Data from the United Health Foundation show Missouri's health ranking in 2017 fell behind three states - to 40th.
The foundation - whose mission is to improve the quality and cost effectiveness of medical outcomes - has produced an annual report for the nation going back 30 years. Used in conjunction with the annual County Health Rankings released Wednesday, the foundation's report helps create a clearer picture of exactly how healthy Cole County is - or isn't.
Wednesday's 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. Cole, for example, had improved in the state's county rankings from 12th to sixth. But problems that plague the state overall also afflict the health of the county - obesity, drug use, excessive smoking and excessive drinking.
Access to good health care nearby, with two hospitals in Jefferson City and University Hospital in Columbia, affects the area's health positively, Cole County Health Director Kristi Campbell said.
But the state has other factors that hurt its health, she said. A problem nationwide is that having colleges and universities that create influxes of young adults into regions can affect communities' drug use and sexually transmitted diseases, she said.
"I think that every community is seeing an increase in heroin and other drug use," Campbell added. "I don't think we're immune to that."
Missouri ranked 30th for drug-related deaths (17.6 per 100,000 population) in 2017, according to the foundation's data.
Even as folks across the country are tackling the opioid epidemic, health officials wrestle with twists and turns that confound and baffle them, said Joy Sweeney, executive director of the Jefferson City-based Council for Drug Free Youth.
She said there was a disconnect between who received prescriptions for opioids and who was using the narcotics.
"Opioids were being prescribed to older women," Sweeney said. "Yet the people having problems with it were young men."
But the prevalence of smoking and its effects on the county and state are among the greatest concerns of the health community.
Missouri ranks 43rd for its high number of smokers. Twenty-two percent of adults statewide self-report as smokers. While Cole County (at 20 percent) isn't quite as high as the state range, it's still very high.
"One of the problems in Missouri is that we still have the lowest tobacco tax in the nation," Campbell said. "Our tax is 17 cents (per pack)."
Not only is it the lowest rate in the nation, according to Stan Cowan, a research aid with the MU School of Medicine's Missouri Tobacco Control Research Center, but it is less than one-tenth of the national average.
The national average is $1.72, he said.
On top of that, tobacco companies' marketing campaigns make the use of "juuls" (electronic cigarettes) and vapes (vapor-producing electronic cigarettes) seem cool to youths, Sweeney said.
"They promote those as cessation devices," Sweeney said. "What they're finding is that those are products that kids are using to start smoking."
That leads to Missouri's higher-than-national-average incidents of lung cancer, heart disease, chronic obstructive pulmonary disease and stroke, Cowan said. Those are the four greatest causes of death in the state, he said. Data show Missouri ranks 41st for its cancer deaths and 41st for deaths from cardiovascular disease - two known results of smoking.
In fact, the state ranked 40th in premature deaths (the number of years lost if somebody dies before age 75). Cole County (at 6,100 years per 100,000 population) is below the state average (7,800 per 100,000).
A group of organizations that included the Campaign for Tobacco-Free Kids, the American Cancer Society and the American Lung Association released a report that noted the state is spending only $48,500 in 2018 on tobacco cessation programs, yet will collect more than $260 million from tobacco taxes and a 1998 tobacco settlement.
New policies will be necessary to make the state healthier, Cowan said.
Some communities like Jefferson City and Cole County have stepped up in that account, he added.
In 2011, Jefferson City implemented a smoking ban (approved in an election the previous November) for almost all public places. Cole County created smoking bans in county buildings and vehicles early in 2011.
Cowans said data show that within a year after policies such as those go into effect, hospitals have a 17 percent reduction in visits for people seeking treatment for heart attacks.
Jefferson City also adopted a Tobacco 21 ordinance, stating people under 21 cannot buy tobacco products.
"Almost 300 communities have adopted such policies," Cowan said. "Five states have done it statewide with state laws."
So Cole County is making progress in reduction of smoking.
Drunken driving may be another story.
Thirty-four percent of traffic fatalities in the county in 2017 involved alcohol-impaired driving, according to statistics.
"That's horrific," Sweeney said. "We had almost 1,000 people die on our highways last year."
The state average was 30 percent.
She said 300 people died in alcohol-related accidents. "That's totally preventable. That's one of the frustrations we have."
Law enforcement agencies work hard to prevent drunken driving, Sweeney said. But they need state support that has been removed, she added. The General Assembly recently reduced the budget for roadside sobriety checkpoints to $1.
Legislators said the alternative was to have law enforcement agencies conduct saturation patrols.
That doesn't work by itself, Sweeney said.
"Saturation patrols in concert with checkpoints are more effective," she said. "When people know there are going to be checkpoints, they turn over their keys, call a cab or let a friend drive.
"It's a sign to people that (the Legislature) doesn't care."