For south-metro counties, health ranking isn't end of road

Patrick Remington knew this would happen.

When his hotly awaited, first-ever county-by-county health rankings emerged, he knew that affluent suburbs would come out on top and would look like the stars. And he worried that the high marks would lull people into complacency when there is still vast room for improvement.

"You got your good headline in the local paper," said the Minnesota-trained associate dean of public health at the University of Wisconsin-Madison. But counties such as Scott and Dakota, which finished second and 21st out of 85 counties, "still have some work to do. They're clearly not always where they'd like to be when it comes to the type and quality of health care. And they have characteristics that could be bad for future health. It's hard to be healthy when there's no place to go out and exercise," or when everyone's at the drive-up window at Taco Bell, he said.

Local public health officials agree the county health rankings published last week by Remington's team shouldn't be the end of the conversation. The point of the rankings, they said, is to draw attention to, and drive discussion about, health issues.

"We'll want to see our rankings improve," said David Rooney, director of social services in Dakota County. "We look to each other and learn from each other and we're competitive. If it dies, if it just becomes another report and doesn't have any impact over time, that would be too bad."

Rooney and Bonnie Brueshoff, the county's public health director, were pleased by Dakota's score in so-called "health factors," such as tobacco use and access to medical care. "We've done a lot of work around a lot of the behavioral lifestyle choices," Brueshoff said.

But a less stellar showing in measures of actual health conditions has piqued the curiosity of county officials. They're also concerned about how the poor economy and shrinking social service budgets will affect health.

Mary Ajax, president of 360 Communities, a nonprofit group that offers a variety of health-oriented outreach programs in the south metro, said it's important to be mindful of the physical and demographic differences when comparing Scott and Dakota counties. Dakota, she said, has more diversity of landscape, density, income and ethnicity.

"With that beautiful mix that we have in Dakota County, compared with less diversity in Scott County, it's going to give us, in some ways, more challenges and affect our health outcomes," Ajax said.

Looking at ideal outcomes

Even highly ranked Scott County, whose board is to hear a formal discussion of the findings on Tuesday, is far from in the clear, Remington said.

"The people at the top of the list can be lulled into being self-laudatory -- 'we're great!' -- but look at the underlying numbers and compare them with other countries, which have universal health care. Look at the absolute numbers on some of these factors instead of comparing with peer counties: Don't rest on the fact that 28 percent obesity, or 20 percent binge drinking [Scott's numbers in both cases] are less or more than other places. Look at the ideal, not the relative comparison.

Some of the data can be deceptive. Scott's so-so ranking for doctor availability, for a rich county, could relate to the fact that there's a major medical facility just across the border in Dakota, Burnsville's Fairview Ridges. "Good point," he agreed. "There's no perfect data system."

The failure to compare with other states can also create wrong impressions. Scott ranks low for unhealthy air days compared with the rest of Minnesota, but comparable high-end suburban counties in Milwaukee have far worse conditions: 13 in one case, 26 in another, compared to Scott's two, as they fail to benefit from the sweeping-out effects of Minnesota's prairie winds.

Still, Dr. Marc Manley, chief prevention officer at Blue Cross Blue Shield of Minnesota, who lives and works in the south metro area, said there's plenty to learn from this data -- including its emphasis on access to healthful food.

"Scott and Dakota are both places where farmland meets suburb, and we're working with Scott on thinking about how to promote local food: making sure there's access to fresh, local produce, and that it keeps being grown there in the future," in a county whose future plans contemplate wiping out a lot of farmland.

On the Dakota side, he said, there's an effort to concentrate the massive buying power of school lunch programs on local, healthful food, rather than bringing in Pizza Hut. "You can really blow it if kids get the idea that that's how to eat. That's been a huge mistake in our part -- including my own."