What are Montana's healthiest, least healthy counties?

Gallatin County is the healthiest county in Montana, and Glacier County is the least healthy, according to a new report released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The County Health Rankings report based these rankings on factors like how many people die prematurely, have poor physical or mental health days, and how many have good health behaviors, access to clinical care, live in a good physical environment and what social and economic factors affect residents.

Counties that ranked high also include Madison, Phillips, Beaverhead, Carbon, Fergus, Toole, Missoula, Ravalli and Pondera. Other lower ranking counties include Roosevelt, Big Horn, Deer Lodge, Meagher, Blaine, Sheridan, Silver Bow, Custer and Rosebud.

Cascade County ranked 26th in health outcomes, an improvement from last year, when it ranked 27th.

"Health outcomes" can be thought of as what a county's health is right now: how healthy people feel and how long they are living. "Health factors" are those variables that affect health outcomes, like whether people smoke, use alcohol, have access to exercise and feel safe in their community, explained Kate Konkle, a researcher with the UWPHI in Madison, Wis.

Of Montana's 56 counties, 10 have populations too low to provide meaningful data to rank them, Konkle said.

Available data from those counties is part of the health snapshot at the website www.countyhealthrankings.org.

Statewide, Montana counties struggle with a high rate of smoking (18 percent), excessive drinking (19 percent), and adult obesity (24 percent). Compared to the rest of the country, Montana has a lower rate of unemployment, violent crime death and sexually transmitted infections.

Cascade County public health officer Tanya Houston said reports like this one shouldn't be looked at by itself to compare the health in counties. Rather, groups of health reports that provide data from different sources should be looked at together.

"If you take just one piece out of one report, it could be misleading, but when you look at them all collaboratively, it can give you a better snapshot of what's going on in your community," Houston said.

The report shows that Cascade County has an adult obesity rate of 29 percent, has a 20 percent uninsured rate and an 18 percent excessive drinking rate and 50 percent alcohol-related fatality rate in car crashes. Those numbers confirm to Houston and others at CCHD that the recent Community Health Needs Assessment that identified obesity, access to care and reduction of substance abuse as the top three health priorities was right on.

While factors like smoking or exercise might remind people of health immediately, education and employment might not, Konkle said. But those two factors are some of the biggest in determining how healthly someone is. People who have a higher level of education and higher income live longer, she said.

Having a higher income might mean living in an area with a large grocery store or farmers market or a neighborhood that has sidewalks, making it easy to walk. Conversely, having a low income may mean living in a place that doesn't seem safe, meaning people aren't getting out to walk, talk to their neighbors. The only source of food may be a small store that doesn't carry fruits and vegetables or a fast food restaurant, she said.

"Those (factors) impact directly health outcomes and our choices," she said.

Konkle said the goal of the report is to provide communities with an idea of what may need work and how to make change. A "Roadmap to Health" action center is available online as well.

Some of the lower ranking counties sit on Montana's Indian reservations. Konkle said poorer health on reservations is a national trend.

"That's a result of system and structural issues that really have led those populations to have some really significant health and economic issues," she said. "It's definitely something we hope raises awareness and continues to raise awareness."

Comparing counties against each other isn't a good idea, said Jon Ebelt, public information officer at the Montana Department of Public Health and Human Services.

"Counties should evaluate their health issues for themselves, decide which health issues to prioritize locally, and which ones can realistically be addressed locally. This will produce more stakeholder buy-in and more effective progress," Ebelt said in an email.

Montana's counties ranked from healthiest to least healthy, according to the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute report:

1 Gallatin

2 Madison

3 Phillips

4 Beaverhead

5 Carbon

6 Fergus

7 Toole

8 Missoula

9 Ravalli

10 Pondera

11 Teton

12 Flathead

13 Stillwater

14 Chouteau

15 Judith Basin

16 Jefferson

17 Lewis and Clark

18 Granite

19 Sweet Grass

20 Valley

21 Yellowstone

22 Prairie

23 Broadwater

24 Park

25 Richland

26 Cascade

27 Musselshell

28 Wheatland

29 Hill

30 Fallon

31 Dawson

32 Sanders

33 Mineral

34 Lincoln

35 Powell

36 Lake

37 Rosebud

38 Custer

39 Silver Bow

40 Sheridan

41 Blaine

42 Meagher

43 Deer Lodge

44 Big Horn

45 Roosevelt

46 Glacier

NR Daniels

NR Wibaux

NR Liberty

NR McCone

NR Powder River

NR Petroleum

NR Garfield

NR Golden Valley

NR Carter

NR Treasure