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HAZARD — This year’s “County Health Rankings” have been released, and once again Perry County ranks as one of the least healthy counties in the state.

Out of 120 counties, Perry has taken the 119th spot with Floyd County beating it out for the least healthy county in Kentucky. This is the fourth year the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute have conducted this report, which ranks the overall health of nearly every county in all 50 states. Since the first rankings were released in 2010, Perry has consistently ranked among the state’s top 5 unhealthiest counties.

According to a press release from the Kentucky Youth Advocates, an organization dedicated to protecting and advocating for the well-being of Kentucky’s youth, the actual data in the report is “based on a range of factors including high school graduation rates, obesity, smoking, and family and social support.”

Terry Brooks, executive director at Kentucky Youth Advocates, noted this report highlights non-health related factors which may not be commonly acknowledged as contributing factors to unhealthiness in certain communities.

“For instance, we know that there is a direct and disturbing link between child poverty and health. Until we tackle poverty, graduation rates, and family supports, the state of health for Kentuckians will not improve,” Brooks said.

The top 20 unhealthiest counties for 2013 are counties in Eastern Kentucky, with Breathitt County coming in at 118, Knott at 103, and Letcher at 101.

“Communities should see these rankings as a challenge. That challenge is less about comparing this county with that county and more about how every community can take action to improve the health of its neighbors,” Brooks said.

The U.S. Census Bureau reported the population estimate for Perry County as of July 1, 2012, to be 28,241. According to the “Rankings,” for this year Perry has a ratio of 897 people to every one primary care physician, and 1,629 people to every one dentist. Surrounding counties are seeing similar ratios. For example, Knott County, with an estimated population of 16,124 for the same time period, is 2,332-to-1 for physicians and 2,834-to-1 for dentists. The ratio for the state, which has an estimated population of over 4 million, is 1,588-to-1 for physicians and 1,855-to-1 for dentists.

“As important as local action is, our state elected officials must shoulder the responsibility for improving the health of Kentuckians,” Brooks added. “We need schools to embrace their role in children’s physical and mental well-being. We need lawmakers to muster the courage to pass a statewide smoke-free law. And until we improve the economic stability of Kentucky families through such provisions as a state-level Earned Income Tax Credit we are not going to sufficiently improve health.”