Philadelphia, for example, came in last of the 67 counties in Pennsylvania.
But Chester County ranked 3rd, Montgomery County was 5th, and Bucks County was 6th in the report, produced by the Robert Woods Johnson Foundation, and the University of Wisconsin's Population Health Institute.
Suburban versus rural and proximity to big cities and high-paying jobs partly explain the disparities. Kendall County is on the edge of Chicago's metropolitan area, while LaSalle County is more farming-based.
"Affluent suburbs tend to have higher paying jobs, often in the cities, whereas rural communities often are dealing with loss of businesses" and declining populations of young people, who tend to be healthier, said Dr. Patrick Remington, a researcher at the Institute.
Residents of rural communities also tend to have less education, less access to health care, and higher rates of substance abuse and smoking - all factors that contribute to the rankings.
Still, counties encompassing big cities aren't immune. Wyandotte County, Kansas learned that when the researchers released their widely publicized first county health rankings report last year.
The county includes Kansas City and boasts two major medical centers, which officials figured would mean a top ranking. But Joe Reardon, mayor and CEO of Kansas City and county government, said the county's listing - 96th out of 98 in Kansas - was a wake-up call. It prompted several meetings with county authorities, local institutions and citizens, resulting in plans for more urban grocery stores and public works projects that aim to make sidewalks and roadways safer and more usable for pedestrians and bicyclists.
The rankings compare counties within each state. They're based on data from vital statistics and government health surveys. In many cases, several years of data are used to calculate rankings, Remington said. For that reason, many rankings this year are similar to those from the 2010 report.
Premature deaths - people dying before age 75 of preventable diseases; self-reported health status; and the percent of low birth-weight babies contribute to the rankings. Other measures include obesity rates, unemployment, high school graduation rates and pollution.
Richard Sewell, a health policy specialist at the University of Illinois at Chicago, praised the report for including a wide array of important measures that affect health.
"It's a call to action" that leaders beyond the medical realm pay attention to, Sewell said.
James Marks, director of the Robert Wood Johnson Foundation's health group, said last year's report resulted in an impressive amount of action in many counties that fared poorly. With annual rankings planned in the future, he said the reports likely will spur real improvement in Americans' health.
Check out your county's rankings at www.countyhealthrankings.org.
