If it’s true that “your ZIP code is more important than your genetic code,” you’d look for a job in 22046, buy a house there, and plant your roots. You’d find yourself in Falls Church, Virginia, named number one in the Healthiest Communities rankings of 500 U.S. towns.

You can see a list of all of the communities here.

The project is a collaboration between the Aetna Foundation and U.S. News & World Report, with help from the University of Missouri Center for Applied Research and Engagement Systems (CARES) and a team from the National Committee on Vital and Health Statistics.

Healthiest Communities is part of U.S. News’ portfolio of healthcare information projects, the best-known of which is Best Hospitals, most recently rated for 2017-18. Eric Gertler, U.S. News’ Chairman, believes that this project will give, “citizens, community leaders and policy-makers the tools to assess health in their communities and develop a blueprint for positive change” with learnings that can translate to less-healthy communities. Key health service factors among the town leaders are lower rates of chronic disease and hospitalizations, and greater access to primary care.

The Healthiest Communities for 2018 are:

• Falls Church, VA
• Douglas County, CO
• Broomfield County, CO
• Los Alamos County, NM
• Dukes County, MA
• Fairfax, VA
• Hamilton County, IN
• Routt County, CO
• Ouray County, CO
• Loudon County, VA

A tally among these top ten clues us into trends in the pack: there are three towns in Virginia, four in Colorado, and one each in Indiana, Massachusetts, and New Mexico.

So what is it about Virginia and Colorado when it comes to the social determinants of health (SDOHs)? A handful of social determinants translate into big positive impacts for public health: education, a resilient local economy, commitment to public safety, and a strong primary care backbone.

Here’s some of the evidence on population health related to these four factors:

Education: Perhaps the most impactful social determinant on health is education. From early childhood education through college, evidence abounds supporting investment in education across a health citizen’s lifespan,.

Economy: Related to education, a good job and sufficient income is key to health outcomes and healthy communities. Being employed, versus unemployed, and earning a fair salary (especially with health benefits for U.S. workers, where low wages have been called an “occupational health hazard”), boost individual and community health. In addition, lower stress in the workplace also improves health status.

Primary care: Throughout the world, people who live in countries that have strong primary care workforces enjoy better health outcomes, which I discussed in my paper, Primary Care, Everywhere, written for the California Healthcare Foundation. In the rich evidence base for primary care improving community health, we can look to the seminal 2005 work of Barbara Starfield .

Several other factors also play out in the top ten:

• Physical activity, especially related to health baked into town/urban planning for walkability, safe neighborhoods, and green spaces. There is a lot of learning about this throughout Europe, where city planners have proven out the direct relationship between planning green and active transportation strategies and health outcomes.
• Public transportation which helps people get to doctor’s appointments and workplaces which, then, bolsters personal income. Recent programs extending Lyft and Uber into healthcare services are working to address this unmet need across the U.S.
• Healthy eating, with local food access through farmer’s markets (such as the award-winning one in top-ranked Falls Church), a strong agricultural sector, and nutrition programs in schools. Note the new program announced by Amazon to offer discounted Prime membership to members of SNAP and Medicaid programs, to help people order healthy food (and other products) if they live in USDA-designated food deserts. Mora, NM, one of the up-and-coming towns, is part of a sustainable food program that’s also bolstering the local economy.

Consider Falls Church across these dimensions: the town has an award-winning farmer’s market and good food access, a public transportation network, a solid economy with relatively good commute to jobs in Washington, DC, walkable streets, and a relatively high primary care: health citizen ratio.

The Healthy Communities rankings evaluated nearly 3,000 American towns, considering ten categories across ten key social determinants of health:

The categories and subcategories considered included:
1. Community vitality, which covers social capital and community stability
2. Equity, addressing equity across social, health, education, and income lenses
3. Economy, dealing with income, employment, and opportunity
4. Education, in terms of infrastructure, achievement, and participation
5. Environment, looking at the natural environment, air and water (THINK: Flint), and natural hazards
6. Food and nutrition, focusing on food availability (versus food deserts) and nutrition
7. Population health, a broad segment including access to health care services, health behaviors, health conditions, mental health, and outcome
8. Housing, with an eye on affordability, capacity and quality
9. Public safety, relative to capacity, crime, and injury
10. Infrastructure, for the community layout and transportation.

There are many versions of SDOHs; this methodology was informed by that developed by the National Center for Vital and Health Statistics, described in its report on The Community as a Learning System. NCVHS has identified the first nine of these ten SDOHs. The Healthiest Communities team added in Equity, to recognize its importance in people’s personal lives and community health.

This was written in collaboration with the Aetna Foundation, which is a paid sponsor for this post.