County Health Rankings and Roadmaps (CHR&R) released their 2022 annual report this week, and what a read it is! Those in the health equity space unfamiliar with this resource need to get familiar quickly! The site provides current data and outcomes on societal disparities for every county in the United States. CHR & R was created by the University of Wisconsin Population Health Institute with funding from the Robert Wood Johnson Foundation. The site is among my favorite “go to” sites for health disparities data, along with CMS’s Mapping US Medicare Disparities and the Health Equity Tracker courtesy of the Satcher Health Leadership Institute and Morehouse School of Medicine). But, back to those CHR & R the interesting results!
What the Data Reveals
Much has been written during the pandemic about economic shifts and their impact on the population. The results of the CHR & R report are glaring, and have strong potential to impact wholistic health equity across physical, behavioral, and psychosocial health:
- Many US residents do not earn a living wage: $35.80 an hour for households with one adult and two children:
- In nearly all US counties, the typical wage is less than the living wage for the area. Among these counties, a more than 73% increase in wages is necessary to meet the living wage; some counties require a 229% increase.
- The gender disparity gap is only eclipsed by that for racial disparities:
- Women earn 81 cents on the dollar relative to White Men
- Women of all races and ethnicities must work more time to earn the $61,807 average annual salary of a White man.
- Asian Women: 34 days more (approximately 1 month)
- White Women: 103 days more (> 3.5 months)
- Black Women: 223 days more (> 7 months)
- American Indian/Alaskan Native: 266 days (>8.5 months)
- Hispanic Women: 299 days more (approximately 10 months)
- The largest pay gaps exist in the South and Western Plains States, often related to prevailing systemic racism
- Childcare costs negate the ability of many parents to work, and is considered unaffordable when it exceeds 7% of the household’s income:
- No counties have the childcare cost for two children at or below the 7% benchmark
- On average, a family with two children spends 25% of its household income on childcare
- Childcare cost burden is highest in urban metro regions and rural counties: 27% and 25% respectively
- For a person earning the federal minimum wage of $7.25-an-hour, the average childcare costs for two children is >90% of their annual income.
- Vast educational disparities appear across rural, suburban and urban schools:
- 50% of all counties in the US have a public school funding deficit, needing to spend >$3,000 more per student, annually
- 70% of counties with deficits of > -$4,500 per student, annually, are rural
- Counties with higher proportions of Black, Hispanic, and American Indian & Alaska Native populations have funding deficits higher than most US counties; deficits are especially high in certain areas, such as the Southern Black Belt region (systemic racism hits again).
- Large school funding deficits (-$4,500 per student, annually) correlate with students performing below their grade level for reading and math.
Ripples Effects and Recommendations
The economic, employment, and racial disparities detailed in the report have a ripple effect across all social determinants of health. Access to all basic human needs is at issue, and must be addressed. The report includes a series of data maps, resources, and successful programming to mitigate the issues. Recommendations encompass, but are not limited to:
- Increasing access to affordable childcare through publicly funded pre-kindergarten programs, child care subsidies, preschool education programs, and Early Head Start.
- Improving community conditions and increase access to financial resources to preserve affordable housing, via Community Development Financial Institutions, Community Development Block Grants, inclusionary zoning and housing policies, housing reparations, and Tax Increment Financing (TIF) for affordable housing.
- Building social connectedness, cultivate community power, and promote civic engagement by addressing barriers to participation in policymaking, resource allocation, information sharing, and collaboration in neighborhoods, schools, and workplaces (e.g., community schools, school-based health centers, youth leadership programs, community health workers)
A table with additional measures and data sources are appears at end of the report, which reaffirms the product’s value to the industry. The report is accessible from the embedded URL above, or through the County Ranking and Roadmaps site, www.countyhealthrankings.org
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