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For the third year in a row, Philadelphia proves to be the state’s least healthy county.

The county ranked last out of 67 counties in measures of health outcomes, which include mortality rates and health factors, such as smoking, air pollution exposure, the percentage of health-insured residents and residents’ education levels.

The University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation study released this month also ranked Philadelphia lowest in terms of social and economic factors.

Perelman School of Medicine assistant professor Carolyn Cannuscio isn’t surprised by this ranking, although she still finds it “disturbing.”

She said one of the underlying reasons for this ranking is the county’s high concentration of poverty and that “poor people shoulder a large proportion of the burden.” She explained that Philadelphia has many features that lend themselves to good health, such as a walkable and bikeable layout. However, other factors, such as a high incidence of tobacco use and a lack of access to fresh, healthy food negate the positives.

“Corner stores tend to sell food that’s calorically dense but low in nutrients,” she said. She pointed out that this food is often the most affordable option.

Additionally, although more than half of public school students qualify for reduced-price school breakfast and lunch, what’s generally provided is processed and packaged food.

“It’s deplorable to think about what we’re feeding our kids,” she said.

“Place shapes health,” she said, adding that when living in unhealthy communities, it is hard to adopt healthy behaviors on an individual level.

City health commissioner Don Schwarz said to the Philadelphia Daily News that poverty and health levels are correlated and that some of the wealthiest counties are the healthiest as well.

In addition, “Much of what this is about is poverty and socioeconomic factors that go beyond individual action,” he said.

School of Design assistant professor Amy Hillier, who specializes in city planning, agrees. “We are the poorest of the 10 major cities in the U.S.,” she said. She explained that this poverty is one of the major factors causing poor health in Philadelphia.

“It’s as simple as that,” she said. “It’s not racial or genetic … it’s poverty.”

She points to high incidences of obesity and smoking as key indicators of poor health.

Cannuscio believes another major factor leading to this low ranking is a high crime rate.

“Crime has shaped other health behaviors,” she said. She also noted that crime here is higher than it is nationally, which could discourage residents from leaving their houses to socialize and exercise.

“I think other health behaviors can only follow after people feel safe,” she said.

But the outlook isn’t all gloom and doom — for the past few years, the city has been working on various initiatives to reverse the trend. The Food Trust, a Philadelphia program started in 1992 that gained national recognition under President Obama’s administration, aims to fund supermarkets, farmers’ markets and school-based nutrition programs.

Additionally, the Centers for Disease Control program Communities Putting Prevention to Work has been trying to decrease tobacco use and increase access to healthy food.

Hillier explained that the health field’s focus on prevention rather than treatment will also help. She added that the city’s Department of Public Health has been working to make Philadelphia a cleaner, safer, healthier place to live for years. But she admits it’s an “uphill” battle, especially with the current recession.

Hillier does not believe the ranking is very useful because Philadelphia has an unusual population density. And because it’s both a city and a county, she believes results might be skewed.

But ultimately, she believes that Philadelphia can’t solve this problem on its own. She would like to see more safety nets for the poor, and a federal urban policy saying that poverty is unacceptable.

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