How healthy you are is strongly linked to where in Pennsylvania you live, according to the results of a new county-by-county study that found Philadelphia the least healthy county and neighboring Chester the healthiest in the state.
Union County, which was ranked first in the 2012 study fell to second this year.
Lycoming County ranked 16, and Clinton County 15.
The report was released today by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, which evaluated Pennsylvania's 67 counties on more than two dozen factors the researchers believe influence a person's health. They include individual healthy behavior markers such as obesity and smoking, as well as social and economic factors like education, violent crime, health care access, family support, education and unemployment.
Philadelphia has starkly higher rates than its four adjacent counties of sexually transmitted diseases, teen births, uninsured residents, smoking and obesity rates, high school dropouts, violent crime and single-parent homes. The Philadelphia-Chester tale of two counties - one urban, one suburban - is not uncommon, said Dr. James Marks of the Robert Wood Johnson Foundation.
"It turns out that social and economic factors are the most powerful (health) predictors," Marks said. "We can't treat our way out of our high health care costs ... Where and how people live, learn, work and play greatly affects their health."
Union, Centre, Cumberland and Snyder counties in central Pennsylvania round out the top five healthiest.
The report ranks the five unhealthiest counties as Philadelphia, Fayette, Greene, Sullivan and Forest, which fare worse than state averages in child poverty, single-parent households, obesity and a sedentary lifestyle.
Among the most significant county-to-county differences was the rate of the STD chlamydia: Philadelphia overwhelmingly topped the list with 1,273 cases per 100,000 residents - next highest was Dauphin County with 574 - while the lowest was Bedford County with 46. The statewide average was 374 per 100,000.
Teen birth rates in Philadelphia are also by far the highest in the state: 57 per 1,000 girls ages 15 to 19 in Philadelphia, compared with the lowest statewide of 7 per 1,000 in Centre County and next lowest, 13 per 1,000 in Bucks, Indiana and Pike counties.
The percentage of low birth-weight babies was 5.1 percent in Juniata County, the lowest statewide, and 11.3 percent in Philadelphia, the highest. The statewide overall average was 8.4 percent.
The report shows that 39 percent of Philadelphia's children live in poverty, a marked difference from its suburbs: 7 percent in Montgomery, 8 percent in Bucks, 9 percent in Chester and 15 percent in Delaware counties. In western Pennsylvania, where the highest child poverty rates were generally found, the next worst was 32 percent in Fayette and Forest counties. The child poverty rate for Pennsylvania overall is 19 percent.
The study found that only 59 percent of Philadelphia ninth-graders made it to high school graduation and 72 percent graduated in Fayette County, the second-lowest statewide, compared with 96 percent in Forest and 94 percent in Clinton and Butler counties.
"We all have a stake in creating a healthier community," said Dr. Patrick Remington of the University of Wisconsin's school of medicine and public health, "and no single sector alone can tackle the health challenges in any given community."
The top 20 healthiest counties overall are Chester, Union, Centre, Cumberland, Snyder, Montgomery, Juniata, Lancaster, Bucks, Butler, Pike, Adams, Lebanon, Franklin, Tioga, Lycoming, Berks, Lehigh, York and Clinton.
The bottom 20 counties are Philadelphia, Fayette, Greene, Sullivan, Forest, Cambria, Elk, Jefferson, Lawrence, Lackawanna, Luzerne, Blair, Potter, Wyoming, Schuylkill, Susquehanna, Mercer, Perry, Erie and McKean.