And that's why improving population health cannot be left solely to providers.
"We want this to serve as a call to action for local leaders across the nation… by working together we can improve the health of the nation from the ground up. It really takes us all working together. If they are going to change the health of the county they have to work alongside educators and the United Way and maybe the local chamber of commerce."
Russell cautions that changing population health is not easy.
"One thing we recognized is that it takes a long time to make change," she says. "We have been putting out this data for four years, but we know things aren't going to change overnight. It's going to take persistent and consistent hard work of leaders across the nation to see change over time."
And finally, if your county is on the bottom or near the bottom of the list with some of the worst health issues in your state, don't despair.
"In fact, use it as a call to action," Russell says. "The rankings give us hope and tell us there are things we can do today to create cultures of health where we live, where we learn, and where we play."