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What Makes Communities Healthy? New Data Weighs Equity Heavily, Showcases Successes

Posted: June 19, 2018

Falls Church, Virginia, is only two square miles, but the tiny city has a huge designation: It has been named the healthiest community in the U.S.

Falls Church tops the U.S. News & World Report and Aetna Foundation’s inaugural Healthiest Communities rankings, an analysis of nearly 3,000 communities across the country on a wide range of health markers, such as education, income, public safety, walkability and bikeability, life expectancy, transportation, and infrastructure. The top 500 communities are ranked in order, and data from all 3,000 are online now.

Falls Church was No. 1, as it scored in the top three communities on education, economy and public safety. A suburb of Washington, D.C., the city is home to 14,000 people. Many of the adults in the city have advanced degrees and high incomes. But they are also invested in their community, said Nancy Vincent, MPA, director of the Falls Church Department of Housing and Human Services.

“This is a very active community,” Vincent told The Nation’s Health. “There’s many boards and commissions and community groups that are all well staffed by participants in the programs, serving on the boards that provide the services. That’s a big factor in my mind.”

Vincent said that while just 3 percent of Falls Church residents live in poverty — and with the cost of living in the area, living below the poverty line puts individuals and families at an extreme disadvantage — the city is working to help its most vulnerable residents. The Falls Church Housing Corporation runs an 80-unit program for low-income seniors, offering wellness activities such as yoga and technology classes to keep seniors connected to the community. But the Healthiest Communities data show the city can do more.

“What we can do to improve health for the future is provide more affordable housing,” Vincent added. “There are all kinds of consequences for the community as a whole for having families who are under-housed.”

To serve members of the community, the city contracts with nonprofit organizations and neighboring jurisdictions — its residents are served by the nearby Fairfax County Health Department, for example, and the Northern Virginia Dental Clinic provides dental services. The Fairfax Community Health Care Network offers health care services to uninsured or under-insured residents.

Partnerships also put Falls Church at the head of rankings. Marybeth Connelly, vice mayor, and community outreach lead for Falls Church City Public Schools, points to the schools’ nutrition efforts as an example of where the city is excelling: A partnership between the district’s food services director and teachers — funded by the Falls Church Education Foundation — has resulted in students growing hydroponic lettuce in school to sell to the food services department, which then serves it at lunch to students. Students also farm tilapia and plan to sell the fish to the cafeteria and local markets.

Food Services Director Richard Kane has also solicited local restaurants and other businesses and individuals to donate to the district’s “weekend backpack program,” providing a weekend worth of nutritious food to families in need of assistance.

Addressing social determinants of health, including access to food, housing, and education, is what makes the Healthiest Communities rankings important, said APHA Executive Director Georges Benjamin, MD. Benjamin introduced the rankings in an April 9 webinar featuring the Aetna Foundation, U.S. News & World Report and APHA.

“Community is very, very important,” Benjamin said. “I’m excited about the U.S. News rankings; they’re designed to raise awareness of many of the things that affect your health outside the doctor’s office.”

The rankings are the first of their kind to pull data from a wide variety of resources, including metrics from the U.S. Census Bureau, environmental information from the U.S. Environmental Protection Agency and more data from the Centers for Disease Control and Prevention and Institute for Health Metrics and Evaluation. The data was then analyzed using a framework from the National Committee on Vital and Health Statistics.

Garth Graham, MD, MPH, FACP, FACC, president of the Aetna Foundation, said the categories were weighted as the communities were evaluated. But no category was given more weight than equity. So a community may be wealthy or well educated, but if its most at-risk residents are not cared for, it can drop in the rankings.

What was particularly interesting, Graham noted, was how neighboring communities’ spots in the rankings could differ wildly.

“What we’ve learned is that all health is local, including the concept of access,” Graham told The Nation’s Health. “What you see in terms of access are areas where people have done unique, specialized infrastructure to improve access.”

The side-by-side comparison is well illustrated by the Tri-County Health Department, which represents three neighboring Colorado counties: Douglas, Arapahoe, and Adams. Douglas was ranked No. 2, while Arapahoe was No. 347 and Adams did not make the top 500 list.

While Colorado is overall a healthy state — four Colorado communities made the top 10 — location matters, said John Douglas, MD, executive director of the Tri-County Health Department. Douglas County has a lot of advantages, he noted: It has plenty of natural amenities, as the Pike National Forest covers about a third of the county. It has a highly regarded school system. It is also a wealthy community, with fewer challenges than its neighbors.

In particular, Arapaho County includes Aurora, which is home to a large number of refugees, who do not come to the community with many resources, Douglas said. Nearly a quarter of the city’s residents are foreign-born, and over 100 languages are spoken by the children in its schools. Adams County is home to the Rocky Mountain Arsenal, a former weapons-manufacturing area that was the most polluted acreage on the planet. The area is being turned into a wildlife refuge.

These are challenges Douglas County does not face. But the department and the county do not rest on their laurels.

“We’re able to build on our baseline,” Douglas told The Nation’s Health. “We’ve got an extraordinarily fortunate circumstance. We could either say, ‘Gosh, you guys are pretty wealthy, so we don’t have to do anything,’ or what we have done, (which) is say, ‘We have a lot to build on here.’”

And while Douglas County sits higher on the rankings than its neighbors, surveys show its residents’ worries are the same. Mental health, obesity, and access to health care are the top three concerns of all three counties in the department’s jurisdiction.

What makes the rankings unique, and potentially useful, is that they are not static. Brian Kelly, editor and chief content officer of U.S. News & World Report, noted that journalists at the magazine will continue to analyze data on the communities for the next two years.

“What makes this different, in addition to the framework, is the ongoing journalistic enterprise,” Kelly said during the April 9 webinar. “You can’t fix what you can’t measure. These tools can greatly benefit counties looking to improve overall community health.”


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