Health Rankings Spark Population Health Initiatives

When it comes to wellness, Hernando, MS Mayor Chip Johnson says it is the individual's responsibility to stay healthy through proper nutrition and regular exercise.

"But I do believe you can't exercise your responsibility for good health if your city or the county you live in does not give you an opportunity and an atmosphere for that good health," the mayor says.

Johnson made his remarks in a teleconference with reporters at Tuesday's launch of the 2012 County Health Rankings. The rankings were compiled and published by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

For those unfamiliar with the Rankings, which for the past three years has examined and ranked more than 3,000 counties in 50 states, it's worth a look.

The Rankings detail county-by-county health measures including per capita education, income, rates of smoking, obesity, sexually transmitted diseases, and the ratio of primary care physicians per county residents. This year the Rankings include new measures such as the number of fast food restaurants in a county and levels of physical inactivity among residents.

Patrick Remington, MD, an associate dean at the University of Wisconsin School of Medicine and Public Health, says the ranking provide a broader perspective of a county's wellness by measuring health behavior, clinical care, social and economic factors, and physical environment.

"What the rankings tell us is that while access to medical care is critically important, (population health) is affected by much more than what happens at the doctor's office," he says. "This shows us that where we live matters to our health."

Remington wants cities and neighborhoods to use the rankings to identify and solve their particular problems. "After three years we are seeing that these rankings are changing the conversation about health in communities from one focused mainly on treatment or sick care to one that involves a more complete view about how we promote health through our communities, schools and workplaces," he says. 

In Hernando, a city of about 12,000 people located south of Memphis, TN, community wellness is incremental and improves with each new bike path, sidewalk, and nutritional program.

The city requires any new development or redevelopment to include access for bicycles and pedestrians and not just cars. Hernando doesn't have money for new recreation and sports facilities, so the city is partnering with schools to use their gymnasiums after school for programs such as basketball leagues. Fourth- and fifth-graders in the city's schools have accepted Johnson's challenge to join him and other city officials in running a marathon—one mile at a time.

The city situated a farmers' market within walking distance of the poorest neighborhoods. "We have to give access to healthier food. We can't expect people to eat healthier and be healthier if they don't have access to those foods. So a farmers market is one way to do that," Johnson says. "And you have to make sure your farmers market is in places that are within reach of your poorest communities, your underserved communities."

Customers can pay for their fresh produce using social assistance such as WIC and low-income senior vouchers. "Don't make your farmers market just something for people with money," Johnson says.

On other wellness fronts, city officials talked Renasant Bank into donating 40-acres of land that it was sitting on after a development deal flopped. The land will be used for a new park named after the bank.

"All across the nation banks are sitting on land they repossessed and they don't know what to do with it," Johnson says. "So I would suggest that all of these neighborhoods go out and ask a bank to give that land to your city to make it a park. You might even name that park after the bank."

The city got a $5,000 grant to build a bike path a half-mile long. Johnson says that's not a very long bike path, but "every little bit helps." The city is also working on ways to "get under the interstate so town is not literally divided in half for pedestrian use."

Johnson says the city is already enjoying a return on investment from its new wellness program for city workers. "Last year we were struggling to find a way to increase the pay of our city employees," he said.

"Suddenly we got our renewal rates for the health insurance premiums and because of the efforts our employees had made to be healthier, our health insurance premiums decreased 15%. And with that windfall we were able to pass that along as a 2% pay raise for our employees. Very literally employees' healthy practices gave themselves a pay raise."

Hernando was named the healthiest hometown in the Magnolia State in 2010 by the BlueCross BlueShield Foundation of Mississippi. Johnson says he's using that honor as an economic development tool.

"When I want to recruit businesses to come to my town, I need to be able to show them that when they move here they are going to have healthy workers who will show up for work every day, and that that they will have workers whose health insurance premiums will be lower, which will go straight to the bottom line," he says.

"We are seeing that people very literally are moving to our town and our county because they perceive it to be a healthy town. That is the best compliment one could get, when people say 'I am moving to your county or city because I want to be in a place that is healthy.'"

It is refreshing to see that Johnson and the city of Hernando have an unabashed willingness to think small when it comes to wellness. There is not some grand, etched-in-stone master plan built by pricey consultants to promote health in Hernando, MS. Instead, there is a commitment to an idea of wellness that they're convinced works. From that commitment come the incremental steps that make Hernando a better, healthier place to live.

"Some of these things may sound small, but it is these small things that build up to a culture of health," Johnson says. "These things just tend to build on one another."