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Moniteau County returned to the top 10 of the state's healthiest counties in 2018, a distinction it had not enjoyed for the previous two years.

It was the sixth-healthiest county in Missouri.

Missouri remained in 2018 among the bottom quarter of states when it comes to residents' health.

Data from the United Health Foundation show Missouri's health ranking was 38th for the year.

On the positive side, that is an improvement over 2017, when the state's ranking was 40th.

The foundation — whose mission is to improve the quality and cost effectiveness of medical outcomes — produces an annual report. Used in conjunction with the annual County Health Rankings, released last week, the foundation's report helps create a clearer picture of how healthy each county is.

The release of the annual county rankings, presented by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, gave snapshots of nearly every county in the United States.

Moniteau County had dropped to the 23rd-healthiest county in 2016, in part because of a spike in the number of people who died before they were 75 (known as premature mortality). For the reporting period, 51 people died of cancers (96.5 per 100,000 population using an age-adjusted rate — which attempts to show what the rate would be if the entire population had similar age distributions). Forty-eight died of heart disease (showing a rate of 93.1 per 100,000).

Another contribution to the bump in the county ranking was the unavailability of health care for the county. Moniteau ranked 70th for clinical care, which includes availability of primary care physicians, dentists and mental health providers. It also takes into account the number of preventable hospital stays residents had and whether residents were able to monitor diabetes or to receive mammogram screenings.

For every 5,290 residents, there was only one primary care physician. The Missouri average was a physician to every 1,420 residents. For every 3,990 dentists, there was only one dentist. The state average was 1,840 to one. For every 3,990 resident, there was one mental health provider. The state average was 630 to one.

Despite moving into the top six counties in the state, the ratio of residents to health care providers has increased. For 2018, there were 8,010 residents to one physician. The dental gap also widened at 4,020 to one. Only mental health care providers slightly closed the gap to 3,210 to one.

Among the most troubling health challenges Moniteau County residents face is the percentage of adults (20 and older) who report a body mass greater than or equal to 30. Body mass is calculated based on a person's height and weight. A BMI of 25 or higher is considered overweight. Healthy BMIs fall in a range between 18.5 and 24.9.

Thirty-six percent of adults reported BMIs of 30 or higher, up from 34 percent the year before and 28 percent the year before that.

A fifth of Moniteau County residents reported they are currently smokers. The population that reports being smokers has been relatively steady over the past five years, according to the data.

Only 38 percent of Moniteau County residents reported having access to locations for physical activity. The state average is 76 percent.

Moniteau County in 2018 scored above average for Missouri in terms of health behaviors — which includes obesity and adult smoking. Overall, the county's health behaviors ranked 46th in the state. By comparison, Osage County ranked third in the state. While 32 percent of Osage County residents reported BMIs of 25 or more, only 18 percent reported being smokers.

Among the health behaviors that kept the county from further improvement was a rise in sexually transmitted infections — the number of newly diagnosed chlamydia cases per 100,000 people in the population. In 2017, Moniteau County had 151 per 100,000 population in 2017, while there were 238 per 100,000 in 2018. In Miller County, 191; Osage, 227; and Cole, 713.

Automobile safety, workplace standards, good schools, medical clinics and reductions in smoking in most regions have benefited the health of communities, according to the report. But, not everyone has seen the same benefits from improvements.

"There are significant differences in health outcomes, according to where we live, how much money we make, or how we are treated," the report states. "There are fewer opportunities and resources for better health among groups that have been historically marginalized, including people of color, people living in poverty, people with physical or mental disabilities, LGBTQ persons and women."