County Health Rankings & Roadmaps, A Healthier Nation, County by County

The County Health Rankings models and measures

Our Approach

The County Health Rankings model of population health

What can I do?

Action Center

Explore guides and tools for improving health.

What Works for Health

Explore programs and policies that work!

What can I learn from others?


Key findings from the last four years of County Health Rankings and other national reports.

County-by-County Blog

Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.

Virginia State Health Gaps Report

Every year, nearly 5,800 deaths in Virginia could be avoided if all residents in the state had a fair chance to be healthy.

Download Data (109.34 KB)

How big are the health gaps?

If residents of all counties in Virginia had the same opportunities for health, there would be:

fewer adult smokers
fewer adults who are obese
fewer adults who drink excessively
fewer people who are uninsured
more adults ages 25-44 with some education beyond high school
fewer people who are unemployed
fewer children in poverty
fewer violent crimes
fewer households with severe housing problems

Most of Virginia’s 5,800 excess deaths tend to occur in counties with higher populations (such as Norfolk City and Richmond City). However, some counties with smaller populations also have a disproportionate share of avoidable lives lost. For example, over 56 percent of premature deaths in Radford City could be avoided if Radford City residents had the opportunities of those in healthier counties (no shading).

Of course, population size is not the only factor that state leaders should take into account when selecting strategies to solve health gaps. We know that there are many factors that shape health. Highlighted below are factors state leaders may want to pay particular attention to as they work to improve health for all.

Highlighted Health Gaps in Virginia

Highlighted measures indicate meaningful gaps that policymakers and leaders may want to examine more closely. We define meaningful gaps as those that are noteworthy or statistically different from a state or U.S. value for factors that have the greatest influence on health (e.g., social and economic factors have a greater influence than clinical care). The best and worst counties represent the top and bottom 10% of county-level values for a given measure, respectively.

Learn how we identified health factors to improve

County Health Rankings data can help to identify factors with meaningful differences across counties. Accounting for the relative influence of various factors on health outcomes, a range of techniques were used to identify those factors that seem to have the greatest potential opportunity for improvement. We identified measures where there are meaningful differences between the state’s or poor performing counties’ value and that of a U.S. or state reference value for the factor. Meaningful differences indicate that for a given state, the magnitude of the difference is consequential and/or statistically significant compared to this reference value.

Health Behaviors
Health FactorsBest VA CountiesWorst VA CountiesMean VA Best US Counties
Adult smoking: adults who are current smokers14%30%18%14%
Adult obesity: adults that report a BMI of 30 or more26%35%28%25%
Food environment index: access to healthy food and food insecurity9.
Physical inactivity: adults reporting no leisure-time physical activity20%30%22%20%
Access to exercise opportunities: adequate access to locations for physical activity99%28%81%92%
Excessive drinking: adults reporting binge or heavy drinking11%20%16%10%
Alcohol-impaired driving deaths: driving deaths with alcohol involvement11%50%31%14%
Sexually transmitted infections: newly diagnosed chlamydia cases per 100,000 population156845427138
Teen births: births per 1,000 females ages 15-1915572920
Clinical Care
Health FactorsBest VA CountiesWorst VA CountiesMean VA Best US Counties
Uninsured: population under age 65 without health insurance12%20%14%11%
Primary care physicians: ratio of population to primary care physicians761:16,257:11,344:11,039:1
Dentists: ratio of population to dentists938:16,904:11,611:11,362:1
Mental health providers: ratio of population to mental health providers362:17,042:1724:1383:1
Preventable hospital stays: hospital stays for ambulatory-care sensitive conditions per 1,000 Medicare enrollees41955541
Diabetic monitoring: diabetic Medicare enrollees, ages 65-75, that receive HbA1c monitoring91%84%87%90%
Mammography screening: female Medicare enrollees, ages 67-69, that receive mammography screening71%57%63%71%
Social & Economic Factors
Health FactorsBest VA CountiesWorst VA CountiesMean VA Best US Counties
High school graduation: ninth-grade cohort that graduates in 4 years91%73%83%93%
Some college: adults ages 25-44 with some post-secondary education74%42%68%71%
Unemployment: population 16+ that are unemployed but seeking work5%9%6%4%
Children in poverty: children under age 18 living in poverty10%33%16%13%
Income inequality: ratio of 80th/20th percentile of income3.
Children in single-parent households: children that live in a household headed by a single parent20%49%30%20%
Social associations: social associations per 10,000 population2381122
Violent crime: violent crime offenses per 100,000 population7338920059
Injury deaths: deaths due to injury per 100,000 population45925250
Physical Environment
Health FactorsBest VA CountiesWorst VA CountiesMean VA Best US Counties
Air pollution: average daily density (µg/m3) of fine particulate matter (2.5)
Drinking water violations: population potentially exposed to water exceeding violation limit during past year0%29%2%0%
Severe housing problems: households with ≥ 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen or plumbing facilities10%20%15%9%
Driving alone to work: workforce that drives alone to work71%86%77%71%
Long commute - driving alone: among workers who commute in their car alone, those that commute more than 30 minutes19%58%38%15%

What can be done to help close gaps in Virginia?

