia cases (336 per 100,000 population vs. 291 per 100,000 nationally). The state also has more air pollution and severe housing problems (such as high housing costs and lack of plumbing) than the national average.

In the social and economic category, Minnesota scored better than the national average on all but two health factors: the percentage of ninth-graders who go on to graduate from high school within four years (78 percent in Minnesota vs. 85 percent nationally) and the rate of violent crime (229 offenses per 100,000 population in Minnesota vs. 199 nationally).

A north-south divide

Among Minnesota’s 87 counties, the ones with the highest overall health outcomes and health factors rankings tend to be located in the southern half of the state, while those with the lowest rankings tend to be found in the northern half.

The lower rankings in the northern counties are driven in large part by socioeconomic factors, such as higher unemployment and more child poverty, but behavioral factors, such as physical inactivity and obesity, are also involved.

The least healthy county, Mahnomen, has a large American Indian population. Health disparities among American Indians — including disparities in access to healthful foods — are well documented.

The county rankings “help illustrate how an individual’s health status is easier to predict by where they live than their use of medical treatment,” said Minnesota Commissioner of Health Dr. Ed Ehlinger in a e-mail statement sent to MinnPost. “It highlights the compelx ways community factors such as economic opportunity, education, housing, and transportation shape the health of communities and individuals.”

“Those rankings can help advance the conversation between communities and local health departments about taking action to improve the health of their population,” he added.

Here are the healthiest and unhealthiest Minnesota counties in terms of health outcomes:

1. Carver

2. Wilkin

3. Nobles

4. Fillmore

5. McLeod

83. Beltrami

84. Norman

85. Renville

86. Cass

87. Mahnomen

Robert Wood Johnson Foundation

And here are the healthiest and unhealthiest counties in terms of health factors:

1. Olmsted

2. Nicollet

3. Washington

4. Carver

5. Scott

83. Mille Lacs

84. Cass

85. Beltrami

86. Clearwater

87. Mahnomen

Robert Wood Johnson Foundation

Among Minnesota’s three most populous counties, Dakota scored the best — 19th on health outcomes and 6th on health factors — followed by Hennepin (46th and 28th) and Ramsey (63rd and 58th).

St. Louis County, home to Duluth, scored 74th on health outcomes and 59th on health factors.

You can explore each county in detail through the County Health Rankings interactive website.

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Comments (4)

  1. Submitted by Ray Schoch on 03/26/2015 - 12:39 pm.


    Not as simple as rich vs. poor, or urban vs. rural, but those are among the factors, nonetheless.

  2. Submitted by Mary David on 03/26/2015 - 04:39 pm.

    83. Mille Lacs84. Cass85.

    83. Mille Lacs

    84. Cass

    85. Beltrami

    86. Clearwater

    87. Mahnomen

    Among the lowest ranked are counties with significant American Indian populations

  3. Submitted by Ray Lewis on 03/27/2015 - 12:10 am.

    Changes in rankings are difficult to interpret

    Anoka County, where I live currently, was ranked 48 of 87 MN counties in 2015 in health outcomes, down from 26 in 2010.

    Anoka is also the only county not currently involved in the Statewide Health Improvement Program (SHIP) which was started in 2008.

    Minnesota has dropped from being the healthiest state in the nation to sixth in the annual state health rankings, so we need to reflect on the value we put on health; and whether to invest in the conditions that create and maintain health for future generations.

  4. Submitted by Paul Udstrand on 03/27/2015 - 10:07 am.

    Methodology and Data

    Calling this the “2015” report is a little misleading. If you track down the data set these guys used to generate these “ranks” you see that most of it is at least two years old if not older. This means what you really have here is snapshot from 2012, not a current snapshot.


    The authors should be a lot more clear about this. Furthermore this does not appear to be a peer reviewed publication, so the methodology may not be state of the art.

    Since the data we’re looking at us actually 2 or 3 years old, it stands to reason we should consider the fact that this data reflects years of budget cuts to vital services and agencies that would have a direct effect on the outcomes this data represents. Pawlenty tossed 35+ thousand people out of Minncare for instance, you don’t do stuff like that without effecting outcomes.

    I’m not saying we can dismiss this study, but it needs further examination.

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