York County ranked 16th in health outcomes and 18th in health factors out of the 67 counties in Pennsylvania in the 2012 County Health Rankings released Tuesday.

Health outcomes are based on mortality and morbidity rates in each county. Health factors are based largely on whether residents avoid health risks such as obesity and their surroundings, ranging from pollution to the number of fast-food restaurants in the area.

This is the third year the data have been compiled by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.

Improvement: York County continues to improve each year in health outcomes, moving up from 19th in 2011 and 25th in 2010.

In the health factors category, York's ranking fell from 14th in 2011 and 16th in 2010.

"Overall, I think we have a lot to be proud of in our community," said Robin Rohrbaugh, executive director of the Healthy York County Coalition, adding that York is doing great in comparison to all of the counties in Pennsylvania.

"I think that it reflects a lot of the very hard work we have been doing to improve health-care quality in our community, so that isn't surprising to me," Rohrbaugh said.

She said the study is helpful to see where more improvements can be made, and the coalition hopes to plan more community activities to improve the county's overall health.

Factors: Under health factors, however, York ranked

59th out of the 67 counties for physical environment. A new measure in this year's ranking takes into account the number of fast-food restaurants in a county. About 55 percent of the restaurants in York County are fast-food restaurants, much higher than the study's national benchmark of 25 percent.

In addition to the types of restaurants, the physical environment is measured by air pollution, access to recreational facilities and access to healthy foods. The study found 10 percent of York's population is low income and does not live close to a grocery store, lowering access to healthy foods.

Health factors are also measured by health behaviors. York scored poorly against the national benchmark in each category of health behaviors, including teen birth rates, obesity, adult smoking, physical inactivity, excessive drinking and sexually transmitted infections.

But York ranked high in other areas, such as the percentage of elderly residents with access to health care and insurance. In York County, only 10 percent of the population under age 65 is uninsured. That's better than the state percentage of 12 percent and the national percentage of 11 percent.

Outcomes: The overall health outcomes ranking is based on mortality and morbidity rankings.

Mortality ratings are based on the number of people who died before age 75 and the age at which they died.

York came in at 14 for its mortality ranking, an improvement from 16th in 2011 and 20th in 2010.

The morbidity rankings are determined by factors such as the number of people reporting poor or fair health, poor physical and mental health days and the percentage of babies born with low birthweight.

York County's morbidity ranking of 36 was a slight drop from last year's ranking at 33.

-- Reach Chelsea Shank at 505-5432 or cshank@yorkdis patch.com.