Health, at its simplest, is a combination of chance and choice. Clatsop County’s health rankings reported last Thursday delve deep into the details of how well we are succeeding and how far we still have to go.

One of the things that really stands out in this annual report is Clatsop’s comparative well-being in a “neighborhood” that isn’t so well. Tillamook was 27th out of 33 ranked counties, and Columbia was 21st – while Clatsop was 11th. Just across the river, Pacific is 32nd and Wahkiakum 38th out of 39 Washington counties.

The details that go into these rankings confirm that many of us contribute to illness and premature death by choosing to smoke, drink excessively, remain obese and get no exercise. By all these measures, Clatsop is about average in the state – nothing to be proud of.

Disturbingly, we have more children living in poverty compared to the rest of Oregon and nearly double the nationwide benchmark. Thirty-eight percent of Clatsop County children are in single-parent households – again far higher than the state and national averages.

So what are we doing to warrant an improvement in our ranking from 19th in the state just two years ago? At least in part, it must be said that we have in some respects held our ground while situations have significantly deteriorated elsewhere in the state,

But there is some good news. Adult smoking, for example, declined to 22 percent from 26 percent in 2010. An estimated 17 percent of county residents engaged in binge drinking in 2010, compared to an excessive drinking rate of 15 percent now.

A good deal of Clatsop’s improvement from 2010 is statistical nonsense that comes with nation-based surveys that attempt to reach out to distant areas such as ours. In 2010, our physical environment was ranked 32nd in the state, whereas in 2012 we are ranked fourth – with this newer number certainly closer to the truth.

In the final analysis, Clatsop County probably is doing better than our immediate neighbors because of having a larger and more diversified economy. Ill health goes hand-in-hand with poverty. We have too many people in economic distress, but relatively fewer than many rural areas.

We must continue to do all we can to make sure families have the incomes to make healthier choices. This means, in part, supporting our schools, college and health providers – including public health workers who are doing a good job leading residents away from tobacco use.