TAMPA, Fla — The health status of Florida's counties has been comparatively ranked for the first time in a statewide report published by University of South Florida researchers.
"This is a consumer report card intended to alert policy makers and elected officials to the strengths and weaknesses of the health performances of their communities," said James Studnicki, ScD, lead author of the report published in the November issue of the journal Managed Care Interface.
"Whenever you present a comparative report like this, it can be controversial. But we're hoping it promotes innovative approaches to closing the gap between the wealth and health of many of our citizens."
The researchers demonstrated, using Florida data, that a statistically reliable, yet practical, national system for rating the health of communities can be produced cost effectively in a format suitable for a broad audience. "Our goal is to create a yearly national rating for the health status of communities," said Dr. Studnicki, a USF professor of public health. "We can cost effectively reproduce the system we've demonstrated in Florida in all 50 states."
The report ranks 66 Florida counties within three peer groups, based on population size. (Union County was eliminated from the report because its large prison population made the county an extreme outlier for several health indicators.) Counties with the least favorable health ratings were primarily those with a larger percentage of people living in poverty.
Among the state's nine large metropolitan counties with 400,000 or more people, Brevard County scored the most favorable overall health rating (72.2%), while Polk County received the least favorable score (22.2%).
Charlotte County ranked the highest (75%) and Putnam County the lowest (25%) among 27 mid-size, predominantly surburban counties with 50,000 to 399,999 people.
Flagler County earned the highest overall health grade (77.8%) while Gadsden County got the lowest score (33.3%) among 30 small, rural counties with populations under 50,000.
The overall rating summarizes how much better or worse each county fares compared to its peer counties across 36 health indicators — ranging from volume of AIDS cases and infant mortality rates to age-adjusted firearm deaths and the numbers of physicians and hospital beds per 1,000 population. So, for instance, a county with 27 out of 36 indicators better than average for its peer group would earn a favorability rating of 75 percent.
In addition, each Florida county is rated for strengths and weaknesses in six categories — age-adjusted adult mortality; premature deaths/violence; screening, prevention and primary care; infectious disease morbidity; maternal and child health; and community capacity and resources.
The USF methodology converts statistics into a simplified format similar to the one popularized by Consumer Reports magazine. Two stars signify that a county is much better than average in a particular health category, two red flags indicate much worse than average, etc.
As the researchers expected, counties with the best overall health performance ratings tended to have more stars while flags were more plentiful in those with the lowest rankings. However, the report also brings to light the deficiencies within counties scoring high on overall health performance. For example, even top-ranked Charlotte County — with stars in nearly every category — was flagged for its lack of health screening and primary care prevention measures.
"Our methodology reinforces the idea that health is multidimensional. Problems can surface where you least expect, and you need to deal with them." Dr. Studnicki said.
The USF team spent the last 10 years developing a statistically reliable, yet practical, method to measure the health needs of communities, known as the Comprehensive Assessment for Tracking Community Health (CATCH). They completed individual reports for 20 Florida counties to help local officials identify and address high-priority health problems.
With the aid of a federal grant in 1998, the researchers created a data warehouse to automate the CATCH system and began working on the first statewide report as the prototype for a national rating system.