Report: Eastern Shore Counties Among Least Healthy in Virginia

County Health Rankings & Roadmaps image.

By Carol Vaughn — Accomack and Northampton counties are ranked among the least healthy counties in Virginia, according to a recently published report.

A group whose mission is to improve the health of Eastern Shore communities reviewed Accomack and Northampton data from the 2022 County Health Rankings, a nationwide report.

“I hope all of you will use the county health rankings and roadmaps as a strategic planning tool,” said Eastern Shore Healthy Communities Executive Director Patti Kiger at the May 12 meeting of the organization, which includes representatives from multiple organizations and agencies.

The report was published in late April by the Wisconsin Population Health Institute and may viewed at

It ranks counties using data about the physical environment, social and economic factors, clinical care, and health behaviors of residents, along with data about health outcomes, including length and quality of life. Accomack ranked in the bottom 25% of Virginia counties for both health factors and health outcomes; Northampton ranked in the bottom 25% for health outcomes, but ranked in the lower middle range of Virginia counties (25%-50%) for health factors.

“That data shows us our challenges and our strengths,” Kiger said.

Demographics may account in part for the Shore’s low rankings, as both counties have higher proportions of groups that typically have more health problems.

Accomack has 25.2% of the population age 65 or older and Northampton has 28.6%, compared to 16.3% for Virginia as a whole.

Additionally, Black residents make up 28.5% of Accomack’s population and 32.4% of Northampton’s, compared to 19.1% of Virginia’s total population.

Among concerning statistics are that Accomack and Northampton have higher numbers of people who die prematurely, defined as years of potential life lost before age 75 per 100,000 population.

Accomack’s number was 10,200 and Northampton’s was 11,600, compared to 6,700 for Virginia as a whole and 5,600 for the top-performing United States counties.

The numbers are higher for Black residents.

In Accomack, the number for Black residents is 13,000, compared to 9,300 for White residents.

In Northampton, the number for Black residents is 14,600, compared to 11,500 for White residents.

Also of concern is that 10% of Accomack births and 9% in Northampton are low birthweight, compared to 8% statewide and 6% for the healthiest U.S. counties.
Those figures also are higher for Black residents than for Whites, at 16% for Black Accomack residents, compared to 7% for White residents and 5% for Hispanic residents, and 13% for Black Northampton residents, compared to 7% for White residents. Figures for Hispanic residents of Northampton were not in the report.

Life expectancy is more than five years longer for White people (76.5 years) than for Black people (72) in Accomack and six years longer for White people (76.5) than Black people (70.5) in Northampton.

“The disparity between the races is profound,” Kiger said.

The report also gives data for behaviors that are health factors, which are self-reported.
In Accomack, 21% of adults smoke; 20% in Northampton smoke, compared to 14% in Virginia.

Accomack has an adult obesity rate of 40% and Northampton has a rate of 39%, compared to 32% in Virginia.

In Accomack, 34% of residents are physically inactive, compared to 25% in Virginia. The figure is 33% for Northampton.

The rate of sexually transmitted infections (defined as the number of newly diagnosed chlamydia cases per 100,000 population) in both counties is significantly higher than the statewide rate, at 717.9 for Accomack and 674.6 for Northampton, compared to 564.3 for Virginia as a whole and 161.8 for the healthiest U.S. counties.

Accomack has a teen birth rate (defined as the number of births per 1,000 female population ages 15-19) of 29 and Northampton has a rate of 32, around double Virginia’s rate of 15 and nearly triple the rate of 11 for the healthiest U.S. counties.

The teen birth rate for Black Accomack residents is 38, compared to 47 for Hispanics and 18 for Whites.

In Northampton, the teen birth rate for Black residents is 48, compared to 20 for White residents.

One negative behavior where Shore residents’ reported rate is lower than the statewide rate is excessive drinking, at 16% for both Accomack and Northampton, compared to 17% in the state. The measure gives the percentage of a county’s adult population that reports binge or heavy drinking in the past 30 days.

Of additional health behaviors that are reported but are not factored into the overall rankings, the rate of motor vehicle crash deaths on the Shore is of concern.
The report used data from 2014-2020.

Accomack had a rate of 19 crash deaths per 100,000 population and Northampton had a rate of 25 for the period, compared to a rate of 10 for Virginia as a whole and 9 for the top-performing U.S. counties.

One bright spot in the Shore’s health rankings is in the area of clinical care.

“The Eastern Shore may be the only rural area left in Virginia with a hospital,” Kiger said, adding that the various health care organizations on the Shore work well together.

Both Accomack (2,963 per 100,000 Medicare enrollees) and Northampton (2,683) have a lower rate than the statewide rate of preventable hospital stays, 3,896.

