One of Virginia’s poorest cities is also its least healthy, new rankings show


For the second year in a row, Petersburg ranked as the least healthy locality in Virginia while Falls Church took over first place.

The rankings, released Wednesday by the Robert Wood Johnson Foundation and University of Wisconsin’s Population Health Institute, are meant to offer an annual snapshot of more than 90 measures affecting health and quality of life in counties across the United States. Researchers factor in behaviors including smoking and excessive drinking but also include measures like violent crime rates and access to grocery stores to assess the overall health of a community.

As in previous years, though, the gulf between Virginia’s highest and lowest-ranked counties underscores the correlation between wealth and health outcomes — a disparity that health officials have long struggled to equalize. Falls Church, a majority White city in Northern Virginia, has a median household income of nearly $147,000 a year, according to the most recent U.S. Census data. Petersburg’s, on the other hand, is less than half of that, at just over $43,000 a year

The majority-Black city south of Richmond has struggled with declining wealth for decades. Once a prosperous community fueled by the railway and tobacco industries, its demographics shifted sharply in the 1970s when White residents began moving out of the city following school desegregation in Virginia. That exodus, coupled with a declining railroad industry, led to job losses and continued relocation by both residents and businesses. By 2009, the city’s tax revenue wasn’t enough to cover its expenditures, according to the Federal Reserve Bank of Richmond.

Medical providers are also in short supply. At a town hall with Gov. Glenn Youngkin earlier this year, city leaders expressed concern that their community of over 33,000 had no urgent care clinic within city limits. Petersburg’s ratio of residents to primary care providers is 1,420 to 1, according to this year’s county health rankings, compared to 330 to 1 in Falls Church. And its rate of preventable hospital stays for conditions that could be managed in outpatient settings was more than double that of Falls Church.

COVID-19 also played a role. In 2021, Petersburg’s premature death rate — a measure of residents who died before the age of 75 — was already nearly seven times higher than Arlington’s, the top-rated county last year. Last year’s report didn’t include deaths attributed to the virus, but those were factored into the rankings in 2022, according to Molly Murphy, a community scientist with the University of Wisconsin Population Health Institute.

While rates of premature death actually fell in Falls Church, despite the pandemic, Petersburg’s increased again. Local health officials also struggled to mobilize testing and treatments. Eric Fly, a member of the Board of Supervisors in nearby Sussex County, told the Mercury last year that testing wasn’t widely available in the Crater Health District, which includes Petersburg, until six months after the state recorded its first case of COVID-19. And while Northern Virginia localities initially received the lion’s share of vaccines, based on population density, Crater couldn’t accept many early shipments because the district didn’t have a deep freezer to store them in.

Health districts in Virginia are funded through a combination of state and local contributions, often putting less-resourced areas at a disadvantage. While national rankings can’t always capture real-world examples of how wealth and income affect health outcomes, Murphy said researchers frequently adapt new measures in an effort to capture those relationships.

This year’s report also focused on child care as a crucial indicator affecting both quality of life and health. According to the report, a Virginia family with two children spends an average 25 percent of their income on child care, on par with the national average. But for many localities, including several in Northern and Southwest Virginia, the average is between 33 percent and 36 percent. 

Federal benchmarks by the U.S. Department of Health and Human Services define child care as unaffordable if it exceeds 7 percent of household income, according to the report. The burden of paying for those services can force many families to make difficult choices, Murphy said.

“That extra money is coming at the cost of other things, like health care or food on the table or educational opportunities,” she said. “All of these things that we know impact our health physically and socially and mentally.”


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