A new study that showed wealthier suburban areas such as Howard County are healthier than urban and rural parts of the state came as no surprise to public health officials, who point to disparities such as access to preventive care and good food.
The ranking was made using data on the length and quality of people's lives, as well as smoking and other behaviors, social and economic conditions, and environmental factors.
Howard, Montgomery and Frederick counties were at the top of the ranking, by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Baltimore City, Somerset and Dorchester were at the bottom.
Olivia D. Farrow, Baltimore's interim health commissioner, said the report provided some useful details but was not new information. Officials had conducted a similar study within the city in 2008 and found residents in wealthier areas such as Roland Park had a life expectancy of 83 years. It was 63 for those in poorer areas.
"We know poverty and other social and economic factors play a big role in the lives of citizens of Baltimore," she said. "But we've already been working on several projects focusing on cardiovascular disease and birth outcomes."
Howard's health officer, Dr. Peter L. Beilenson, who formerly served as Baltimore's health officer, agreed that general wealth and high educational levels help, but so do public policies such as smoking bans and efforts to provide care to the uninsured.
"We think policies followed have made a difference," he said.
Leigh Vinocur, an emergency room doctor at the University of Maryland School of Medicine, sees the effects of the disparities. City patients frequently come in with preventable problems - from the cancer patient who should have had a colonoscopy to the obese child who now has diabetes.
She said other studies, including a recent one on obesity, showed similar disparities.
"We can fix sick people in most cases, but this is an issue of getting coverage and preventive care and not getting sick to begin with," she said. "In the inner cities you're going to have poverty and no health insurance. The education levels may not be as high, there's less access to healthy food, there's more smoking and it's just not your priority to work out."
She noted that the sick in Baltimore often get good care because of the city's top-notch medical institutions - something lacking in many rural areas that landed on the bottom of the ranking. Education, access and prevention would mean more healthy people, she said, touting the growth of farmers' markets and programs for the poor.
The problems in Maryland are similar to those across the country, said Bridget Booske, senior scientist with the Population Health Institute who repeated the study in all 50 states.
She acknowledged that many public health officials probably knew that urban and rural areas were less healthy than many wealthy suburban areas, but not everyone in the community knows.
The size of the disparities might also surprise many people. For example, in the 50 least healthy counties, the likelihood of dying before 75 years of age is two to three times as high as in the 50 healthiest counties. In the least healthy counties, 26 percent smoke, while 16 percent smoke in the healthiest ones. In the healthiest, almost half the ZIP codes had places to buy fresh fruit and vegetables, but in the least healthy ones, that was the case in about a third.
"This is a call to action," Booske said. "This should be talked about in schools, hospitals and businesses, as well as health departments. Maybe you encourage your workers to take the stairs instead of the elevator. Everything adds up."
To read the report, go to countyhealthrankings.org