The ratio of primary care physicians to residents in Northampton is 840 to 1, better than the state ratio of 1,310 to 1. Accomack’s ratio is 2,310 to 1.

The ratio of dentists to residents in Northampton is 730 to 1, and in Accomack is 2,150 to 1, compared to the state ratio, 1,390 to 1.

Still, another clinical care factor, the uninsured rate — 15% in Accomack and 13% in Northampton — is higher than the state’s 9% rate.

Among social and economic factors that may affect health, the Shore’s rankings in education and poverty lag behind the state.

“Of all our factors, these social and economic factors give us the greatest challenge,” Kiger said.

In Accomack, 82% of adults completed high school and 45% have some college. In Northampton, 85% of adults completed high school and 54% have some college. That compares to 90% completing high school statewide and 72% having some college.

The percentage of Shore children living in poverty, 24% in Accomack and 27% in Northampton, also is significantly higher than the statewide percentage, 12%.

In both Accomack and Northampton, 36% of children live in single-parent households, compared to 24% statewide.

Accomack has 10% of youth ages 16 to 19 who are neither in school nor working, double the state percentage. No figure for Northampton was reported.

In a measure of school funding adequacy — defined as the average gap in dollars between actual spending and the estimated spending required per pupil to achieve U.S. average test scores — Accomack is minus $7,389 and Northampton is minus $7,895, compared to the state’s minus $186.

According to the report, the living wage (defined as the hourly wage needed to cover basic household expenses plus taxes for a household of one adult and two children) in Accomack should be $33.07 per hour and in Northampton should be $34.96, compared to the state rate, $41.81.

“If we can focus, our county boards of supervisors and the people who recruit new businesses into the area can focus in on bringing employers who can pay at least a living wage or higher, the cascading effect of that will be more people can pay taxes, which would then feed into adequate school funding. Better schools then might engage our youth,” Kiger said.

Kiger noted ESHC in July will begin a year-long planning process for its 2024-2026 plan for well-being for the Eastern Shore.

“We have mountains to climb. This is a marathon, not a sprint,” she said.

Virginia Rankings and New Measures
In Virginia as a whole, Falls Church ranked as the healthiest locality and Petersburg ranked as the least healthy, according to a press release from the Virginia Department of Health.
The 2022 report focused on the importance of economic security for communities, especially as they recover from the COVID-19 pandemic. As a result, several new measures were introduced in the 2022 report, according to the release.

One is childcare cost burden, which can pose a threat to economic security for families. In Virginia localities, it ranges from 14 to 36 percent. The typical cost burden of child care among counties nationwide is about 25 percent of household income, higher than the U.S. Department of Health and Human Services’ benchmark of 7%, according to the release.
Another new health measure is COVID-19 deaths, taken from 2020 data.

Virginia’s rate, 56 deaths per 100,000 people, was lower than the national rate of 85 per 100,000. Only 79% (103) of Virginia localities were included in the measure; 26% of those exceeded the national average.

An additional new measure was the average number of mentally unhealthy days people reported in the past 30 days. Virginians overall reported 4.2 days, slightly better than the national average of 4.5 days. Virginia counties ranged from 3.3 to 5.8 days.

“The results of the study make it clear that health disparities and inequities occur, not only between regions of the commonwealth, but also within localities, even the wealthy ones,” said State Health Commissioner Dr. Colin M. Greene.

Greene added, “While change in health-influencing factors takes time, the Virginia Department of Health is committed to supporting its local health departments and focusing on improving the health and well-being of all people in Virginia. We will be taking an analytical, evidence-based look at all of these factors, and incorporating them into the next state health improvement plan, Virginia’s Plan for Well-Being, with the intent of improving measurable health outcomes that truly matter to Virginians.”

Kiger noted that the health rankings do not include measures of how trauma affects health.

“We have a goal of having as many organizations (as possible) on the Eastern Shore become trauma-informed organizations,” she said, adding that a trauma-informed community is one “that has much more empathy for some of the problems that people suffer — behavioral health issues, mental health issues — as a result of having had an experience or multiple experiences that impacted them negatively in a way that it had impacted their lives.”

Kiger said around 80% of the population has had multiple traumas in their lives.

Eastern Shore Community College and the Nurse-Family Partnership on the Shore both are trauma-informed organizations, she said.

The county health rankings data is a good tool for localities and organizations to use for planning, according to Kiger.

“It is not a picture of doom and gloom. I am so pleased at the strengths that we have, but we still have that cycle of childhood poverty, family poverty, education systems needing help, jobs not in the area that pay a living wage. That’s the cycle that we need to break and that we need to address as a coalition,” she said.

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