Hale County, Alabama

CASE STUDIES

29

Hale County [is] focused on people having access to healthy foods, having 

access to a nice park to be physically active. We have had good success here.

 —Stacey Adams, Assistant Area Administrator, 

 Alabama Department of Public Health

Located in Alabama’s rural Black Belt, Hale County is no longer the place captured so starkly by 

journalist James Agee and photographer Walker Evans in their 1941 book, Let Us Now Praise Famous 

Men. The book documented the abject lives of impoverished sharecropper families, mostly white, 

subsisting in the rural South. Hale County still struggles with poverty, but it is also home to innovative 

nonprofits and creative collaborations reimagining how to improve community health and well-being.

Agriculture in Hale County benefits from local environmental conditions, including the water-retentive 

soil of the southern Black Belt region. That same soil once made cotton an important agricultural crop for 

the area; though, now, Hale is known for its catfish industry.

Hale is among the ten percent of Appalachian counties—and the only county in Appalachian Alabama—

identified as a Bright Spot. It performed better than expected on 15 out of 19 health outcome measures. 

Notably, Hale County performed better than expected on the following measures:

 Chronic obstructive pulmonary disease (COPD) mortality: 32 percent better than expected

 Percentage of Medicare beneficiaries with depression: 26 percent better than expected

Greensboro, Alabama, is the county seat of Hale County.

© Kim Cross 
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 Years of potential life lost: 14 percent better than expected

 Percentage of excessive drinkers: 13 percent better than expected

 Infant mortality: 13 percent better than expected

These better-than-expected results are likely influenced by local conditions and initiatives that improve 

overall well-being. For example, field research suggests that a strong commitment to both providing 

access to health care and addressing social factors that affect health—such as housing and employment—

plays a major role in community health. At the same time, a sense of connectedness among different 

generations and diverse sectors helps to promote overall health and meet community needs with limited 

resources. 

Hale County’s classification as a Bright Spot means that, on average, the county performed better than 

expected on a number of health outcome measures, given its characteristics and resources—that is, the 

socioeconomics, demographics, behaviors, health care facilities, and other factors that influence health 

outcomes. It does not mean that all residents here enjoy excellent health. Like other counties with limited 

resources, Bright Spot counties face challenges to attaining good health outcomes. Hale County’s 

performance, however, indicates that certain county conditions or programs may be helping generate 

better-than-expected outcomes—and that other resource-challenged Appalachian counties may benefit 

from adopting similar initiatives.1

 1 See Table 6 in the data appendix at the end of this case study for a full list of actual health outcomes for Hale 

County compared with predicted outcomes. For details on the outcome measures, see the data files accompanying 

the report Identifying Bright Spots in Appalachian Health: Statistical Analysis.
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31 

COUNTY OVERVIEW 

Figure 5: Map - Bright Spot Community Hale County, Alabama 

Hale County represents a metropolitan county in Southern Appalachia. It was the

only county in Appalachian Alabama identified as a Bright Spot.

Hale County lies in Appalachia’s southernmost part, where the mountains may be more accurately 

described as foothills. It is approximately 33 miles southwest of Tuscaloosa. Three distinct areas make up 

most of the county: the town of Newbern in the south, the city of Moundville in the north, and the county 

seat of Greensboro in the middle. The remainder of the county consists of small rural communities, 

although the county is designated by the federal Office of Management and Budget as a metropolitan 

county. 

With a population of just over 15,000, Hale County is Alabama’s tenth-poorest county. Unemployment in 

2014 was 9.9 percent, compared with 6.5 percent regionally and 6.2 percent nationally. Classified by the 

Appalachian Regional Commission as economically distressed in fiscal year 2017, Hale County has a 

median household income of $33,315, about 60 percent of the national median. 

The catfish industry employs many county residents, and more than half of the county’s residents work in 

health and social assistance, retail and wholesale trade, or manufacturing. The transportation and real 

estate sectors offer the highest-income jobs. 

GEORGIA

SOUTH 

CAROLINA

NORTH CAROLINA

ALABAMA

MISSISSIPPI

TENNESSEE

KENTUCKY

OHIO PENNSYLVANIA

MARYLAND

VIRGINIA

NEW YORK

WEST

VIRGINIA

Hale County, AL

Northern

Southern

Central

South Central

North Central

0 100 50

Miles
CREATING A CULTURE OF 

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32

Hale’s population is 58 percent black and 41 percent white, with other races, including American Indians, 

nominally represented. Nearly half (48.8 percent) of adults have some college education, compared with

63.3 percent nationally.

