In 2016, a greater percentage of babies were born at low birthweight in Jackson County, Colorado, than anywhere else in the country.

That might not seem like such a big deal these days, with modern technology powerful enough to nurse babies who are born months premature back to health. But according to the Robert Wood Johnson Foundation’s annual County Health Rankings Report, we should think twice before dismissing the importance of underweight babies. Indeed, the 2018 Key Findings Report cautions that low birthweight (LBW) is an important signifier of long-lasting health discrepancies.

The context surrounding health problems like these is the focus of the 2018 annual County Health Rankings Report: After eight years of focusing largely on place-based health discrepancies, this year’s report seeks to highlight the disparities that exist between different communities in America. To do this, the researchers dig into the lines along which various health discrepancies fall, such as birth weight, child poverty, teen pregnancy, educational attainment, unemployment, and residential segregation. What they find is that these health measures are the worst in the Southwest, Southeast, Mississippi Delta, Appalachia, and the Plains regions. Within these places, communities of color are disproportionately affected across all measures.

“We need to understand those gaps in order to be able to present the whole story,” said Marjory Givens, an associate scientist at the University of Wisconsin’s County Health Rankings and Roadmaps Program. “Our intention is to call attention to the fact that not everyone has the opportunity to be healthy where they live, and that means having difficult conversations about segregation and structural inequities.”

So why is low birthweight so important? As Givens says: “When you start behind, you tend to stay behind.”

The annual report ranks the health of nearly every county in the nation, shedding light on the state of public health in America. Their rankings are based on a model that analyzes county-level data from all 50 states, which weighs over 30 health behaviors and outcomes (spanning housing and transit to drug and alcohol use, income, and access to clinical care). For some, the obstacles these measures define start at birth and persist throughout their lives.

According to the report, LBW babies—that is, those born at less than about 5.5 pounds—are at greater risk of developmental problems, cardiovascular disease, cognitive problems, and premature mortality, as well as other associated health issues. What makes this especially alarming is that, after about a decade of incremental decreases, the percentage of low birthweight babies grew 2 percent between 2014 and 2016.

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