An overview of recently released public health data for the metro region.

1. Atlanta Regional Commission
For more information, contact:
mcarnathan@atlantaregional.com
Public Health in Metro Atlanta:
How Healthy Are We?

2. In Sum…
The latest County Health Rankings show that health is generally improving across metro Atlanta, but again,
there are some notable exceptions in mostly the same places as in previous rankings.
Based on Years of Potential Life Lost (YPLL) before the age of 75, overall public health is improving slightly,
but that is not true everywhere. In fact, some counties have seen dramatic increases in premature deaths.
Overall public health is improving, most notably in cardiovascular diseases. But diabetes is a troubling
outlier in the general improvement of public health in the Atlanta area.
Place matters. The spatial patterns are clear – areas with lower incomes typically have poorer health
outcomes.
Race matters. The racial patterns are clear, as well – Blacks generally have poorer health outcomes than
Whites. This is particularly true in the case of diabetes.
Drug overdoses in general, and prescription opioid overdoses specifically, continue to rise.

3. In looking at the leading causes of death in Georgia, Ischemic Heart and Vascular Disease (reduced blood supply to the
heart) ranks first, but this ranking is driven by high incidence in older age cohorts. The leading cause of death for those age
20-34, for example, is Motor Vehicle Crashes, with Assault (Homicide) second, and then accidental poisoning (which would
include drug overdoses) at a very close third.
Leading Causes of Death in Georgia, By Age
Ranks (Ranked by years of life lost before age 75)
Under
20 20-34 35-49 50-64 65+ Total
1) Ischemic Heart and Vascular Disease 1 56 447 1,857 6,049 8,410
2) Motor Vehicle Crashes 177 493 309 355 280 1,614
3) Intentional Self-Harm (Suicide) 87 378 325 396 217 1,403
4) Accidental Poisoning and Exposure to Noxious Substances 23 380 432 395 87 1,317
5) Certain Conditions Originating in the Perinatal Period 502 - - - 0 502
6) Assault (Homicide) 127 383 168 92 33 803
7) Malignant Neoplasms of the Trachea, Bronchus and Lung 1 5 97 1,217 3,074 4,394
8) Essential (Primary) Hypertension and Hypertensive Renal, and
Heart Disease 1 32 240 831 2,093 3,197
9) Cerebrovascular Disease 13 29 179 657 3,458 4,336
10) All COPD Except Asthma 2 3 55 756 3,886 4,702
Source: Georgia Department of Public Health (OASIS)

4. The County Health Rankings breaks down overall health into two basic categories – Outcomes (orange bars on the above chart) and Factors
(green bars on the above chart). “Outcomes” include how healthy one feels while alive, as well as premature death. “Factors” include behaviors
(smoking, drinking alcohol, etc.), quality of clinical care, and social/economic/physical characteristics. Once all of these are considered, each
county is given a rank, where “1” is the healthiest county in the state, and “159” is the least healthy county in the state.
Most counties in the Atlanta area have a relatively low rank, meaning they are among the healthiest counties in the state. This is particularly
true for the relatively wealthier counties of Cherokee, Cobb, Fayette, and Forsyth. There are exceptions, however. Clayton County, even though it
has a moderate rank for “Outcomes,” ranks among the lowest in the state for “Factors”; eventually, these factors may begin to drag down
Clayton residents’ overall health outlook. Spalding is another outlier in the region, ranking poorly in both “Outcomes” and “Factors” categories.
Counties in Metro Atlanta Generally Healthy
Source: County Health Rankings, Robert Wood Johnson
25
42
74
3
59
7 10
18
26
4 1
14
5
13
22
54
9
53
137
30
49 51
72
6
131
5
17
24
36
3 2
19
9
27
20
60
14
57
111
32
County Health Rankings, 2018
Health Outcomes Health Factors

5. Metro Atlanta is a healthy place when compared to the rest of the state, and especially so when
compared to the southern half of the state. However, in the Health Factors map shown on the right,
Clayton and Spalding counties stand out within the metro area as poorly ranked counties—at 131
and 111 respectively.
How Metro Atlanta Compares
Source: County Health Rankings, Robert Wood Johnson
Health FactorsHealth Outcomes

6. Years of Potential Life Lost (YPLL) Rate
(A Measure of Premature Death)
Years of Potential Life Lost (YPLL)
before the age of 75 is a measure of
premature death. The measure
simply adds up the difference
between actual age of death and age
75. So, for example, if a person dies
at age 65, that equates to 10 years of
potential life lost. This calculation is
then performed for every death in
an area.
When compared to the rest of the
state, Metro Atlanta has some of the
lowest YPLL rates. Yellows/Light
Purples represent the lowest rates;
Dark Purple shading represents the
highest rates).
Source: County Health Rankings, Robert Wood Johnson

