U.S. News 'Healthiest Communities' Rankings Shine Light on Health Disparities

It's no secret where you live can profoundly impact your health. And now you can see how your county fares, with U.S. News & World Report's recently released 2020 Healthiest Communities rankings.

This year, the rankings include tools to track COVID-19 data, as well as in-depth analysis of the relationship between COVID-19 and social factors, especially in underserved communities across the U.S. The rankings, released on September 22, are a collaboration with the Aetna Foundation, an affiliate of CVS Health.

If you don't live in a top-ranking area, there are steps you can take to improve your health regardless of location, Elizabeth Klodas, MD, a cardiologist based in Minneapolis, Minnesota, tells Verywell. While we have relatively little control over some variables determining the rankings, like infrastructure, she says others, like food and nutrition, are things people can work on at an individual level.

“You can impact your own health, even if you can’t impact the overall health of your community,” Klodas says.

Even though it’s possible to be healthy within a community that lacks some of these key health-promoting factors, it is certainly more of an uphill battle, Sharon Palmer, RDN, a California-based nutritionist, tells Verywell.

“While there may be a percentage of people who can maintain good health, it’s usually a lower percentage within the community, because there is no support system to make good health attainable in everyday life,” Palmer says. “Think of all the things people need every day for good health: clean air and water, good jobs, health care, a community that treats you fair and equitably, healthy food, places to walk safely—if those aren’t available, it makes it much tougher to be healthy."

“Healthiest” Communities

The U.S. News and World Report top five healthiest communities are:

1. Los Alamos County, New Mexico
2. Douglas County, Colorado
3. Falls Church city, Virginia
4. Broomfield County, Colorado 
5. Routt County, Colorado

These results remain fairly consistent with previous years. In 2019, Douglas County and Los Alamos County were swapped. Falls Church retained its spot from 2019 and Broomfield County jumped up a spot after previously coming in fifth.

This year, 61 counties in Iowa ranked among the top 500 healthiest communities, making it the state with the most counties on the list. Minnesota has the second highest number of healthiest counties at 48, and Nebraska is third at 32.

Klodas evaluated the U.S. News ranking list in order of food and nutrition quality. She found that the worst-ranked counties were in the middle or southern areas of the U.S., while those at the top of the list were either in coastal or mountain states.

“[This is] yet another validation of a theme that comes up over and over again: what we eat has tremendous impacts on health metrics,” she says.

This order remained true when filtering for population health, as well as distributions of obesity and type 2 diabetes. 

“Regardless of where you live or where you’re starting from in terms of your own health, make nutrition a priority,” Klodas says. “It’s the single most important factor that will determine your individual health status and health outcomes, and it yields almost instant health benefits.”

COVID-19 Connections

The COVID-19 tools track case numbers, death rates, unemployment, and other metrics. Updates are made in nearly real-time—and can be as frequent as daily—so people can find out how the pandemic is affecting health locally. Data on obesity and diabetes, factors which can put people more at risk from COVID-19, are also included.

“The COVID-19 pandemic has brought attention to the existing disparities in our healthcare system that have a significant impact on underserved communities,” Garth Graham, vice president of community health and chief community health officer at CVS Health, said in a statement. “Using data from the Healthiest Communities rankings can help create insight on how to better address COVID-19 at the community level."

According to data collected prior to August 24, counties that performed better in the 2020 Healthiest Communities rankings generally had a lower COVID-19 case rate. In fact, Los Alamos, New Mexico—the top-ranked city—had a COVID-19 rate of 124 cases per 100,000 residents.

Within the rankings, the COVID-19 case rate was most strongly linked to scores in the "community vitality" category, and to the census response rate. The death rate from COVID-19 was most strongly linked to community scores in the "equity" category, particularly to measures of income equality—a link that points to existing COVID-19 racial disparities.

Counties with about 13% share or more of Black residents have an average COVID-19 case rate 1.4 times the national average and an average death rate 1.2 times the national average. Counties that have 50% or more Black residents a Black majority have an average case rate and death rate double the national average.

COVID-19 case rates were 14% higher than the national average in counties with about 18% or more Latinx residents. Communities with Latinx majorities had an average COVID-19 case rate 1.4 times the national average and a higher COVID-19 death rate.

Rural vs. Urban

Rural counties outperformed urban counties overall in six states: Massachusetts, Wyoming, Kansas, Nebraska, Iowa, and New York. In these states, rural counties tended to score better in the "environment" and "food and nutrition" categories. Rural counties in Massachusetts ranked the highest with a 75% average score.

Michael Miller, MD, a cardiologist and professor at University of Maryland School of Medicine, says he believes the high-ranking towns are lesser-populated communities that have an abundance of outdoor activities. People in those regions may live a simpler way of life than city-dwellers. They may experience less pollution and crime compared to many larger regions throughout the country where stressors contribute to heart disease. 

Making a Change

Miller says he believes some people may be discouraged to see where their community ranks.

“For those less interested [in their health] or even apathetic, it could serve as an excuse for not making healthier changes,” Miller says. “Some might even rationalize that ‘it doesn’t really matter what we do’ because of all of the toxins they are exposed to.”

If you live a healthy lifestyle that includes managing stress, not smoking, making time to exercise, and having a solid social network, “you can still, to an extent, overcome a less healthy environmental living area,” Miller says.

Palmer recommends taking steps to improve your community's overall health. Starting a community or school garden in your neighborhood to share produce can make a difference, Palmer says. You can also do research on programs aimed at helping communities and advocate for bringing screenings or fitness opportunities into your area.