County health rankings website rank counties and states in a number of areas. Funded by the Robert Wood Johnson Foundation, the interactive website County Health Rankings breaks out a number of factors to compare counties to counties.

The report reached some national conclusions:

• More Americans are dying prematurely, notably among our younger generations
• Premature death rates rose across urban and rural community types and racial/ethnic groups in 2015. Premature death has consistently been highest in rural counties and among American Indian/Alaskan Native and black populations.
• In recent years, premature death increased most among those ages 15-44.
• Drug overdose and other injury deaths heavily influenced the rise in premature death
• Drug overdose was by far the single leading cause of premature death by injury in 2015 and contributed to the accelerated rise in premature death from 2014 to 2015.
• Large suburban metro counties went from having the lowest to the highest rate of premature death due to drug overdose within the past decade.
• For those ages 15-24, an increase in drug overdose deaths was part of the equation, but more deaths due to motor vehicle crashes and firearm fatalities also played a role in the accelerated rise in premature death.
• A focus on opportunities for youth and young adults
• Disconnected youth (a new measure this year) are youth and young adults ages 16-24 who are not in school and not working, and represent untapped potential to strengthen the social and economic vibrancy of local communities. In 2015, there were about 4.9 million youth - or 1 out of 8 - not in school or working.
• Youth disconnection is most prevalent among American Indian/Alaskan Native, black, and Hispanic youth. Rates of youth disconnection are higher in rural counties than in urban counties. Places with high levels of youth disconnection have higher rates of unemployment, child poverty, children in single-parent households, teen births, and lower levels of educational attainment - all barriers to a successful transition from youth to healthy adulthood.

In Kentucky, the top ten counties in health outcomes are Oldham first, followed by Boone, Spencer, Shelby, Woodford, Scott, Fayette, Marshall, Bullitt and Henry Counties All are in Central Kentucky with the exception of Marshall County.

Without exception, the bottom ten are all in Eastern Kentucky: Bell, Clay, Leslie, Perry, Floyd, Harlan, Knott, Owsley, Wolfe and Breathitt.

Looking at the eight Purchase Counties - Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall and McCracken and comparing to state measures is a mixed bag. The region with its mix of rural and small town populations marches along with the rest of the state.

Rankings for Purchase Counties: Ballard ranks 67^th, Calloway 15th, Carlisle 32^nd, Fulton 103rd, Graves 29th, Hickman 23rd, Livingston 24th, Marshall 8th, McCracken 51^st.

In the category of premature deaths which measures lives lost before age 75 per 100,000 population, 8900 Kentuckians out of 100,000 died prematurely. In the Purchase:

Livingston 7400

Hickman 8000

Marshall 8200

Graves 8400

Calloway 8600

Ballard 9400

Carlisle 9700

McCracken 10000

Fulton 12400

Smoking: Twenty six percent of Kentuckians reported smoking in 2015. In the Fulton County matched the state average at 26%. Other counties fared better: Marshall - 18%, Carlisle 20%, Ballard, Calloway, Graves, Hickman and Livingston 21%, and McCracken 22%.

Adult Obesity: Adult obesity is defined in this study as adults who report a BMI (body mass index) of 30 or more. (Don't know your BMI? Go to Google BMI calculator)

Kentuckians report that 33% of adults are obese. In the Purchase, Livingston, Graves, Calloway are at 30%, Fulton at 32%, Carlisle 33%, Ballard, McCracken and Marshall at 34%, and Hickman at 35%

"Access to Exercise Opportunities measures the percentage of individuals in a county who live reasonably close to a location for physical activity. Locations for physical activity are defined as parks or recreational facilities. Individuals are considered to have access to exercise opportunities if they:

• reside in a census block that is within a half mile of a park, or
• reside in an urban census block that is within one mile of a recreational facility, or
• reside in a rural census block that is within three miles of a recreational facility.

The numerator is the number of individuals who live in census blocks meeting at least one of the above criteria. The denominator is the total county population. Parks included in the Access to Exercise Opportunities measure include local, state, and national parks. Recreational facilities included in the Access to Exercise Opportunities measure are businesses including gyms, community centers, YMCAs, dance studios and pools."

In Kentucky, 70% of adults report they live close enough to an exercise opportunity.

In Ballard, the percentage is an astounding zero (0%), Carlisle reports 24%, Fulton 40%, Livingston, 52%, Graves, 50%, Livingston 52%, Hickman 53%, Marshall and Calloway 59%, and McCracken 73%.

Teen Births: the number of births per 1,000 female population ages 15-19 in Kentucky is 44 per 1000.

In the Purchase:

Ballard 57 per 1000

Calloway 21 per 1000

Carlisle 38 per 1000

Fulton 72 per 1000

Graves 53 per 1000

Hickman 36 per 1000

Livingston 52 per 1000

Marshall 44 per 1000

McCracken 50 per 1000

Children in Poverty: In Kentucky, 25% of children under 18 live in poverty. The eight counties of the Purchase fare little better. Marshall County fares best with 20%, Calloway with 24%, Ballard, Carlisle, McCracken and Livingston match the state average with 25%. Graves has 27%, Hickman has 30%. Fulton County has 48% of its children living in poverty.

In light of the ongoing debate over health care, it is notable that in several of the eight counties, there is one primary care physician for whole populations. In Ballard County, the ratio is 4110:1. In Fulton County, the ratio is 6240:1. Only in McCracken County are the ratios below the state average of 1620:1. McCracken is home to two regional hospitals, so the ratio of 1120:1 is understandable.

The statement quoted in the report bears repeating here: "Premature death has consistently been highest in rural counties (emphasis added) and among American Indian/Alaskan Native and black populations."

Obviously, medical care is available across county lines. But the services that keep rural people alive as long as their urban cousins are shown to be lacking.