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County Health Rankings: Advancing Policies to Build Healthier Communities

posted on Thu, Aug 11 2011 8:41 am by Julie A. Willems Van Dijk

The second year of the County Health Rankings is well underway. Already counties are taking proactive steps to address local health concerns through new programs, awareness campaigns and, increasingly, through laws and policy initiatives. Although these policies may take time to implement, they can be the foundation for securing the long-term health and vitality of our communities.

Smoke-free air laws are among the most celebrated examples of how laws and policies promote health, guaranteeing that everyone has clean air to breathe. It’s also one of the most common areas to which communities look to improve their county health ranking  because tobacco is one of the leading causes of preventable death in the United State and studies show that decreasing the prevalence of tobacco use by even one percent can yield billions in savings.

Policies range from making workplaces smoke free to increasing taxes on cigarettes. Mississippi is an example of a state in which cities passed the most local smoke-free air laws and policies in 2010. Smokefree Air Mississippi is a major step to limit exposure to secondhand smoke in public places and workplaces in a state with one of the highest rates of adult smoking in the country – about 24 percent, according to the 2011 County Health Rankings.

Another example is in King County Washington, which has higher than national average rates of adult smoking. There, nine housing providers, including the Seattle Housing Authority, plan to implement smoke-free policies by March 2012.

Preventing obesity and associated conditions like diabetes and heart disease is another area where counties are employing public health laws and policies to promote a healthy diet and physical activity. Policies range from labeling foods to show serving size and nutritional content to limiting access to non-nutritious foods in schools to expanding school-based physical education.

For example, in Nashville, Tennessee, Mayor Karl Dean has taken steps to address obesity and shed the state’s reputation as “the lethargy belt.” Nashville’s Mayor signed an order for “Complete Streets”—a policy that will encourage residents to get more exercise by making sure the city’s roads accommodate walkers and bikers. The Mayor also has committed funds to extend greenways, expand parks and build more sidewalks to lower obesity rates in Nashville.

But public health laws guarantee much more than smoke-free air and safe sidewalks.

At the National Association of County and City Health Officials’ (NACCHO) Annual Conference in Hartford, Connecticut (July 20-22), the County Health Rankings staff facilitated a session where local health department officials shared their experiences on how  the Rankings data can be used to promote policy initiatives. Participants said just having the information in hand to show policy-makers the factors that influence the health of residents and where their county does well and where they need to improve helps health officials more effectively make the case for implementing laws or policies to improve health.

In six counties in Central Michigan, a coalition of community partners responded to their counties’ low health rankings with a commitment to “Do something!” In the past year, they have identified their top health priorities and are exploring policy initiatives to address these challenges. To address obesity, they are considering a mandate for BMI screening and a ban on unhealthy foods in schools, including vending machines and at sporting events. To address substance abuse, they will advocate for revoking expanded hours of alcohol sales, maintaining the current minimum drinking age laws, and implementing higher alcohol taxes and stronger age compliance checks. To protect citizens from secondhand smoke, they will advocate for preserving Michigan’s smoke-free air law.

In addition to creating environments that support healthy behavioral choices, effective laws can also help guarantee that everyone is able to enjoy safe housing, a clean environment, a quality education and gainful employment. These social and economic determinants ultimately affect our health in greater proportion than medical care or behavioral choices. That’s why diverse cross-sections of community leaders are collaborating to use the County Health Rankings, (part of the Robert Wood Johnson Foundation’s Mobilizing Action Toward Community Health initiative or MATCH)  to engage policy-makers in a broader discussion—one that considers health in all policies. This is our next step in leveraging the Rankings to improve community health, moving from a focus on policy that creates environments for healthy behavioral choices to one that fully embraces social and economic policy as health policy.

Health is local, but law and policy change is a powerful tool for improving health everywhere. Although they may take longer to enact, improvements like increasing the minimum wage, expanding access to early-childhood education and increasing taxes on alcohol have a significant and lasting effect on the future health of our communities. We hope the County Health Rankings provide the needed data to help move counties in that direction.

To learn more about what policies and laws your community might consider to improve health, visit the County Health Rankings “take action.” Stay tuned for more updates from the County
Health Rankings in the coming months, as grantees of the Mobilizing Action Toward Community Health (MATCH) program begin to implement policy strategies that address the social and economic obstacles to health in their communities.


This information was developed by Julie A. Willems Van Dijk, R.N., Ph.D., community engagement director, University of Wisconsin Population Health Institute.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
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