Missouri in 2018 remained among the bottom quarter of states when it comes to residents' health.
Data from the United Health Foundation shows 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 Tuesday, the foundation's report helps create a clearer picture of exactly how healthy each county is.
Last week'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 County has expanded programs to promote healthy lifestyles, said Kristi Campbell, director of the Cole County Health Department.
"We can educate and we can show individuals the consequences of their actions. We will continue to promote healthy behaviors," Campbell said. "People are responsible for making their own decisions."
Adjusted data shows Cole County ranked as the 13th healthiest in the state in 2017. (It had previously been reported as sixth.) For 2016, the county was ranked 12th in the state. In 2015, it was the 18th healthiest.
Among the most troubling health challenges Cole 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-five percent of adults reported BMIs of 30 or higher, up from 33 percent the year before and 31 percent the year before that.
"(People) don't always have access to the screenings or services others might have or access to healthy food. It's important for people at or below 185 percent of the poverty level to join our Women Infants and Children program," Campbell said.
The program is available for families that are pregnant or have children under 5. Grandparents, foster parents and guardians can qualify.
According to the U.S. Department of Health and Human Services, the poverty level for a single person in a home is $12,140. And, 185 percent of that is $22,459. A two-person household qualifies at an income of $30,451; and a three-person household qualifies at an income of $38,443.
A fifth of Cole 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.
"We see a lot of people suffering from conditions associated with smoking," Campbell said.
Cole County, as part of a federal Maternal Child Health Program, offers a smoking cessation program for pregnant women.
"They monitor the carbon dioxide in their breath - by breathing into a machine," she said. "It measures their (carbon dioxide) and tells them how much is passing on to the babies.
"When they see the effect on the unborn child, they say, 'Oh, my goodness.'"
The expectant mothers are rewarded with diapers for reducing the carbon dioxide.
Cole County scored low in terms of health behaviors - which includes obesity and adult smoking. Overall, the county's health behaviors ranked 54th in the state. By comparison, Boone County ranked second in the state. Only 27 percent of Boone County residents reported BMIs of 25 or more. Only 18 percent reported being smokers.
Among the health behaviors that shot Cole County up the scale was a rise in sexually transmitted infections - the number of newly diagnosed chlamydia cases per 100,000 people in the population. In Boone County, there were 667 per 100,000 in 2018. In Miller County, 191; Moniteau, 238; Osage, 227; and Cole, 713.
The data show Cole County's physical environment plays a role in its health. The county environment ranked 78th in the state - when measuring for air pollution, drinking water violations, housing problems, long commutes for work and driving a lone for work. Eighty-six percent of the workforce drives alone to work each day, according to the report.
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."