7. The chart illustrates the number of years of potential life lost before the age of 75 (YPLL) by county for all
races and ethnicities. As the chart shows, the wealthier counties such as Cherokee, Cobb, Fayette and
Forsyth have (in general) better health outcomes as measured by Years of Potential Life Lost (YPLL).
Years of Potential Life Lost
(A Measure of Premature Death)
Source: County Health Rankings, Robert Wood Johnson
Total Years of
Potential Life Lost
0
2,000
4,000
6,000
8,000
10,000
12,000
Years of Potential Life Lost, 2018
All Races/Ethnicities

8. The chart illustrates the number of years of potential life lost before the age of 75 (YPLL) by county by
race. In a number of counties, YPLL rates among Black and White residents are relatively similar.
However, in Coweta, DeKalb, Fulton, and Walton YPLL rates for Blacks are much higher, while in
Clayton and Douglas, White YPLL rates are significantly higher.
Note: Overall, YPLL rates for Hispanics are lower in every jurisdiction, thus we did not show those rates on this chart.
Years of Potential Life Lost – By Race
(A Measure of Premature Death)
Source: County Health Rankings, Robert Wood Johnson
Total Years of
Potential Life Lost
0
2000
4000
6000
8000
10000
12000
14000
Years of Potential Life Lost by Race & Ethnicity, 2018
Black White

9. -2,000
-1,000
0
1,000
2,000
3,000
4,000
5,000
Change in YPLL Rate: 2006-2016
Years of Potential Life Lost – 10-Year Change
Overall, the YPLL rate is dropping over the ten year period, but not every jurisdiction has seen
declines. Spalding, notably, has see a dramatic increase in the years of life lost before age 75 since
2006. This, of course, corresponds to the county’s overall low ranking in a number of health factors and
outcomes
Source: Georgia Department of Public Health (OASIS)

10. The two maps above show similar patterns. Place matters. It has been well-established in research that
income and education levels are key determinants of health. These two maps show that, in general, the
counties with the highest percentages of those without a high school education also have higher rates of
premature death.
% Of Adults, No HS Diploma, 2012-2016
Source: Georgia Department of Public Health (OASIS), ACS- 2012-2016 via Neighborhood Nexus
Education Levels and Premature Deaths-
Spatially Related
Highest
Values
Lowest
Values
YPLL Rate (Premature Deaths), 2016

11. Deaths Due to Major Cardiovascular Diseases
Have Declined Significantly
Major cardiovascular diseases, including ischemic heart and vascular disease, are the number one cause
of death in the state and region, but the rate of deaths due to cardiovascular diseases has declined
greatly over the past 10 years, on an age-adjusted basis. Even when not adjusting for age, deaths dues to
cardiovascular diseases have declined in almost all jurisdictions, except for those that have experienced
rapid aging, like Fayette.
Source: Georgia Department of Public Health (OASIS)
-160
-140
-120
-100
-80
-60
-40
-20
0
Change: Death Rate by Major Cardiovascular Diseases, 2006-2016 (Age- Adjusted)

12. Hospital Discharges for Diabetes Rising
in Most Jurisdictions
Despite overall improvement in public health (as evidenced by decline in YPLL rates and deaths due to
major cardiovascular diseases) rates of hospital discharges due to diabetes are rising in most jurisdictions.
Like most diseases, diabetes is strongly correlated to certain social determinants of health like race,
education and income.
Source: Georgia Department of Public Health (OASIS)
-100
-80
-60
-40
-20
0
20
40
60
Change in Discharge Rate for Diabetes 2006-2016 (Age-Adjusted)

13. Place Matters for Diabetes Too!
Source: Georgia Department of Public Health (OASIS) via Neighborhood Nexus; SAPIE income estimates, Census
Hospital Discharge Rate for Diabetes, 2012-2016Household Income, 2016
Darker colors indicate lower incomes Darker colors indicate higher discharge rates
While not perfectly correlated, the two maps show a definite spatial similarity between lower
incomes (map to the left) and higher rates of hospital discharges due to diabetes (map to the right).