2 Approximately 16 percent of the population receives benefits from the Social 

Security Administration, compared with about 5 percent of the national population.3

Beyond the poverty are signs of community investment and creative use of limited resources. The field 

work conducted for this report shows that a handful of leaders and nonprofits have played a major role in 

addressing the county’s housing shortage. Hale County has emphasized collaboration to leverage 

available resources. Stakeholders note that county residents have looked through the lens of opportunity 

instead of the lens of need. 

A DEEPER LOOK AT HALE COUNTY: COMMUNITY STRENGTHS

As in the other Bright Spot communities explored in this report, people in Hale County have worked to 

elevate physical, social, and economic health in several ways. In Hale County, these efforts include 

developing affordable housing initiatives, establishing social programs for helping elderly people as well 

as those who are isolated and who have mental illness, and creating a health care clinic network. 

Field work helped identify local practices that appear to be contributing to overall health, document 

effective practices that could be replicated in other counties, and identify promising practices and 

strategies that should be explored further.4 Specifically, the research identified these features in Hale 

County:

 Presence of strong social programs and sustainable community-focused nonprofits: The 

long history of social support and community development of nonprofits in Hale County indicates 

strong community support and a high likelihood that the work of these nonprofits aligns with the 

needs of the community. 

 Cross-sector collaboration of local leaders, organizations, and volunteers: Organizations in 

and outside of health care regularly communicate and collaborate face to face to address 

community issues such as transportation, housing, and chronic health conditions. The presence of 

committed and resourceful leadership supports these efforts. Volunteers often fill in when 

funding is insufficient.

 Access to health and human services: Hale County has the basic infrastructure necessary to 

maintain and strengthen access to health care services. The county has a hospital, network clinics, 

home health services, rehabilitation and therapy, and mental health services.

 Targeted support of youth and at-risk groups: Empowering youth and providing opportunities 

for them to engage with the community creates strong social connections between generations. It 

also provides the opportunity and space for young people to become community leaders. The 

elderly, as well as other vulnerable groups, benefit from strong social support systems.

 2 Table 4 in the Hale County data appendix at the end of this case study provides a quantitative profile of county 

characteristics.

3 This includes receipt of benefits either through the Old-Age, Survivors, and Disability Insurance (OASDI) program 

or the Supplemental Security Income (SSI) program in 2014. 4 For a full explanation of the methodology, see Appendix B: Research Approach. For a list of key informants 

interviewed for this county, see Table 5 in the data appendix at the end of this case study.
CREATING A CULTURE OF 

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Community connectedness, the presence of exceptionally strong nonprofit leaders, and a focus on 

addressing underlying social factors such as lack of housing, workforce training, and substance abuse, 

seem to be important components in making health a shared value in Hale County. County residents also 

see value in collaborating with organizations outside the county, such as the Auburn University School of 

Architecture, to create a win-win for the university’s own learning initiatives and for Hale County

residents.

Hale County has undertaken efforts that fall into four overarching categories echoed in other Bright Spot 

counties: leadership, cross-sector collaboration, resource sharing, and local providers committed to public 

health. 

Community Leaders Engaged in Health Initiatives

Strong, sustained leadership is evident in all of the Bright Spot communities, but especially so in Hale. 

Leaders include longtime resident entrepreneurs, members of the faith community, and dedicated health 

providers. Three programs have played a major role in shaping the county’s emphasis on housing—a 

known social factor that impacts health and well-being—and using local resources creatively to meet 

needs. These are the Hale Empowerment and Revitalization Organization (HERO), the Auburn Rural 

Studio, and Project Horseshoe Farm.

Pam Dorr has been a dedicated steward of Hale County for years. She came to Hale County from San 

Francisco as a fellow in the Auburn Rural Studio program, one of Hale County’s first collaborative 

initiatives aimed at solving the county’s affordable housing problem. She found the work so meaningful 

that she decided to stay in Hale County and, in 2006, revived a defunct 501(c)(3) organization known as 

HERO.