Here are some examples of evidence-informed strategies to improve the above highlighted health factors:

Tobacco Use (Adult smoking)

Deliver phone-based behavioral counseling and follow-up for tobacco users who want to quit

Implement private sector rules or public sector regulations that prohibit smoking or restrict it to designated areas

Limit the pricing, flavoring, placement, or promotion of tobacco products via regulation

Increase tobacco per unit prices through taxes or point-of-sale fees

Alcohol and Drug Use (Alcohol-impaired driving deaths)

Regularly adjust taxes levied for beer, wine, and liquor purchases

Reduce density of alcohol beverage outlets (i.e., places that sell alcohol) or limit increases in the density of such outlets via regulatory authority

Identify persons with harmful alcohol consumption before consequences become pronounced and motivate them to address their alcohol problems

Education (High school graduation)

Combine academics, physical health, mental health, and social service resources for students and families through partnerships with community organizations

Provide services  such as remedial education, vocational training, case management, health care, and transportation assistance, to help students complete high school

Support interventions that provide at-risk students and families with resources to improve self-esteem, social skills, discipline, and unmet needs in order to increase school attendance

Provide pre-K education to all 4-year-olds, regardless of family income

Employment (Unemployment)

Extend or raise the compensation provided to eligible, unemployed workers looking for jobs

Support acquisition of job-specific skills through education, certification programs, or on-the-job training

Housing and Transit (Long commute - driving alone)

Support a combination of land uses (e.g., residential, commercial, recreational) in development initiatives, often through zoning regulations

Support transportation options that are available to the general public and run on a scheduled timetable (e.g., buses, trains, ferries, rapid transit, etc.)

Enhance streetscapes with greater sidewalk coverage and walkway connectivity, street crossing safety features, traffic calming measures, and other design elements.

Choosing strategies that work

Taking time to choose policies and programs that have been shown to work in real life and that are a good fit for your state will maximize the chances of success. Focusing on policy, systems, and environmental changes – or implementing programs in a broad, systematic way – can lead to the most substantial improvements over time. The strategies listed above are among many resources in What Works for Health, a searchable database of policies or programs that have worked in other places or are recommended by unbiased experts.


How have states and local communities taken action?

The approach to reducing health gaps is not ‘one size fits all.’ Each state and community has different assets and opportunities they can use. Many communities across the U.S. are already addressing health gaps and building a Culture of Health. States and local communities have improved health by taking action and making changes. Just look at community revitalization efforts, the expansion of education programs that empower young people, and local and state economic development. For more detailed tools and guidance on how to improve health for all:


Robert Wood Johnson Foundation Culture of Health Prize

State and local efforts can harness the collective power of leaders, partners, and community members to provide everyone with opportunities for better health. The 2015 RWJF Culture of Health Prize winners are prime examples of making this a reality. Here are links to examples of how these communities are cultivating a shared belief in good health for all:


Find out more about health gaps in another state:


Recommended citation

University of Wisconsin Population Health Institute. County Health Rankings Health Gaps Report 2015.

Lead Authors

Bridget Catlin, PhD, MHSA
Marjory Givens, PhD, MSPH
Julie Willems Van Dijk, PhD, RN

This publication would not have been possible without the following contributions:

Research Assistance

Alison Bergum, MPA
Kathryn Hatchell
Amanda Jovaag, MS
Hyojun Park, MS
Elizabeth Pollock
Matthew Rodock, MPH

Outreach Assistance

Mary Bennett, MFA
Kitty Jerome, MA
Stephanie Johnson, MSW
Jan O’Neill, MPA

Communications and Website Development

Forum One


Centers for Disease Control and Prevention: National Center for Health Statistics
Dartmouth Institute for Health Policy & Clinical Practice

Robert Wood Johnson Foundation

Abbey Cofsky, MPH
Andrea Ducas, MPH
Michelle Larkin, JD, MS, RN
James Marks, MD, MPH
Joe Marx
Donald Schwarz, MD, MPH
Amy Slonim, PhD
Kathryn Wehr, MPH

Scientific Advisory Group

Patrick Remington, MD, MPH, Chair
Maureen Bisognano, MS
Bridget Catlin, PhD, MHSA
Tom Eckstein, MBA
Elizabeth Mitchell
C. Tracy Orleans, PhD
Maggie Super Church, MSc, MCP
Renée Canady, PhD, MPA
Ana Diez Roux, MD, PhD
Wayne Giles, MD, MS
Ali Mokdad, PhD
Steven Teutsch, MD, MPH