What makes us sick continues to be a complex and intriguing question. We have gone from the thinking
of previous centuries that associated illness with superstition to understanding that small organisms
that we cannot see with the naked eye make us sick. We now understand that it’s more than germs,
bacteria, viruses etc. Now we understand that it’s our behavior, our social and physical environment and
even the level of resources we have available to us.
The County Health Rankings published annually by the Robert Wood Johnson Foundation and the
University of Wisconsin is a report that helps us in understanding this. The report looks at counties
around the U.S. and ranks them in two categories, Health Outcomes- how healthy the county is in
terms of deaths and illnesses and Health Factors- the things that influence health in each county, and
this list is long. The health factors list includes data on health behaviors, clinical care and health access
data, social and economic data and information on the physical environment. Counties are ranked in
both of these categories.
Can a community improve their ranking? Maybe with focused efforts, but it may take a couple of years. I
would also suggest that it will take continued attention to what really makes us sick.
In 1854 Dr. John Snow was skeptical of conventional wisdom in rejecting the belief in his time that “bad
air” was the cause of the cholera epidemic that was killing hundreds in London. Through his
investigation he determined that contaminated water was the cause. You have to understand that in
those days few people understood or believed that there were tiny organisms that could make us sick.
He removed the handle of the public water pump on Broad Street preventing people from drinking this
water and thus ended the epidemic. Really the start of not just some epidemiological concepts we now
use in public health but also an understanding of social determinants of health. Farfetched, in the minds
of many in those days, but a relevant lesson for us today. We too may have to think differently about
how to keep residents in our communities healthy. How do we move beyond conventional thinking to
solve the health problems of our population? Where do we need to remove the handle?