New data on smoking rates, obesity, poverty and other health factors highlight the large health gap among Deschutes, Crook and Jefferson counties.

The Robert Wood Johnson Foundation, a Princeton, N.J.-based health care research organization, released its fifth annual county health rankings late last month. The rankings detail a variety of health statistics for nearly 3,000 counties in the United States.

Central Oregon’s rankings for 2013 largely mirror past years: Deschutes County ranked near the top — healthiest — in Oregon for most health factors, while Crook County ranked near the bottom and Jefferson County came in at the very bottom for the fifth straight year.

Health officials in Crook and Jefferson counties said economic and social factors have played into their low rankings.

Both were hit hard by job losses starting in 2008 and have been slow to recover. The Robert Wood Johnson data include factors such as unemployment, child poverty rates and social support in the rankings.

“We’re a rural county, and the bigger issue is that we’re a poor community,” Jefferson County Public Health Director Tom Machala said Wednesday. “Average income is pretty low; there’s a low living wage.”

The rankings come from nearly two dozen local, state and federal data sources such as the National Center for Health Statistics, Centers for Disease Control and Prevention, and the U.S. Census Bureau.

Overall, Deschutes County ranked fifth in Oregon for health factors. Benton County ranked first, followed by Washington, Hood River and Clackamas counties ahead of Deschutes.

Across Oregon, 14 percent of residents are classified as being in “fair” or “poor” health, but just 9 percent were in Deschutes County, according to the Robert Wood Johnson figures. Crook County had a fair or poor health rate of 16 percent, while Jefferson County’s was 13 percent. Deschutes County had lower obesity and smoking rates than the state and a better ratio of primary care physicians for the total population.

“We continue to be encouraged by our numbers,” Deschutes County Health Services Director Scott Johnson said Thursday.

Crook and Jefferson have been stuck near the bottom of the rankings, along with many other rural counties, including Klamath, Josephine, Douglas and Malheur. Three small Oregon counties, Sherman, Gilliam and Wheeler, aren’t included in the health rankings.

That means Jefferson County’s 33rd ranking has been last for each of the five years of the Robert Wood Johnson studies.

Machala sees clear reasons for Jefferson County’s struggles. Despite having just 22,000 residents, it’s one of Oregon’s most diverse counties, with large Hispanic and Native American populations. Those groups bring unique health issues, with adults that often work tough jobs with long hours, and sometimes struggle with addictions such as alcoholism.

Especially troubling is the county’s high rate of teen births — more than twice the state average, according to the Robert Wood Johnson data.

As many rural areas do, Jefferson County struggles with a doctor shortage. Its ratio of residents to primary care physicians is 1,814-to-1 , according to the rankings. The statewide ratio is 1,115-to-1, while Deschutes County’s is 1,034-to-1.

But Jefferson County has made some strides, Machala said, with help from the state.

Oregon formed 17 coordinated care organizations, or CCOs, in 2012, creating regional hubs for medical care. The goal is to reduce unnecessary emergency room visits by linking residents with basic medical services.

Mosaic Medical, a local medical practice, is playing a key role in Central Oregon’s CCO and has added two primary care physicians in Madras since the CCOs launched.

“We’re always looking to bring in different kinds of family practice physicians,” Machala said. “But the bigger point here is, if you have a low socioeconomic standard, that has a broad impact on people’s health.”

Crook County ranked 28th out of 33 counties for health factors. As with Jefferson, Crook has suffered from a high unemployment rate and drastic doctor shortage. The county has just one primary care physician for every 2,977 residents, one of the worst ratios in the state.

Those numbers probably have improved a bit, as health care reforms have provided more funds for rural counties to recruit physicians, Crook County Health Department Director Muriel DeLaVergne-Brown said.

“We’re working really hard as a region, trying to look at what the issues are that are making people sick, and where we can do prevention work,” she said.

Machala and DeLaVergne-Brown both said improving economies and further health collaboration could boost their rankings in the coming years.

— Reporter: 541-617-7820, eglucklich@bendbulletin.com