How healthy are you? It could depend on where you live.
A health ranking of California counties made public Tuesday shows big differences in the overall health across California counties. And counties in the central San Joaquin Valley are among the unhealthiest.
The report -- a county-by-county snapshot of health in the 50 states -- looked at overall health and factors affecting health such as personal behavior, poverty and the environment.
Two Valley counties ranked in the bottom 10 for overall health in the 2010 County Health Rankings released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
"None of us fared very well," said Carol Barney, health director for Madera County.
Del Norte was the unhealthiest county, followed in order by Siskiyou, Lake, Trinity, Yuba, Kern, Inyo, Tulare, Madera and Modoc.
The healthiest counties in order were Marin, San Benito, Colusa, Santa Clara, San Mateo, Placer, Orange, Santa Cruz, Sonoma and El Dorado. Two counties were not ranked.
The researchers measured the rate of people dying before age 75, the percent who report being in fair or poor health, the number of days people report being in poor physical and poor mental health, and the rate of low birth weight infants.
Tulare County ranked at the bottom for health factors -- such as tobacco use, diet and exercise, access to care, education, income and the physical environment. Fresno, Merced, Madera and Kings were in the bottom tier.
Poverty, more than any other factor, affects people's health in the Valley, Barney said.
"People don't have the money to get preventive health care," she said.
Dr. Anna Marie Gonzalez, a primary-care physician at the Kerman Health Center, sees the effects of poverty on her patients.
One diabetic patient she saw recently had reduced an insulin dose to make the medicine last longer; another diabetic couldn't afford to have a laboratory test that was ordered, she said.
"Even when we want to give the care and even when they want to comply, they're constantly choosing between buying groceries and buying their medications," she said.
The county rankings included health factors to encourage communities to look at what they can do to improve a county's health, said Julie Willems VanDijk, an associate scientist with the Population Health Institute in Madison, Wis.
"Those health factors are really the drivers of tomorrow's health outcomes," she said.
"And those health factors are the things you can change."
Where you live affects your health, said Marlene Bengiamin, a senior research associate at the Central Valley Health Policy Institute at California State University, Fresno.
"But I would take this a little further," she said. "It's not just the county where you live, but the neighborhood where you live."
The Central Valley institute is studying Fresno neighborhoods for a report to be issued this year, Bengiamin said.
Valley counties can use the health rankings, Barney said.
It can help communities understand the "things we need to focus on, whether it's planning and development, parks, access to fresh fruits and vegetables, grocery stores in neighborhoods and safe places for children to play," she said.