Under Dorr’s leadership, HERO worked to provide affordable housing and utilities assistance to 

residents. It focuses on three areas: supporting affordable housing development and education to reduce 

homelessness; helping families cover utility bills; and creating social enterprises that help residents in 

other ways, providing them with the knowledge, skills, and confidence to foster their own well-being. 

HERO does this through a combination of grants, partnerships, and reliance on a culture of recycling and 

resourcefulness. 

During her tenure at HERO, Dorr recognized the need to shift from a business model that relied on 

federal grants for 94 percent of its funding to a more entrepreneurial model designed to generate income 

from local businesses. Dorr helped create 11 small businesses and at least 50 new jobs. Those operations 

have generated more than $15 million in profits that were invested back into the community to build 

affordable housing for a large number of residents. HERO also subsidizes utility bills for approximately 

1,800 households, which represent 30 percent of all homes in the county. These subsidies are a big part of 

the shelter safety net in Hale County.

Dorr’s vision was not limited to housing. She wrote many grant proposals that have influenced public 

health, including one credited with helping improve the county’s high infant mortality rate in the early 

2000s.
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Cross-Sector Collaboration 

In Hale County, there is a rich network of health and human services organizations collaborating with 

organizations rooted in very different fields, ranging from the Auburn University School of Architecture 

to local businesses and public housing. For example, the publicly owned Hale County Hospital, which 

provides a full range of primary care services, works closely with the Hale County Cooperative Extension 

Office, keeping it informed of new services as well as offering blood pressure checks and other 

supportive services at events and festivals. 

Established in 1993, Auburn Rural Studio is a unique, Hale County–based nonprofit internship program 

created by the Auburn University School of Architecture. Students accepted into this program receive 

poverty-level income and live in substandard living conditions while learning to work with tight resources 

to design and build sustainable infrastructure for Hale County and its residents. 

Third- and fifth-year architecture students spend 

months— even years—living in a restored 

farmhouse in Hale County as they see their projects 

through to completion. The students and local 

helpers learn how to be resourceful and creative as 

they organize, design, and construct a project. The 

projects emphasize addressing community 

infrastructure deficits, low-cost construction and 

operations, sustainability, local sourcing of building 

elements, and student leadership development. One 

of Auburn Rural Studio’s more recent endeavors is 

the development of “$20K Houses.” Students and 

staff are putting together a portfolio of relatively 

easy-to-build one-bedroom homes designed to be 

affordable and energy-efficient. Other communitycentric projects have included new builds and 

renovations for the Antioch Baptist Church, the 

Newbern Volunteer Fire Department, the Hale County Animal Shelter, the Akron Boys and Girls Club, 

the Safe House Black History Museum, and, most recently, the redevelopment of Lions Park. 

Over the years, Auburn Rural Studio has engaged students in more than 170 projects in Hale and two 

other counties, often attracting resources from national nonprofits. By recognizing that lack of safe, 

affordable housing can negatively impact health, Auburn Rural Studio is making health a shared value. 

A number of other collaborative programs in Hale County support at-risk populations such as youth and 

the elderly. Several of the county’s most successful programs give young people meaningful ways to 

contribute to their personal development, to their families, and to their community. For example, 

YouthBuild, a national program with an active chapter in Hale through HERO, teaches construction 

skills to young people who have dropped out of high school as they work toward obtaining their GED. 

YouthBuild collaborates with Auburn Rural Studio on a wide range of construction projects, providing 

opportunities for creative, meaningful work. 

© Kim Cross 

A prototype of Auburn Rural Studio’s “$20K House”
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Resource Sharing

Hale County has an industrial board that serves as a de facto chamber of commerce. While the board 

fosters cross-sector collaboration, a major focus is on helping secure resources, spur economic 

development, and attract business. The board is composed of representatives of local organizations and 

businesses, which have an interest in and sense of responsibility for helping improve the health of the 

county.

Many entities across the county share resources. Project Horseshoe Farm (PHF) has grown adept at 

doing this to meet the needs of the community’s most vulnerable populations: children, seniors, and 

adults with mental illness. Launched in 2007 by psychiatrist John Dorsey, PHF recruits college graduates 

in their “gap year” between graduation and medical school to live and work in Hale County, operating 

community-based health and service programs.

