PUBLIC HEALTH UPDATE: Marin Ranked State’s Healthiest County

Matt Willis, MD, MPH

For the sixth year in a row, the Robert Wood Johnson Foundation, in collaboration with the University of Wisconsin Population Health Institute, has ranked Marin as California’s healthiest county in its annual County Health Rankings, which assess counties across the entire nation. The rankings are based on data collected from 2004 through 2013.

The foundation’s rankings consider multiple factors that affect people’s health within four broad categories: healthy behavior, clinical care, physical environment, and social and economic factors. The rankings account for a range of factors that, when improved, help make communities healthier.

Marin ranked highest among California counties (56 of the state’s 58 counties were included in the rankings) in several areas, including clinical care, healthy behaviors, length of life and lowest teen birth rate. We ranked in the top 5% of California counties in, among other categories, low premature death rate, low prevalence of adult obesity, low rate of physical inactivity, and a high per capita rate of primary care physicians, dentists and mental health providers.

However, the rankings are based on population averages and mask important areas of unmet need. While Marin residents—and physicians in particular—have good reason to be proud of our status as California’s healthiest county, it is important to recognize that not everyone in Marin enjoys high levels of health and wealth. The income gap can make poor people more vulnerable to poor health.

CHALLENGES WE FACE

Income inequality. Marin ranks poorly —in the bottom half of California’s counties—in income inequality. There is a wider gap between the rich and poor here than in many other counties. Our high cost of living and insufficient affordable housing cause many poorer residents to be segregated by neighborhoods and schools, breaking down social connections and creating stress. This income gap and related stressors can lead to poor health outcomes for residents who struggle to meet basic needs.

Increasing opportunities for educational achievement, safe housing and self-sufficiency can help give everyone a chance to live a healthier life. High-quality childcare and preschool for all children will help them get ready for kindergarten, a key predictor of academic success and, later, economic success. Affordable rental housing and programs that help lower-income and middle-class families achieve home ownership are also an important step in building intergenerational wealth. Increasing the minimum wage locally can also help working families and strengthen the economy.

Several regional and local initiatives such as Rise Together, Marin Promise and Marin Strong Start are working on alleviating poverty and setting the foundation for future success for all Marin residents.

Alcohol and prescription drugs. Marin continues to fare poorly—again in the bottom half of the state’s counties—in both alcohol- and drug-related metrics: excessive drinking, driving deaths related to alcohol, and deaths related to drug poisoning. For five years in a row, more than one-fourth of Marin adults report binge drinking.

Growing concerns about these issues have led to widespread community action. Coalitions in Mill Valley, Twin Cities, West Marin and Novato are all working on community-based solutions that (1) revolve around better enforcement of laws known to reduce drinking and (2) promote a culture where alcohol abuse is not the norm. For more information contact klaw@marincounty.org.

Launched in 2013, RxSafe Marin is a coalition of community members and experts collaborating to tackle the local prescription-drug-misuse-and-abuse epidemic. Strategies include working with prescribers toward more judicious prescription practices, promoting safe medication storage in homes, and creating more medication take-back sites. To learn more, contact RxSafeMarin@gmail.com.

An aging population. Good health and long life expectancy mean that Marin has a growing number of aging residents. In 2023, an estimated one in four Marin residents will be 65 and older, compared to one in five today. Fortunately, the Marin County Health and Human Services Aging and Adult Services program, along with many community partners, is poised to act and serve as an advocate for the needs of our seniors. Our active Commission on Aging advises the Marin County board of supervisors and holds monthly public meetings. The county’s Health and Human Services information and assistance line, 415-457-INFO (4636), can help older adults and their caregivers find the services and support they need.

As Marin’s public health officer, I hope to spread the standard of clinical excellence modeled by our county’s providers into all areas of public health, to support community wellness for everyone in Marin.

This Public Health Update is intended to provide information on key local public health topics, especially those that may affect clinical care, and to strengthen communication between my office and the county’s physicians. I welcome suggestions for topics to address in future issues of Marin Medicine that will help support our county’s physicians in their efforts to provide outstanding health care.

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Dr. Willis is Marin County’s public health officer.

Email: mwillis@marincounty.org