Wadena is the second unhealthiest county in Minnesota, according to a study prepared by the University of Wisconsin Population Health Institute.

The study ranks Wadena County at 84 out of 85, with only nearby Cass County being worse off. Cook County and Traverse County were not ranked.

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In the state overall, the rural northwestern counties tended to rank low and the south metro counties tended to rank high.

Paul Sailer of Wadena County Social Services said high poverty and age demographics factor into the rankings.

"Wadena County's unemployment is very high compared to the rest of the state. So people that are unemployed aren't as likely to go in to the doctor because they don't have their health insurance," Sailer said.

Sailer said that statistics from the agency give evidence of a bad economy. In 2007, 898 people in Wadena County were in the food support program. In the same month in 2011, the number had nearly doubled to 1,795.

Use of public medical programs also rose from 2,470 to 2,882 in the four-year period.

"That's an indication of more poverty in the county, and as a rule, counties with more poverty have more health issues," he said.

Sailer said that Wadena County has a very high per capita of elderly residents, and they tend to have more medical problems on average than the general population.

Age and economic factors interplay when the youngest - and healthiest - residents leave rural counties to find jobs elsewhere, he said.

"The purpose of the health rankings is to inform interested stakeholders of potential areas to look at to improve the health of the population. It is an opportunity to join together and look at what we can do as a community to influence health," Cindy Pederson of Wadena County Public Health said in a written statement.

Peterson said that access to healthy foods, reduced smoking and active living such as exercise and having walkable communities would give people opportunities for better health.

Premature deaths counted in 2005-2007 accounted for 50 percent of the health outcomes score.

"This portion was the primary area that we were above average in. Looking at our causes of premature death in those three years, the top causes for years of life lost were heart disease and cancer," she said.

According to a press release, Minnesota's counties are included in a report ranking the health of every county in each of the 50 states. The County Health Rankings ranks the overall health of counties by using a standard formula to measure how healthy people are and how long they live.

Counties are ranked in two categories: health outcomes and health factors (also known as health determinants). Health outcomes include the rate of people dying before age 75, the percentage of people who report being in fair or poor health and the rate of low-birth weight infants. Health factors include health behavior, clinical care, social and economic factors and physical environment. The rankings, which launched nationwide last year, are designed to compare the health of counties within each state; they do not compare counties in one state with counties in another state.

Wadena County is 52nd in the health factors score.

"We are doing well in some of these health factor areas, but there are also some areas that we could improve in," Pederson said.

"The County Health Rankings help everyone see that much of what influences our health happens outside of the doctor's office and where we live matters to our health," Dr. Risa Lavizzo-Mourey said.

Lavizzo-Mourey is president and CEO of the Robert Wood Johnson Foundation, which collaborates with the University of Wisconsin on the rankings.

"We hope this second annual release of County Health Rankings data will spur all sectors - government, business, community and faith-based groups, education and public health - to work together to find solutions and take action and implement programs and policy changes to improve health," Lavizzo-Mourey said.

The County Health Rankings are an additional tool that highlights the essential role of prevention across Minnesota.

"The Rankings not only shine a light on the health of individual counties; they also demonstrate the need to include prevention in our health reform efforts," Dr. Edward Ehlinger, Minnesota Commissioner of Health, said. "We have an unprecedented opportunity to make reforms that will improve the health of all Minnesotans, and we must be sure to look at upstream disease prevention and health promotion at the same time we address other aspects of health reform."

Local health departments in Minnesota already do extensive measurement of the health of their communities. Minnesota's Local Public Health Act requires local health departments to conduct a comprehensive assessment and planning process every five years in order to identify public health challenges and strategies for improving health. "Our local health departments already do an excellent job measuring the health of their populations, to help them understand what they do well and where they can improve," Ehlinger added. "This is one reason why Minnesota consistently ranks as one of the healthiest states in the nation."

The County Health Rankings are available for viewing at www.countyhealthrankings.org.

For a list of Minnesota's local health departments, see: www.health.state.mn.us/divs/cfh/ophp/system/administration/chb.cfm.

In a separate study by the hunger relief organization Feeding America, Wadena County is the third worst in terms of hunger with 16.1 percent food insecurity. The only counties with more food insecurity are Clearwater County (18.7 percent) and Kanabec County (16.3 percent).

Results of the "Map the Meal Gap" study can be accessed at feedingamerica.org/our-network/the-studies/map-the-gap.aspx.