Which Utah counties are healthiest? Which are struggling? A report shows big disparities within the state.

For years, eastern Utah counties have been deemed the least-healthy counties in Utah, and 2019 is no different — but health officials say new efforts are underway to help alleviate two of the biggest catastrophes in the state’s poorest rural corners: opioid addiction and suicide.

“It is distressing when you start circling all those names and looking at the ages,” said Bradon Bradford, director of the Southeastern Utah District Health Department, who recently tallied all of the opioid overdose deaths in the past eleven years .

There were 88 deaths just in Carbon, Emery and Garfield counties — and the victims’ average age was 34. Bradford is beginning a similar review of suicide deaths, and while the average age appears to be similar, the number of victims is even larger.

Those two crises almost certainly explain why those counties are among the bottom five in the County Health Rankings and Roadmaps list, which is created by the Robert Wood Johnson Foundation and the University of Wisconsin and evaluates an array of health criteria to rank almost every county in the country.

Only San Juan County ranked lower; Duchesne, Uintah and Sevier counties also have made frequent appearances in the bottom five of Utah’s 27 ranked counties (Daggett and Paiute are too small to be ranked).

Morgan County was deemed the state’s healthiest county, a ranking it has held every year except one since 2010, the date of the earliest available report.

The report ranks counties by “health outcomes,” measuring how long people in each county live and how healthy they report feeling, as well as the prevalence of low birth weight. Early deaths are given the heaviest weight in counties’ scores, making the dual crises of opioid addiction and suicide noticeable in the rankings.

The state legislature last year provided funds for two southeast Utah health department employees to work full time studying and preventing suicide and opioid abuse, Bradford said. They have been working to connect new moms, recently-released inmates and people with mental illnesses to resources, and their projects have caught the attention of some federal agencies for their success in reducing stigma around treatment.

“Being toward the bottom ... alerts us to some of the problems,” Bradford said. “We’re not trying to be No. 1 tomorrow. We’re trying to look at each of those factors. We understand there are some inherent challenges and we’ll try to address those a little bit at a time.

The Utah counties with the poorest health outcomes often are also among Utah’s most economically troubled, according to childhood poverty and unemployment data.

Meanwhile, Utah’s healthiest counties generally are among the most affluent, with Morgan, Cache, Summit, Utah, Davis and Wasatch counties shifting around the top slots from year to year.

Salt Lake County ranked 10th for health outcomes and 11th for “health factors.” Those factors include health behaviors in each county, like drinking alcohol, smoking and exercise; access to clinical care; social and economic factors; and environmental factors, such as air and water pollution and how much time people spend driving alone.

Most, but not all, of Utah’s counties had similar rankings for health outcomes and health factors. Emery County ranked near the bottom — 25 of 27 — for health outcomes, a ranking pulled down by a relatively high number of years lost to “premature” deaths, defined as deaths before age 75. But the county’s high environmental quality pulled its ranking for “health factors” up to 13 of 27.

Meanwhile, Juab County’s residents appear to be healthy on the whole, ranking 9th for “health outcomes,” thanks to a low number of reported sick days and people describing their health as fair or poor. But the county had the state’s highest rate of preventable hospital stays, which calls into question the quality of clinical care there, per the report’s metrics. It’s ranking for “health factors” was 19 of 27.

San Juan had the highest percentage of homes with severe housing problems, defined as the cost burden, overcrowding or the lack of a kitchen or plumbing. While Wasatch County had the highest cost burden, followed by Washington, Wayne and Salt Lake counties, San Juan led the state on the other measures.

Morgan County’s consistently high rankings come despite some significant shortfalls. The county ranked dead last for “physical environment,” with the state’s highest percentage of people who drive alone to work (85 percent) and the seventh-worst air quality. The county’s ratio of residents to mental health care providers is the lowest in the state — 5,940:1, more than 10 times worse than the national average. But with the lowest rate of uninsured residents, high rate of mammography screening and low number of preventable hospital stays, the county still ranks high for quality of and access to clinical care.

Racial disparities in Utahns’ health outcomes were wide, with American Indian residents faring worse than all other racial and ethnic groups in premature deaths, poor or fair health (reported by 26 percent of Native American respondents polled), and days of poor physical and mental health.

However, low birth weight was more frequently experienced by Utahns of Hispanic (10 percent) and Asian (9 percent) descent. White newborns in Utah were underweight 7 percent of the time, with black and American Indian newborns at 8 percent.