14. Place Matters for Diabetes:
@ Neighborhood Level in Particular
Darker colors indicate higher rates of
poverty (at left) and higher percentages
of discharges due to diabetes (at right)
% of population in poverty, 2012-2016 % of discharges due to diabetes, 2012-2016
Source: Georgia Department of Public Health (OASIS) and American Community Survey via Neighborhood Nexus

15. Race Matters Too!
Darker colors indicate a higher share of
black population and higher percentages
of discharges due to diabetes
% of Black population, 2012-2016 % of discharges due to diabetes, 2012-2016
Source: Georgia Department of Public Health (OASIS) and American Community Survey via Neighborhood Nexus

16. Another area that is trending the wrong way is deaths due to drug overdoses. Again, while overall public
health is improving, deaths due to overdoses are increasing in most jurisdictions since 2010. The only
exceptions are those counties that already had relatively high deaths rates due to overdoses in 2010 –
these communities have been grappling with the problem longer. For more information, see a recent post
on our 33N blog.
Source: Georgia Department of Public Health (OASIS)
Drug Overdoses Continue To Defy Overall
Public Health Improvement
0
5
10
15
20
25
30
Death Rate due to Drug Overdoses, 2010-2016
Death Rate, 2010 Death Rate, 2016

17. 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
All Deaths 19,503 20,271 20,522 20,843 20,951 20,740 20,764 21,424 21,473 22,156 22,307 22,709 22,935 23,257 24,665 25,348 26,265 26,556
Age-Adjusted Death Rate 897.1 909.1 897.5 889.3 868.4 840.4 815.3 796.5 773.8 774.0 757.1 752.7 728.2 708.8 718.7 710.6 708.4 691.9
Overdose Deaths 158 204 259 246 278 266 258 309 314 355 364 389 386 389 442 541 582 629
Age-Adjusted Death Rate 7.3 9.1 11.3 10.5 11.5 10.8 10.1 11.5 11.3 12.4 12.4 12.9 12.3 11.9 12.9 15.2 15.7 16.4
Opioid Deaths 82 107 147 130 140 111 127 110 154 189 195 207 215 240 232 335 457 482
Age-Adjusted Death Rate 3.8 4.8 6.4 5.5 5.8 4.5 5.0 4.1 5.5 6.6 6.6 6.9 6.8 7.3 6.8 9.4 12.3 12.6
Rx Opioid Deaths 24 40 61 66 60 69 80 64 105 118 131 142 141 117 125 161 224 239
Age-Adjusted Death Rate 1.1 1.8 2.7 2.8 2.5 2.8 3.1 2.4 3.8 4.1 4.4 4.7 4.5 3.6 3.6 4.5 6.0 6.2
Deaths by Overdose Increasing 3 Times the Rate as
Deaths Overall, Driven by Prescription Opioids
10x
6x
4x
1.4x
Since 1999, the number of Rx opioid-related overdose deaths has increased at more than 5 times the
rate of deaths overall, at 2.5 times the rate of overdose deaths, and at 1.67 times the rate of all opioid-
related overdose deaths.
Source: Georgia Department of Public Health (OASIS)

18. Next Steps: 500 Cities Data Challenge
Source: Centers for Disease Control and Prevention, 500 Cities Project Dataset
The 500 Cities project is a collaboration
between CDC, the Robert Wood Johnson
Foundation, and the CDC Foundation. The
purpose of the 500 Cities Project is to provide
city- and census tract-level small area estimates
for chronic disease risk factors, health
outcomes, and clinical preventive service use
for the largest 500 cities in the United States.
These small area estimates will allow cities and
local health departments to better understand
the burden and geographic distribution of
health-related variables in their jurisdictions,
and assist them in planning public health
interventions.
This week it was announced that Neighborhood
Nexus has been selected by the Urban Institute
and the Robert Wood Johnson Foundation, as
a 500 Cities Data Challenge Grantee. The
Challenge aims to encourage communities to
dig into the 500 Cities dataset and design
innovative solutions which address social
factors that influence health, such as housing,
education, and transportation.
500 Cities Interactive Mapping Tool
Model-based estimates for coronary heart disease among
adults aged >= 18 years, 2015

19. Next Steps: 500 Cities Data Challenge
Source: Centers for Disease Control and Prevention, 500 Cities Project Dataset
The 500 Cities Data Challenge Grant will support
Neighborhood Nexus’ work on developing Health and
Wellness Community Toolkits for four cities in Georgia:
Albany, Atlanta, Columbus, and Savannah. The toolkits will
feature curated data based on the five social determinants of
health: economic stability, education, social and community
context, health and health care, and neighborhood and built
environment.
Neighborhood Nexus’ aim is to provide a product that will
inform and help design policy interventions for critical public
health needs as well as strengthen community partnerships
and collaborations to build healthier communities. With the
help of our partner organizations in this work, Neighborhood
Nexus is hosting a series of workshops and trainings in the
target cities. These workshops are designed to bring together
community stakeholders from the public and private sectors
to learn how to use the tool, collaborate, and implement
successful solutions to their community's public health
needs.
Stay tuned for a forthcoming Regional Snapshot (scheduled
for this fall), detailing our 500 Cities project work.