PHF’s student recruits live on the farm in a bunkhouse built by Auburn Rural Studio students and work 

with the farm’s senior community center program, mental health housing, and youth after-school 

program.

Students lead day programs four days a week at the Community Clubhouse, a senior center that sits in the 

center of town. The programs are for the elderly, those who are isolated, and those with mental illness,

and are designed to overcome the isolation and lack of purpose that often accompany old age and mental 

illness. Each day has a theme, such as arts and crafts or nutrition and cooking. A volunteer nurse 

practitioner comes in to take blood pressure, provide nutrition counseling, and make sure participants are 

taking their medications. Moreover, the program provides snacks for the attendees and delivers meals to 

seniors who cannot get to the clubhouse.

PHF also operates an independent 

living program for women, most of 

them elderly, who are transitioning 

from being institutionalized for mental 

illness. Dorsey bought and renovated a 

farmhouse capable of housing up to 12 

women. The farmhouse is not an 

assisted living facility—residents must

cook and take care of themselves—but 

PHF students and other volunteers are 

accessible to the residents 24 hours a 

day, 7 days a week.

Before creating the senior center and 

the farmhouse, PHF started with an 

after-school program for fourth- and 

fifth-graders. Dorsey partnered with local schools and teachers to provide tutoring, mentoring, and 

enrichment programs for the children. The success of this program is quantifiable: 70 percent of the 

children in the program improved at least one quartile on the math portion of the Alabama Reading and 

Math Test. Also, more than 20 percent of the children advanced one to two years in their GatesMacGinitie reading levels. The program supports more than 80 children every day, and has a high 

retention rate, with children returning year after year. 

© Kim Cross 

Programs at Project Horseshoe Farm’s Community Clubhouse serve seniors and 

other vulnerable adult populations in Hale County.
CREATING A CULTURE OF 

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Local Providers Committed to Public Health

In an area where health decisions are often made by “the pocketbook,” many Hale County residents think 

about health in terms of whether they can or should seek treatment. Local health facilities and programs 

such as Auburn Rural Studio, HERO, and PHF approach health from a different angle, working to address 

conditions such as housing, education, or work opportunities that can help improve overall community 

health. 

CREATING A CULTURE OF HEALTH IN HALE COUNTY

Creativity, collaboration, and strong leadership are making a difference in Hale County. Across sectors, 

partners are operating innovative, entrepreneurial programs that make efficient use of local resources and 

recruit people from both inside and outside of the county to create an environment that fosters health. A 

resourceful, entrepreneurial approach by nonprofit and faith-based leaders has helped to advance 

community well-being, in part by tapping into the strong culture of volunteerism here. Relationships 

between generations and different sectors are part of what brings the community together. Several 

programs work to reduce social isolation and address mental health for vulnerable populations, such as 

the elderly, and to support and nurture young people. 

Access to fundamental health care services is good, but community leaders also recognize the importance 

of social factors beyond medical care, including affordable housing and good jobs, to support health and 

well-being. This broad approach to health as part of the fabric of everyday life, combined with a 

commitment to ensuring that all residents have the basics they need for good health, has helped Hale 

County accomplish much with few resources.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Hale County, Alabama | CASE STUDIES 

37 

REFERENCES 

Agee, James, and Walker Evans. 1941. Let Us Now Praise Famous Men. Boston: Houghton Mifflin. 

Agency for Healthcare Research and Quality. 2011. “Chapter 9: Access to Health Care, 2011 National 

Healthcare Quality Report.” Agency for Healthcare Research and Quality.

https://www.ahrq.gov/research/findings/nhqrdr/nhqr11/chap9.html

Alabama Department of Public Health. 2007–2015. “Alabama National Health File, 1974–2006.” 

http://alabama.nationalhealthfile.org/Hale/Details/5--Year-Average-Total-Infant-Mortality-Rate,-lessthan-1-year-old 

Bernstein, Fred A. 2005. “In Alabama, a Poor County is Rich in Modern Architecture.” New York Times,

December 25, 2005. Accessed May 15, 2018. 

https://www.nytimes.com/2005/12/25/travel/in-alabama-a-poor-county-is-rich-in-modernarchitecture.html 

Catlin, Bridget, A. Jovaag, and J. Williams Van Dijk. 2015. 2015 County Health Rankings Key Findings 

Report. Population Health Institute, University of Wisconson, Madison, Wis.: County Health Rankings & 

Roadmaps. 

