Marquette remains one the state's least healthiest counties, according to a University of Wisconsin-Madison study released today, but Columbia County has made great strides to improve.

The study ranked the state's 72 counties as well as the city of Milwaukee. Menominee County, home of the Menominee Tribe in northeast Wisconsin, was once again the least healthiest, followed by the city of Milwaukee and then Marquette County.

Marquette fell from 70th last year to 71st this year. It was 65th in 2006, 64th in 2005 and 62nd in 2004, according to the study.

Columbia County is moving in the other direction: It ranks 21st healthiest, improving from 32nd last year. It was 48th in 2006, 52nd in 2005, and 54th in 2004.

Along with Ozaukee and Waukesha counties, Dane County, home to Madison and state government, ranked as the healthiest.

The sixth annual study ranked Wisconsin's counties based on 30 factors including mortality rates, surveys of people about how they felt, the availability of health care, whether people smoked or were obese, binge drinking, level of education, exercise and living in housing with an increased lead risk.

The 12-page report used two factors to measure the overall level of health, or "health outcomes," by county: the rate of premature death (dying before age 75) and the percent of people who report being in fair or poor health.

The report then analyzes several factors in four major categories that can affect a community's health: health care, health behaviors, social and economic factors and the physical environment. Columbia County ranks 21st for health outcomes and 36th for health determinants. Among the categories of health determinants, Columbia County ranks 22nd in socioeconomic factors, but fares worse in health care (53rd) and health behaviors (52nd). The county also ranks among the lower half of the state's counties in environmental health, with a rank of 46.

Marquette is 71st in health outcomes, 66th in health determinants, 58th in socioeconomic factors, 71st in health care, 70th in health behaviors, and 19th in environmental health.

Columbia County is last in one category: number of people involved in a crash per 1,000 population. It is 71st in inpatient care. The score is based on the percentage of patients without recommended care. Its best ranking is seventh, for percentage of children in poverty.

Some of Marquette's worst rankings are in obesity (72nd), number of people involved in a crash per 1,000 population (71st), and no dentist visit in the past year (70th). Its best rankings are for lead-poisoned children (1st), radon risk (2nd), and violent crime rate per 100,000 population (9th).

The study calls "attention to the fact we have health discrepancies in Wisconsin," said Pat Remington, director of UW Population Health Institute. "It is a challenge for the entire state to think about what we might call the unequal distribution of health across the state and what approaches the entire state might do to provide resources and support for communities who need it the most."

A healthy county is one where people live to be 75 and older, their health is generally good and their quality of life is high, Remington said in a telephone interview from Madison.

Lisa Waukau, chairwoman of the Menominee Indian Tribe, said being last on the list again was disappointing but not unexpected.

Menominee County has many people without health insurance, "a lot of risky behavior," such as smoking, and a high incidence of diabetes because of genetics and poor diet, Waukau said.

The state's five leading causes of death are cancer, heart disease and stroke, respiratory diseases, unintentional motor vehicle accidents and suicide, according to the study.

The study found 7.5 percent of the state's population younger than age 65 did not have health insurance.

"The general sense is the number is increasing," Remington said. "People without health insurance have more diseases. Cancers are detected later, and people have an increased chance of dying. It is certainly not acceptable to have that many people uninsured."

Jefferson and Langlade counties had the fewest people lacking health insurance - 2.8 percent and 3.2 percent - while Sawyer and Clark counties had the most - 22.8 percent and 21.5 percent, according to the research.

"Those are big differences. They are not occurring by chance alone," Remington said.

For example, Sawyer County may have more seasonal employers not providing health insurance to workers, while a larger manufacturing base in Jefferson County, near Milwaukee, does, the researcher said.

Sawyer County includes the reservation for the Lac Courte Oreilles band of Lake Superior Chippewa in northwest Wisconsin, and Clark County is a farming area just east of Eau Claire in western Wisconsin.

The study also found wealthier counties tended to be healthier, which was no surprise, Remington said. People with education and money are more likely to have healthy behaviors, good health care and better overall health, he said.

Only 7.8 percent of people in Ozaukee County and 8.6 percent in Waukesha County rated themselves in fair or poor health, compared with 26.6 percent in Menominee County, 19.6 percent in Marquette County and 19.3 percent in the city of Milwaukee, the study found.