Although access to health care remains difficult in rural Nevada, it was actually two of those counties that came out on top in a new set of health-care rankings released Wednesday.

Pershing County and its 6,560 residents had the best health outcomes in the state, while the significantly larger Douglas County, with 48,020 residents, had the best overall health factors, the behaviors and resources that determine health outcomes long term, according to the 2018 County Health Rankings from the the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Nye and Mineral counties ranked in the last two spots for both health outcomes and health factors this year, while the urban population centers of Clark and Washoe counties fell in the middle of the pack.

The rankings aim to determine how healthy each population is now by looking at premature deaths and quality of life to assess each county’s current health outcomes. They then examine health factors — such as how much of the population smokes, access to primary care providers and income inequality — to project which counties are on the right track for the healthiness of their residents.

“With health equity, it’s about providing opportunity for everyone across the board and that goes deeper than clinical care,” said Kimberly Hertin, disease surveillance supervisor at the Southern Nevada Health District, at a Wednesday meeting presenting the new rankings. “It goes into economic and social issues.”

Sixteen of seventeen counties were ranked this year. Esmeralda County, Nevada’s least populous county, was not ranked this year because of insufficient data, though it has been included in previous years.

Pershing County’s first-place health outcome rank was largely attributable to its low premature death rate, the lowest in the state. Although Pershing ranked 10th in terms of quality of life, its residents have fewer poor physical health and mental health days, and fewer report only poor or fair health compared to the state as a whole.

However, Pershing didn’t fare as well in terms of its health factors, coming in at 13th. Pershing has higher rates of smoking, obesity, physical inactivity, excessive drinking and alcohol-impaired driving deaths than both the state average. It also ranked poorly for access to primary care physicians, dentists and mental health providers, a challenge that plagues Nevada’s rural and frontier counties.

It also ranked poorly on several social and economic factors, including a violent crime rate that exceeds the state average. The county had a rate of 841 violent crimes per 100,000 people, compared to the state average of 616 violent crimes.

Douglas County came in at second for health outcomes but first for health factors. The county has the best health behaviors in the state with low rates of physical inactivity, relatively high access to exercise opportunities and a teen birth rate significantly lower than the state’s overall rate.

It also has the second best clinical care in the state with fewer uninsured, fewer preventable hospital stays and higher rates of mammography screening than the state as a whole. It also has the second best social and economic factors, with a 91 percent high school graduation rate, 15 percent of children in poverty and only 138 violent crimes per 100,000 people.

However not all rural counties performed as well. Nye County had the worst health outcomes and second worst health factors, while Mineral County had the second worst health outcomes and the worst health factors.

Nye County has the worst premature death rate in the state, with an estimated potential years of life lost rate of 11,500 years per 100,000 people compared to 7,100 years per 100,000 people for the state as a whole. Residents of Nye County also experience more poor physical and mental health days than the rest of the state.

Nye County also ranked second to last for clinical care, with one primary care physician for every 3,270 residents and one dentist for every 4,820 residents. It also has a lower high school graduation rate, a higher unemployment rate and a higher number of children in poverty than the state average.

However, the county did outperform the state as a whole in a few categories. Nye has a slightly lower excessive drinking rate than the rest of the state, less income inequality and less air pollution than the state as a whole.

Mineral County had a similarly poor premature death rate and quality of life factors. As far as health factors, the county has low rates of mammography screening, high numbers of preventable hospital stays, high rates of childhood poverty, high numbers of children in single-parent households and high numbers of injury deaths.

Nevada’s two urban counties, Washoe and Clark, landed roughly in the middle of the counties, coming in at 9th and 10th, respectively.

Washoe County ranked first in the state for clinical care, with one primary care provider for every 1,400 residents, one mental health provider for every 350 residents and 61 percent of women receiving mammography screenings. The county also ranked second for health behaviors, with less adult obesity and less physical inactivity than the state as a whole.

Still, the county also has more excessive drinking, alcohol-impaired driving deaths and income inequality than Nevada at large. It also tied with Clark County for the highest percentage of households with severe housing problems, 22 percent.

Clark County excelled in several areas, including low rates of physical inactivity, high access to exercise opportunities and low numbers of injury deaths. However, there were many more where it fell short, including high rates of smoking and obesity, lower high school graduation rates and a high violent crime rate.

Dr. Joseph Iser, chief health officer for the Southern Nevada Health District, said that the county will continue to focus on boosting access to clinical care, including through training more students at UNLV medical school, addressing environmental health issues such as air pollution and naturally occurring asbestos and long-term educational issues.

“I think that we need to look more globally and to look at the specific determinants of health,” Iser said. “We can look at low birthweight babies. What are the determinants of that? It’s access to care. It’s education. It’s family planning. It’s a whole variety of things. So that’s what concerns me about that is what are the determinants of health that we in Southern Nevada and throughout the state can work on.”