County Health Rankings: What can we do?

In the above diagram, if you look at the left, it shows that policies & programs can influence health factors which will then influence health outcomes.  At the top, health outcomes are basically half and half length of life and quality of life.  We all want to have longer more fulfilling lives.  The thing thats missing from this is that there should be another arrow atop health outcomes.  It should say cost, because better outcomes can mean lower costs to healthcare.

The factors portion is what’s interesting.  Only about 10% of factors comes from the physical environment. In West Virignia we really get beat up on rankings of housing and transportation because we are a rural community and have a lot of poverty.  

The next section is social & economic factors.  This is 40% of the factor scores.  Educated citizens make better choices.  We should all make certain physical education & health classes are taught at a young age and continued throughout the K-12 education for our youth. It might not hurt to bring home economics back either.  Family & social support and community safety make up the rest of this.  There is nothing you can substitute for family & social support or for community safety.  Any investment in these will eventually lead to better outcomes.  And remember, better outcomes means lower costs.

Clinical care is only 20%.  Access to care is driven a great deal by employers providing health insurance and other benefits like sick leave.  Quality of care is up to providers.  We are fortunate in West Virginia to have some truly high quality providers in such a small rural state.

The last block you see going up is health behaviors.  It is 30%.  If you use tobacco, investment in a cessation program will pay you back.  Diet and exercise are also big drivers.  Having a limited use of alcohol and limiting drug use can help tremendously.  If you are sexually active, and not in a monogamous relationship there are risks that you may be taking.  Talking with your healthcare provider about the risks and how to mitigate them may save you from certain sexually transmitted infections.

More than half of the factors listed above are things you can help your employees with.  This investment in their health will pay dividends.  Keep in mind these are long term investments and they don’t happen over night.

If you’re further interested in how these are calculated or how your community is graded versus the rest of West Virginia or the rest of the county, go to and you can see the data in an easy to use format. 

Published by Danny Scalise

Danny Franklin Scalise, II is the Executive Director and Chief Lobbyist of the West Virginia State Medical Association and its subsidiary organizations as well as a professor of Health Policy at the West Virginia University School of Public Health. He is considered one of the leading health policy experts in West Virginia and is a passionate advocate for public health. Scalise has been a public policy adviser to two Governors. He is well known across West Virginia as a problem solver and a great student of West Virginia politics & the legislative process. As part of the Manchin administration, Danny was the Recovery Czar in West Virginia managing $1.8 billion in grants and entitlement funds from the American Recovery and Reinvestment Act of 2009.
 Danny earned his Bachelor of Science degree in Business Management from West Virginia University Institute of Technology in 2002, his Master of Business Administration from West Virginia University in 2005, and his Master of Public Health degree in Health Policy in 2018. In 2016 he became Certified in Public Health by the National Board of Public Health Examiners. He has been published on and regularly speaks on issues of public health, health policy, and local health department governance & organizational structure. Danny sits on the Board of Directors for the Thomas Health System in South Charleston, WV and in 2019 Mayor Amy Shuler Goodwin appointed him to serve on the Kanawha-Charleston Board of Health which governs the largest and first PHAB Accredited Health Department in West Virginia. 
 Danny has been recognized by Opportunity Nation in 2013 as part of their national Opportunity Leaders & Scholars program and was awarded the “Health Administration Rising Star” by the American Public Health Association in 2016. He is a 2012 Leadership West Virginia graduate, was on the State Journal’s 2016 Generation Next: 40 under 40 list, was named a 2019 Young Gun by West Virginia Executive Magazine, and was given the 2019 Advocacy Award by the West Virginia Immunization Network for his work to protect West Virginia’s childhood immunization laws. Since joining in 2007, Danny has been an active participant in Mensa.

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