Forsyth County continues to trail its North Carolina metro peers when it comes to quality of health, according to a national study released last month.

The county ranked 31st in the state for overall health outcomes for the state’s 100 counties.

However, that represents Forsyth’s best ranking since being 29th in 2015.

For overall health outcomes for 2018, Forsyth remains behind Wake (first), Mecklenburg (fourth), Durham (12th) and Guilford (21st) counties. It also ranks below several suburban and rural counties in the Triad and Northwest North Carolina, including Watauga (10th), Davie (18th) and Ashe (23rd).

The 10th annual study is done by the Population Health Institute of the University of Wisconsin with the Robert Wood Johnson Foundation. It ranks each county within a state but does not make state-by-state comparisons.

When it comes to health factors, Forsyth was ranked 41st, down two spots from 2018.

“We are working on initiatives with community partners to keep the forward momentum,” said Joshua Swift, the county’s public health director.

“Key focus areas continue to be health behaviors (obesity, smoking, physical activity and nutrition) and social and economic factors (such as housing, jobs, education, access to healthy foods and transportation).

“Those factors greatly influence the health of Forsyth County residents,” Swift said. “I hope these rankings create a sense of urgency around the issues and can help us improve in these areas.”

Dave Plyler, chairman of the county Board of Commissioners, said the foundation report is not disappointing: “It is challenging. With an aging population, it is my opinion that political will can make a difference. The question is that can that be achieved with positive results. For the sake of our citizens I hope.”

Top 5 healthiest

The five healthiest counties — starting with the healthiest — remained unchanged with Wake, Orange, Union, Mecklenburg and Camden.

The five counties in the poorest health, starting with the least healthy, also were unchanged with Robeson, Scotland, Vance, Edgecombe and Northampton.

“Among North Carolina’s children living in poverty, 49 percent were living in a household that spends more than half of its income on housing,” according to the foundation.

“High housing costs make it difficult for families to afford other essentials that contribute to good health, such as healthy food, medicine, or transportation to work or school.”

About 14 percent of households spend more than half of their income on housing costs, including black households at 21 percent, compared with white households at 11 percent.

Dr. Elizabeth Tilson, the state’s chief medical officer, said the current transition to Medicaid managed care platforms “will allow even more flexibility to identify and address the non-medical drivers of health, including the healthy opportunity pilots that allow investment in housing quality and stability, food security, transportation, interpersonal safety and resilience.”

North Carolina has slightly more than 2 million individuals eligible for Medicaid services. There are projections for the enrollment to reach 2.46 million by 2022.

Another 470,000 to 650,000 could be enrolled now if the Republican-controlled legislature would support expanding Medicaid through a waiver request with the U.S. Department of Health and Human Services.

However, many key GOP legislative leaders have expressed little or no interest in expansion, even after the state gained permission from the Trump administration to add a work requirement for some individuals to receive benefits.


Health outcomes measure premature deaths before age 75 (Forsyth is 22nd, up from 19th in 2018) and physical and mental-health measures (67th, up 64th).

Health factors has subcategories focused on health behaviors (59th, down from 62nd), clinical care (10th, down from 13th), socio-economic factors (55th, up from 44th) and physical environment (26th, down from 78th). Physical environment measures air and water quality, housing affordability and commuting patterns.

For health factors, Wake was second, Mecklenburg 14th, Durham 16th and Guilford 42nd.

By using a standardized measuring stick, the study helps explain why Forsyth’s rankings are not directly related to lack of care, considering it has two of the largest hospitals in the state.

“The local-level data make it clear that good health is influenced by many factors beyond medical care, including housing, education and jobs,” according to the report. “Meaningful gaps in health persist not only by place, but also by race and ethnicity.”

Sheri Johnson, acting director of the county health rankings report, said the rankings can help communities “do the difficult work of coming together to undo policies and practices that create barriers to opportunity … through important conversations in data, evidence, guidance, and stories about challenges and success.”

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Source: N.C. Division of Public Health, Women’s and Children’s Health Section; State Center for Health Statistics. 336-727-7376 @rcraverWSJ

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