The gap in the overall quality of health between Forsyth County and its urban peers grew wider in the past year, according to a national study released Wednesday.
The study, conducted by the Population Health Institute of the University of Wisconsin, ranks each county within a state and does not make state-by-state comparisons. When the study was launched in 2010, Forsyth ranked 20th.
For 2015, Forsyth is No. 29, down from 26 in 2014. The rankings are available at www.countyhealthrankings.org.
The county also ranked No. 29 in one of the two main categories: health outcomes, which consists of measuring premature deaths — before age 75 — and frequency of poor physical and mental-health days.
Forsyth was No. 27 in the health-factors category, up two spots. That category has subcategories focused on health behaviors, clinical care, socioeconomic factors and physical environment.
By comparison, Wake County was No. 2 overall and in both main categories.
Orange County is the healthiest county in the state, with Columbus County the least healthy.
Mecklenburg County was No. 5 overall, including No. 5 in outcomes and No. 114 in factors; Guilford County was No. 10 overall, including No. 10 in outcomes and No. 20 in factors; and Durham was No. 11 overall and in both categories.
Forsyth health officials said in a statement that although the annual rankings are important for gaining updated comparative information, “a county’s rank cannot be used to evaluate progress over time.”
“The updated rankings can be used to raise awareness about multiple factors that affect health, and target action in areas where there are the greatest opportunities for improvement.”
Forsyth health director Marlon Hunter said he hopes the overall ranking will help rally “leaders from business and government, educators, employers, citizens and organizations representing many interests to work together to create opportunities to live a healthy life and improving the health of residents.”
Dave Plyler, chairman of the Forsyth County Board of Commissioners, said he was “somewhat surprised” by the lower ranking.
“The people in our county determine results,” Plyler said. “Infant mortality is an example of the nagging problem.”
In September, the state Department of Health and Human Services reported that the number of infants who died in Forsyth declined by 10 to 37 in 2013. Fifteen of those deaths were black, 11 were white, nine were Hispanic and two were other ethnic groups.
Plyler said he believes that efforts by county health officials to improve overall health quality are making a difference.
However, one area that Plyler cited as an example of where improvements should be made is the ratio of public school nurses to students, which he described “as dismal at best. I would think that in itself is indicative of the continuing challenge.”
A study released in July determined there is one nurse for every 1,854 students in Winston-Salem/Forsyth County Schools, one of the highest ratios in the state.
The Population Health Institute placed a bigger focus in the 2015 report on income inequality, which measures the divide between the poor and affluent within counties. It said that income inequality has “broad health impacts over and above those of poverty, including an increased risk of mortality and cardiovascular disease.”
For the 14-county region of the Triad and Northwest North Carolina, Watauga County had the best health outcomes ranking at No. 3, down one spot; Davie was No. 12, down five spots; and Rockingham had the lowest ranking at No. 81, up two spots.
Hunter said the rankings again “confirm the results of a 2011 community health assessment that determined the priority focus areas should be physical activity and nutrition, chronic disease prevention, maternal and infant health, and social determinants of health.”
Hunter said that initiatives helping to improve overall community health include opening supermarkets that sell healthy foods in underserved neighborhoods; designing safe and accessible streets; expanding early education opportunities; and encouraging more physical activity.
In 2011, two national studies determined Forsyth County and the Winston-Salem metropolitan statistical area are struggling to ensure that residents have access to enough food for an active, healthy life for all household members.
The first subcategory for health outcomes is length of life, which measures premature deaths. Forsyth’s rank was 27, up one spot.
The second health outcomes subcategory is quality of life, which measures the level of poor physical health days, poor mental-health days and low birth weight. Forsyth’s rank was No. 31, up one spot.
The first subcategory for health factors is behaviors, such as rates of smoking and drinking, adult obesity, teen births, motor-vehicle crash death rates and sexually transmitted infections. Forsyth’s rank: No. 27, down one spot.
The second is clinical care, such as rate of uninsured residents, access to primary care physicians and dentists, preventable hospital stays, and diabetic and mammography screenings. Forsyth’s rank: unchanged at No. 18.
The third is socioeconomic factors, such as high school graduation rates, unemployment levels, children living in poverty, violent crime rate and children in single-parent households. Forsyth’s rank: No. 38, down two spots.
The fourth is physical environment, such as safety of drinking water, access to recreational facilities and health foods, and rate of fast-food restaurant intake. Forsyth’s rank: No. 65, down one spot.
“Regardless of the rankings, we have a responsibility to seek consistent improvements in our quality of life,” said Rep. Donny Lambeth, R-Forsyth, and a former president of N.C. Baptist Hospital.
“Improvement starts with changing the culture with a focus on health and wellness. One of the priorities and role of the state is to reform the Medicaid program. I believe, if done properly with the right focus, the state can shift the priority from sick care to health care.”