Data USA. 2017. Hale County, AL. 

https://datausa.io/profile/geo/hale-county-al/ 

Downes, Lawrence. 2011. “Of Poor Farmers and ‘Famous Men’.” New York Times, November 26, 2011. 

Accessed May 15, 2018. 

https://www.nytimes.com/2011/11/27/opinion/sunday/of-poor-farmers-and-famous-men.html 

Edge, John T. 2010. “Pie + Design = Change.” New York Times, October 8, 2010. Accessed May 15, 

2018. 

https://www.nytimes.com/2010/10/10/magazine/10pielab-t.html 

Grabowski, David C. 2007. “Medicare and Medicaid: Conflicting Incentives for Long-Term Care.” The 

Milbank Quarterly 84 (4): 579-610. doi:10.1111/j.1468-0009.2007.00502.x. 

Holmes, G. Mark, Nancy M. Lane, Thomas A. Arcury, Michael L. Schwalbe, Randy Randolph, John 

Frank, Sharita Thomas, et. al. 2018. Identifying Bright Spots in Appalachian Health: Statistical Analysis.

Washington, D.C.: Appalachian Regional Commission. 

Marshall, Julie L., Logan Thomas, Nancy M. Lane, G. Mark Holmes, Thomas A. Arcury, Randy 

Randolph, Pam Silberman, et al. 2017. Health Disparities in Appalachia. Appalachian Regional 

Commission. 

Rural SW Alabama. 2017. About Rural Southwest Alabama. 

http://www.ruralswalabama.org/about/ 

Sawyerville Day Camp. 2017. Sawyerville Day Camp. 

http://www.sawyervilledaycamp.org/ 
CREATING A CULTURE OF 

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APPENDIX: HALE COUNTY DATA

Table 4: Hale County Characteristics

Characteristic Hale County United States

Population, 2010–2014 15,393 314,107,084

Percent population change, 2010–2015 -4.4% 4.1%

Median age, 2015 40.6 37.8

Percent persons over age 65, 2015 17.8% 14.9%

Median household income, 2014 $ 33,315 $ 56,135

Per capita income in past 12 months (in 2015 

dollars), 2011–2015 $ 18,877 $ 28,930

Unemployment rate, 2014 9.9% 6.2%

Percent persons in poverty, 2014 28.1% 15.6%

Percent white alone, 2015 41.1% 77.1%

Percent black alone, 2015 57.8% 13.3%

Percent adults with at least some college, 2010–

2014 48.83% 63.27%

Distance to nearest large population center from 

county center Tuscaloosa – 33.1 miles N/A

ARC designations, fiscal year 2017 Distressed

Southern Appalachia N/A

Source: These data are compiled from the U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics, 

2014, and the U.S. Census Bureau American Community Survey Selected Social Characteristics, General Economic 

Characteristics, Demographic and Housing Characteristics, and Educational Attainment Tables for years 2010–2014 

and 2011–2015.
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Table 5: Hale County Key Informants

Name Location Title Organization Interview 

Date

Stacey Adams Greensboro Assistant Area 

Administrator

Hale County Health 

Department 9/21/2016

Regina Knox Greensboro

Executive Director,

West Central 

Alabama AHEC

Area Health Education Center 9/21/2016

Tyrone Smith Greensboro County Coordinator Alabama Cooperative 

Extension System 9/21/2016

Pam Dorr Greensboro Director Hale Empowerment and 

Revitalization Organization 9/21/2016

Dr. John Dorsey Greensboro Director Project Horseshoe Farm 9/21/2016

Xavier Vendrell Newbern Director/Professor Auburn Rural Studio 9/22/2016

Natalie Butts-Ball Newbern Communications 

Manager Auburn Rural Studio 9/22/2016
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Table 6: Hale County Health Outcomes – Actual vs. Predicted

Outcome Measure Actual Predicted

Percentage 

Difference

(negative = 

better)

