One of my objectives with Trouble in God’s Country has been to put Georgia’s performance across a range of socio-economic measures into a national context. As regular readers may recall, I’ve reported that Georgia has hugely disproportionate shares of its geography and population mired at the bottom of the national ladder for various measures.  

In 2020, for example, Georgia had more people living in counties that were in the bottom national quartile for per capita income than any other state in the nation. Likewise, I found in analyzing educational attainment data that the 147 counties outside my 12-county Metro Atlanta region would constitute the second-worst educated state in the nation, behind Mississippi and just a little better than West Virginia. The Atlanta region would constitute the second-best educated state in the country, behind Colorado and ahead of Massachusetts.

Doing the same thing with health data has always been a little trickier, but a couple of months ago the nonprofit organization County Health Rankings & Roadmaps (CHRR) came to the rescue.   

As a little background, CHRR has, for more than a decade now, been collecting and reporting key population health metrics on the vast majority of counties in the nation (there are always some counties you can’t get data for). The program is run by the University of Wisconsin’s Population Health Institute and funded, at least in part, by the Robert Wood Johnson Foundation. 

As part of its annual report, it has historically included in-state rankings; with this year’s report, it includes data that makes it possible to rank all counties nationally. Which is just what I needed.

So, the question I’d been waiting to get an answer to was simply: Would the same thing hold true with health? The answer, sadly, is… absolutely.

CHRR gauges county-level health outcomes by stirring together local data for the following measures: premature death rates, the percentage of live births reported with low birthweight, the percentage of adults reporting fair or poor health, and the average number of physically and mentally unhealthy days reported in the past 30 days.

Eighty-three of Georgia’s 159 counties are in the bottom national quartile for health outcomes, based on the CHRR rankings—more than any other state. This includes all but 20 of the counties south of the Gnat Line.

According to the Census Bureau’s latest population estimates, those 83 counties are home to 2.43 million Georgians. I’m still stitching together the national population analysis, but I’ll go out on a limb and say I’ll be more than a little surprised if we don’t also lead the nation in the number of people living in bottom-quartile counties.

The counties at the top and bottom of the Georgia list won’t come as a surprise to anybody.  The top five Georgia counties for health outcomes, per the CHRR report, are (in order): Forsyth County, Oconee County, Cherokee County, Cobb County and Columbia County. The bottom five are: Early County at 155th; Crisp at 156th; Randolph County at 157th; Hancock County at 158th and Miller County at 159th.

One other factoid I can include here is that the Georgia-North Carolina contrast I’ve found with other measures holds true with health outcomes as well. Generally regarded as perhaps Georgia’s closest peer state, North Carolina has somehow managed to do a much better job than Georgia of limiting the number of its citizens who fall into the nation’s bottom tier for economic performance and educational attainment.

The same is true with CHRR’s health outcomes. Only 19 of North Carolina’s 100 counties and 6.7% of its population fell into the bottom national quartile for health outcomes in the latest study. In contrast, 22% of Georgia’s population live in the 83 counties that landed in the bottom quartile for health outcomes. 

With both per capita income and educational attainment, I’ve been able to demonstrate that the gap between Georgia and North Carolina developed over time. With both those measures, there was a time when the two states had very comparable data profiles. But over time, North Carolina has done a better job of pulling its citizens out of the bottom national quartile for economic performance and educational attainment. I’ll be surprised if the same pattern doesn’t hold true with health outcomes.

Charles Hayslett is the author of the long-running troubleingodscountry.com blog. He is also the Scholar in Residence at the Center for Middle Georgia Studies at Middle Georgia State University. The views expressed in his columns are his own and are not necessarily those of the Center or the University.

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