Baltimore City ranked as the least healthy jurisdiction in the state, followed by several rural counties on the Eastern Shore and Western Maryland, in a report released this week by the Robert Wood Johnson Foundation, which looked at counties across the country.
Montgomery County was considered the healthiest based on 30 factors, including education, housing, violent crime, employment, diet and exercise, according to the foundation, which worked with the University of Wisconsin Population Health Institute on the study.
The next healthiest were Howard, Frederick and Carroll counties.
The sixth annual rankings showed that areas that were healthiest in the country had higher college attendance, fewer preventable hospital stays and better access to parks and gyms, among other things.
The report also found wealth was a key factor, with poverty rates twice as high in the least healthy counties. Montgomery and Howard counties are among the nation's richest.
Baltimore City has one of the highest populations of people living in poverty. Other jurisdictions considered the least healthy were Caroline, Cecil and Somerset counties to the east and Allegany County in Western Maryland.
In the least healthy counties, there were more smokers, teen births and alcohol-related car crash deaths.
The report did note that the rate of premature deaths in Baltimore City in 2010-2012 showed a 23 percent decline from 2004-2006, one of the largest drops for jurisdictions nationwide with more than 65,000 people.
Baltimore City Health Commissioner Dr. Leana Wen acknowledged that that the city has a lot of health problems but said officials were working on many fronts in concert with other agencies and outside groups. She said the health problems were so intertwined with poverty, housing, education and other factors that it would be difficult to quickly erase the disparities with other jurisdictions.
"Our city just like every city has so many silos with everyone doing their own thing," she said. "And while each project is meaningful, we need to make sure we are coalescing under a single city strategy."
Researchers from the Robert Wood Johnson Foundation said their goal is to spur communities to find innovative ways to improve, and to borrow ideas from each other.
"The county health rankings have helped galvanize communities across the nation to improve health," said Dr. Risa Lavizzo-Mourey, the foundation's president and CEO, in a statement. "Solutions and innovation are coming from places as diverse as rural Williamson, W.Va., in the heart of Appalachia to urban New Orleans; they are engaging business, public health, education, parents and young people to build a culture of health."
Nationally, the study looked at categories including health behaviors, clinical care, social and economic factors and the physical environment.
Compared to the rest of the country, Maryland had fewer smokers, excessive drinkers, teen mothers and obese people, as well as fewer reporting poor health in general. There were fewer uninsured and higher ratios of medical providers for the population, more in college and fewer in poverty.
But the state also had less access to exercise opportunities and more sexually transmitted infections, violent crimes, drinking-water violations and housing problems. It also had longer commutes.
Health leaders in Montgomery, which got high marks in every category but its physical environment, credited relationships with hospitals, schools and community-based organizations.
"We have reason to be proud but the work of improving and maintaining the health of a community is a continuing focus for us," said Dr. Ulder J. Tillman, Montgomery's health officer.