COPD mortality per 100,000 people, 2008–2014 44.04 64.41 -31.6%

Percentage of Medicare beneficiaries w/ depression, 

2012 10.50% 14.18% -26.0%

Years of potential life lost, 2011–2013 10,037 11,691 -14.1%

Percentage of excessive drinkers, 2014 10.10% 11.67% -13.4%

Infant mortality per 1,000 births, 2008–2014 10.53 12.05 -12.6%

Stroke mortality per 100,000 people, 2008–2014 48.85 55.68 -12.3%

Heart disease hospitalizations per 1,000 Medicare 

beneficiaries, 2012 55.50 61.95 -10.4%

Poisoning mortality per 100,000 people, 2008–2014 8.41 9.26 -9.1%

Suicide mortality per 100,000 people, 2008–2014 11.81 12.76 -7.4%

Average Medicare condition score, 2013 0.91 0.98 -7.0%

Injury mortality per 100,000 people, 2008–2014 58.39 60.77 -3.9%

Percentage of obese adults (>30 BMI), 2012 35.9% 37.1% -3.2%

Cancer mortality per 100,000 people, 2008–2014 206.66 213.48 -3.2%

Heart disease mortality per 100,000 people, 2008–

2014 293.52 298.88 -1.8%

Mentally unhealthy days per month per person, 2014 5.10 5.14 -0.8%

Opioid prescriptions as a percent of Part D claims, 

2013 7.84 7.75 1.1%

Low-birth-weight births (<2,500g) per 1,000 births, 

2007–2013 14.26 14.06 1.4%

Percentage of adults with diabetes, 2012 17.20% 16.77% 2.6%

Physically unhealthy days per month per person, 2014 5.60 5.36 4.5%

Notes:

Percentage Difference = 100 * [ (Actual / Predicted) – 1]

Green = County value was better than predicted

For details on the outcome measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.
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Table 7: Hale County Health Drivers vs. National Median

Driver Measure Lower is 

Better?

National 

Median

Hale 

County

Air pollution (average daily particulate matter 2.5), 

2011 Yes 11.87 12.92 

Average travel time to work in minutes, 2010–2014 Yes 22.82 28.98 

Chlamydia incidence rate per 100,000, 2013 Yes 287.16 1,260.72 

Dentists per 100,000 population, 2014 No 37.45 13.18 

Economic index, fiscal year 2017 Yes 108.79 159.67 

Full-service restaurants per 1,000, 2012 No 0.68 0.26 

Grocery stores per 1,000 residents, 2012 No 0.20 0.19 

Median household income, 2014 No $45,226.00 $33,315.00 

Mental health providers per 100,000 population, 2015 No 80.00 19.76 

Percentage of adults currently smoking, 2014 Yes 17.8% 21.8%

Percentage of adults not physically active, 2012 Yes 27.7% 35.3%

Percentage of adults with at least some college, 

2010–2014 No 56.3% 48.8%

Income inequality ratio,5 2010-2014 Yes 4.4% 5.6%

Percentage of diabetics with A1C testing, 2012 No 85.4% 77.2%

Percentage of doctors who e-prescribe, 2014 No 65.0% 80.0%

Percentage of eligibles enrolled in SNAP, 2014 No 78.0% 79.0%

Percentage of households with income below poverty, 

2014 Yes 15.8% 28.1%

Percentage of Medicare women with recent 

mammogram, 2013 No 61.0% 65.0%

Percentage of population with access to places for 

physical activity, 2011 and 2014 No 61.9% 58.3%

Percentage of total population in social assistant jobs, 

2013 N/A 0.01% 0.00%

Percentage receiving disability OASDI and/or SSI, 

2014 Yes 5.4% 16.2%

Percentage spending >30% of income on housing, 

2010–2014 Yes 29.0% 35.1%

Percentage w/ no car, low access, 2010–2014 Yes 19.7% 0.06%

Primary care physicians per 100,000 population, 2013 No 48.54 12.99 

5 Income inequality is the ratio of household income at the 80th percentile to that at the 20th percentile. A higher 

ratio reflects greater division between the top and the bottom of the income spectrum.
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Driver Measure Lower is 

Better?

National 

Median

Hale 

County

Social associations per 10,000 population, 2013 No 12.68 5.19 

Specialist physicians per 100,000 population, 2013 No 25.93 19.49 

Students per teacher, 2013–2014 Yes 14.13 14.76 

Teenage births per 1,000, 2007–2013 Yes 39.96 42.58 

Uninsured rate for people under 65, 2013 Yes 17.24 16.09 

Notes:

Green = County value was better than national median

For details on the driver measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.