The 2012 County Health Rankings & Roadmaps program analyzes factors within four health categories. The list below also shows how the four categories are weighted for health factors rankings.
• Health behaviors -- 30 percent: Smoking, obesity, physical inactivity, excessive drinking, fatal car crashes, sexually transmitted diseases, teen birth rate.
• Clinical care -- 20 percent: Numbers of uninsured, doctor/patient ratio, preventable hospital stays, diabetic screening, mammography screening.
• Social and economic factors -- 40 percent: High school graduation rate, college attendance, unemployment rates, percentage of children in poverty, inadequate social support, single-parent households, violent crime rate.
• Physical environment -- 10 percent: Air pollution, particulate matter days and ozone days; recreational facilities access; access to healthy foods; fast-food restaurants.
Source: County Health Rankings & Roadmaps Program
Tennessee's 10 healthiest counties (1-10): Williamson, Sumner, Rutherford, Blount, Moore, Wilson, Chester, Weakley, Putnam, Knox
Tennessee's 10 least-healthy counties (86-95): Rhea, Lauderdale, Marion, Sequatchie, Fentress, Carroll, Clay, Campbell, Benton, Grundy
Source: County Health Rankings & Roadmaps Program
A national study puts Grundy at the bottom of Tennessee's 95 counties when it comes to factors affecting health and life expectancy, including death rates, access to health care and healthy foods, economic and education factors, diet and smoking rates.
Even at dead last, Grundy is not far below Marion and Sequatchie, which rank 88th and 89th, respectively. Meigs, Rhea and Polk all rank in the bottom 25 percent of Tennessee counties, according to the 2012 County Health Rankings.
The study, released in April by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, analyzes factors within four categories -- health behaviors, clinical care, social and economic factors and physical environment -- each of which contain several measures.
Grundy ranked in the bottom 25 percent -- 72nd or worse -- of Tennessee counties in three of the four categories, the study shows.
It ranked 89th in health factors, which includes a 35th ranking in health behaviors, 92nd in clinical care and 88th in social and economic factors.
But the county notched a 31st rank -- second best next to Bledsoe among Southeast Tennessee's 10 counties -- under physical environment factors thanks to its clean air and access to healthy food, study officials said.
The study shows "that where you live, work and play matters to your health," and "tells community leaders where they're doing well and where there are opportunities for improvement," said Angela Russell, associate researcher with the project at the University of Wisconsin Population Health Institute.
Russell said the "health outcomes" ranking shows the impact of health factors over time while measures under "health factors" show what's happening now.
She said a major factor in Southeast Tennessee health outcomes rankings arises from the premature death rate, which refers to the number of people who die before age 75.
For Grundy, the premature death rate is 13,947 per 100,000 people (adjusted for comparison) while Bradley is lowest in the region at 8,452 per 100,000. Bledsoe follows just behind Bradley at 8,505, and Hamilton falls in line at 8,597. Even though the counties do not have populations of 100,000, the rates reflect a per-100,000 measurement so counties can be compared equally.
"You've got a really high premature death rate in Grundy compared to the rest of the state, and you have a lot more people reporting they feel physically and mentally unhealthy," Russell said.
On the other hand, Grundy shines in other categories compared with state averages.
"Grundy does better on sexually transmitted disease and lower excessive drinking rates," she said.
For health outcomes rankings in the Sequatchie Valley, the rural county that stands out is Bledsoe, according to Russell.
"They rank 35th out of 95 counties" largely because of a lower premature death rate compared with its neighbors, she said.
To the east, Bradley County leads all others in Southeast Tennessee with a health outcome ranking of 18th and health factors ranking of 19th, the study shows.
Marion County ranked 43rd overall in the four health factors categories but had a high premature death rate of 10,817 per 100,000, which helped put the county in the lowest 25 percent of health outcomes rankings.
Beth Delaney, spokeswoman for the Southeast Tennessee Regional office of the state Department of Health, said the study shows that prime issues for Grundy, Marion and Sequatchie counties, as well as many other rural counties, are the social and economic factors that carry considerable weight in the rankings.
Economic factors force families to make tough decisions between expensive healthy food and cheaper stand-ins, she said. Struggling families face challenges even getting access to health care, though TennCare for children helps with medical care, Delaney said.
"Social and economic factors are the biggest issues, and the fact that so many people are living in poverty puts them at risk for poor nutrition [and] the stress of living in poverty," she said.
"Think how much more a gallon of milk costs than a two-liter soft drink," she said.
Grundy's unemployment rate stands at 12.1 percent in the study, compared with the state's 9.7 percent, Delaney said. Marion's and Sequatchie's jobless rates both were 10.5 percent.
An even bigger indicator of the economic and social impact on health shows in the percentage of children living in poverty, she said.
Grundy's rate is 43 percent, while Marion, Sequatchie, Bledsoe, Meigs and Rhea have very similar rates in the economic and social factor categories, data shows.
Delaney said health care help is available for rural folks and improvements are being studied.
"One thing we're doing to help in Grundy is we have a primary care site, and uninsured people between the ages of 19 and 64 can go to the primary care site for services," she said.
She said Women, Infants and Children program vouchers can help with nutritional food and counseling on healthy eating.
The study data will be valuable, according to Delaney.
"Later this summer, all our health councils will begin a community assessment process and information like this helps us know what we need to focus on," she said.