The nation’s counties continue to show wide disparities in health status owing in large part to income gaps, according to the annual county health rankings from the Robert Wood Johnson Foundation.

Now in its fifth year, the County Health Rankings and Roadmaps report measures counties in a wide range of factors and ranks each within its state. In past years top counties have often placed among the highest in average income, and this year Robert Wood Johnson found that the least healthy counties have twice as many children living in poverty and twice the mortality rate of healthier counties. 

“Poverty or income are among the most important factors to health,” said Bridget Catlin, director of the County Health Rankings and Roadmaps Program at the University of Wisconsin Population Health Institute. “They’re not the only factors, but they have a strong relationship, whether you use income or poverty or child poverty—it’s all the same relationship.”

The report included numerous signs of progress, such as steady declines in teen birth rates and preventable hospitalizations, but the proportion of children living in poor households has grown from 18 percent in 2007 to 23 percent in 2012, the report notes.

Nationally, the childhood poverty rate by county ranged from 3 percent to 60 percent. The state with the widest gap was Kentucky, where child poverty ranged from 8 percent to 57 percent.

Just northeast of Louisville, Kentucky's Oldham County earned the top rank overall in that state, with an 8 percent child poverty rate. Oldham also has far lower smoking rates, rates of uninsured people, higher college attainment and a far lower percentage of people reported in poor health than state averages. Wolfe County, a sparsely populated county in the Appalachian portion of the state, ranks near the bottom in health. It has more than 6 times the proportion of children in poverty, along with a nearly 40 percent smoking rate and 13 percent unemployment--figures that far and away exceed state and national averages. The median household income there is $19,310, compared with $70,171 in Oldham. 

Child poverty should lead policymakers to consider actions that support higher household income, such as wage laws or more robust earned-income tax credits at the state level, Catlin argued. At least 11 states are considering raising their minimum wage, along with at least a handful of cities, such as Seattle and Portland, Maine. 

Other key factors that show particularly strong correlations with population health are college attendance, smoking, physical inactivity and hospital stays, according to the report.  

The report weighs a number of health outcomes and factors to produce an overall state-wide ranking for each county. Health outcomes include mortality rates and incidence of sickness or mental illness. The factors include standard health measures such as smoking and obesity, but also high school graduation rates, unemployment and violent crime. This year’s factors expanded to include housing, transportation, the availability of healthy food, and access to mental health providers and recreational facilities. 

“People don’t often think about education, transportation, housing, community development, and one of the important things about the report is they’re not just important for expanding jobs but have that direct link to the health of the population,” said Julie Willems Van Dijk, deputy director of the County Health Rankings program.

Data Select a state and county below to display aggregate rankings compiled for the 2014 County Health Rankings. For more information on the rankings, see here.  Learn About Tableau