Ignorance, poverty and addiction.
Those three factors came together to put Merced in the bottom third of recent county health rankings.
The Robert Wood Johnson Foundation, the country's largest philanthropy devoted exclusively to health, ranked the overall health of every county in all 50 states.
Each county is ranked within the state on how healthy its residents are and how long they live. Key factors that affect health, such as smoking, obesity, binge drinking, high school graduation and rates of violent crimes, are also ranked.
"I'm absolutely not surprised by these findings," said Dr. David Simenson, a family practice physician and the associated medical director for Golden Valley Health Centers.
Simenson said he sees problems every day such as smoking and obesity running rampant in his patients. One of the biggest problems he sees is addiction.
"People are having problems with tobacco, alcohol and meth addiction," Simenson said. "Even though two of those are legal, they still affect people's health."
Merced County ranked 40th out of 58 counties in the state. Marin County ranked first overall in health outcomes, while Del Norte County was ranked last. Although Merced ended up in the bottom third, in some areas, the county ranked much lower.
In the category of social and economic factors, Merced ranked 52nd. Unemployment, lack of education, violent crime and children living in poverty all affect the health of the county's population.
In health behaviors, such as adult smoking, adult obesity and binge drinking, the county ranked 50th.
Richard Rios, the community health services manager for public health in the county, said the county takes these rankings seriously.
"A report like this just refocuses the needs and attention where it should be focusing," said Rios.
He added that where a person works, lives and plays are big factors on how long that person lives.
"Health is everyone's business," Rios said. "The health of the community depends on a lot of factors."
Simenson said another thorny problem in the county is mental health. Merced County's mental health system has seen huge budget cuts, Simenson said, and that has affected the care patients get.
"I had a patient, a young adult, who was admitted to Marie Green for suicide risk," Simenson said. "Then that person was sent home with no plan. And the reason is the funding cutbacks."
Simenson said he believes some health problems in the county can be resolved by making access available.
"There are 7 million Californians without health insurance," Simenson said. "Access to good primary care would be my No. 1 wish."
Rios said despite recent challenges to staffing and other resources, the county health department is working hard to address local problems.
"We want to do our role in helping make Merced County healthier," Rios said.
Judging from the rankings, that role will be a big one.
Reporter Carol Reiter can be reached at (209) 385-2486 or firstname.lastname@example.org.