By Tammy Gray-Searles Navajo County is ranked 13th among Arizona’s 15 counties in health outcomes, according to a survey unveiled by the University of Wisconsin and Robert Wood Johnson Foundation. The survey relies heavily on economic factors in determining health outcomes. While Navajo County ranks highest in the state in the physical environment component, low scores in social and economic factors, health behaviors and clinical care pushed it down to the bottom of the rankings. Factors considered as part of the physical environment included the number of annual air pollution particulate matter days, the number of air pollution ozone days, access to healthy foods and access to recreational facilities. The county scored well in all areas, ranking seventh in the state for access to recreational facilities, which was the worst score it received in the physical environment portion. Social and economic rankings, however, were dismal for Navajo County. A low high school graduation rate coupled with a high unemployment rate, a large percentage of children living in poverty and “inadequate social support” put Navajo County at number 14 among the 15 counties for social and economic factors. According to the report, Navajo County has a 55 percent graduation rate, compared to the national benchmark of 92 percent and the statewide average of 70 percent. The number of children living in poverty was calculated at 32 percent for Navajo County. The national benchmark is 11 percent, while the state average is 20 percent. Navajo County ranked eighth among the counties for health behaviors that contribute to poor health outcomes. These include adult smoking, adult obesity, excessive drinking, sexually transmitted infections, teen birth rate and motor vehicle crash death rate. While the county remained close to the state average in most areas, the rate of sexually transmitted diseases and fatal auto crashes was high. Navajo County had a rate of 537 cases of Chlamydia per 100,000 people, compared to the national benchmark of 83 and the statewide average of 391. The motor vehicle crash death rate for the county was 57 per 100,000 people, while the national benchmark is 12 and the statewide average is 20. A high number of preventable hospital stays combined with low rates of diabetes and mammography screenings, as well as a low number of physicians, put Navajo County 12th in the state for clinical care. According to the report, Navajo County has one primary care physician for every 1,170 people. The national benchmark is one primary care provider for every 631 individuals. The state average is one for every 1,118 people. The county’s preventable hospital stay rate is 84 per 1,000 Medicare enrollees, while the national benchmark is 52 and the statewide average is 53. Only 44 percent of Navajo County Medicare enrollees were screened for diabetes and 43 percent had mammograms, compared to the national benchmark of 89 percent for diabetes and 74 percent for mammograms. The statewide average was 76 percent for diabetes and 64 percent for mammograms. The report also looked at mortality and morbidity to rank health outcomes. Navajo County ranked 14th in mortality, or early death rates, and 12th in morbidity, or poor health. Premature death rate was calculated in “years of potential life lost before age 75 per 100,000 population.” Navajo County’s total was 12,381, compared to the national benchmark of 5,564 and the state average of 7,498. Morbidity included poor or fair health, poor physical health days, poor mental health days and low birth weight. The report noted that 18 percent of adults in Navajo County reported poor or fair health, compared to the 10 percent national benchmark and 16 percent statewide. Low birth weight in the county was 7.8 percent. The national benchmark is six percent and the statewide average is seven percent. Navajo County Health Department officials did not comment on the report, noting that they will continue to offer as many services as possible as long as funding allows, but do not have control over a number of factors used in the ranking, such as local economics.