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Every year when the County Health Rankings are released, Debbie Marvidikis of the Southeast Utah Health Department knows where counties in her jurisdiction will fall.

Carbon County has been dead last for the last eight years. Emery and Grand counties have cycled through the bottom 10 places, landing this year at 22nd and 24th respectively, out of the 27 Utah counties ranked.

It's discouraging, Marvidikis said, but the success of recent local efforts to combat suicide and adult smoking have given her hope. "We are working hard to not only save but improve the lives of people we share a community with," said Marvidikis, the department's health education program director.

After seven years as Utah's healthiest county, Morgan County was knocked to fourth place and Wasatch County took the top spot, according to the national analysis released Wednesday. The study, a partnership between Robert Wood Johnson Foundation and the University of Wisconsin Population Health, evaluates more than 30 health criteria to numerically rank almost every county in the country.

There was insufficient data to evaluate two small Utah counties — Daggett and Piute.

Data used to rank each county include rates of premature death, health behaviors, access to clinical care and socioeconomic factors that influence health, such as income and education levels.

Deaths that occur before age 75 are considered premature. The number of lost years of life in Utah's counties range from 4,200 years in 2nd-ranked Cache County to 10,800 years in Carbon County.

Carbon's total is a slight increase from last year and about double the state average.

Carbon has seen negative trends in several other areas, including having one of the highest rates of children living in poverty, at 21 percent. Between Carbon, Emery and Grand counties, there is only one place that sells car seats for children — Wal-Mart's Price location, in Carbon County.

Among adults in the county, 27 percent are considered obese. The county is tied with several others for the second highest percentage of adult smokers, at 12 percent.

The health department doesn't take its low ranking lightly, Marvidikis said. But she points out that counties like Carbon, Emery and Grand face barriers to helping residents become healthier, such as minimal state and federal funding and little access to larger health care networks.

The department has to do more with less and get creative with its fundraising, she said. The department regularly rallies the public to help fund health initiatives — a partnership that has given the staff clarity on health issues that are most important to those they serve.

To help the department address suicides in Carbon County, local businesses, organizations and the Mike Ballard Memorial Fund worked together to raise about $13,000 for new prevention training for the general public. The local contributions helped the department stretch the little funding it receives from the state for injury prevention.

In 2013, when the effort began, there were 23 suicides reported for the county of about 21,000. The national average is 11 per 100,000 population.

Suicides in the county decreased to 11 in 2014 and 2015.

Although the suicide prevention initiative has been successful, Marvidikis said, there is more the department could do with additional state and federal funding.

But much of the money the federal government gives to states for public health improvements is earmarked for areas with greater populations, said Janae Duncan, director of the state Bureau of Health Promotion. Funds also can be directed toward health provider networks, rather than individual communities, to ensure more people benefit from the money, she said.

Interim Health Director Bradon Bradford said reports like the County Health Rankings help departments target limited funds.

"We take this seriously because we know exactly who our work impacts. It's the nature of a small town," he said. "We care about the people here and want them to be part of what we do."

Twitter: @kelgiffo