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  • The lagoon at the Marin County Civic Center in San...

    The lagoon at the Marin County Civic Center in San Rafael, Calif., on Tuesday, March 19, 2019. (Alan Dep/Marin Independent Journal)

  • Yoga instructor Stacie Dooreck leads a chair yoga class for...

    Yoga instructor Stacie Dooreck leads a chair yoga class for elderly at the Intergenerational Center in Corte Madera, Calif. on Tuesday, Nov. 20, 2018. (Alan Dep/Marin Independent Journal)

  • Yoga instructor Stacie Dooreck leads a chair yoga class for...

    Yoga instructor Stacie Dooreck leads a chair yoga class for elderly at the Intergenerational Center in Corte Madera, Calif. on Tuesday, Nov. 20, 2018. (Alan Dep/Marin Independent Journal)

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Marin has been rated the healthiest county in California by the Robert Wood Johnson Foundation for the ninth time in 10 years.

The annual rankings compare California’s 58 counties on more than 30 factors that influence health including length of life, quality of life, health behaviors, access to health care, socioeconomic factors and physical environment. The years of data used to create the rankings vary by data category.

“The rankings highlight what so many of us love about living in Marin,” Dr. Matt Willis, Marin County’s public health officer, said in a statement. “We have great access to green space and opportunities for physical activity, nutritious local foods, and high-quality health care. All these things contribute to health and longevity.”

According to the new report, Marin and Santa Cruz counties are tied for first place when it comes to the number of residents who are physically active. Only Santa Cruz County has fewer obese residents than Marin. And Marin is tied with four other counties for the third-lowest percentage of residents who smoke tobacco, 10 percent.

“One of the healthiest habits in Marin is a strong history of policies designed to protect health,” Dr. Kim Newell-Green, president of the San Francisco Marin Medical Society, said in a statement. “The recent decisions to prevent the sales of flavored tobacco and vaping products is a clear example.”

Not all of Marin’s habits are healthy, however. The survey ranked Marin 48th, near the bottom, based on the number of adults who reported binge or heavy drinking.

In the category of life expectancy, Marin led the state.

“We can be lulled into a false sense of superiority by looking at averages when we look at something like life expectancy,” Willis said. “When we dig under the surface, we see there are large differences within the county.”

The study provides plenty of examples.

African-Americans in Marin lost twice as many years to premature death, defined as death before age 75, as white Marin residents. African-American babies born in Marin are twice as likely as their white counterparts to have a low birth weight. Hispanic teens in Marin are nearly 30 times more likely than a white teen to give birth.

White women in Marin receive mammograms at twice the rate of African-American women living in Marin. And 25 percent of Marin’s Hispanic children live in poverty compared with 12 percent of Marin’s African-American children and 3 percent of Marin’s white children.

“When the disparities start at birth and persist into adulthood, it’s no wonder we see differences in life expectancy between racial groups,” Jenny Chacon, the Marin County health department’s chief strategy officer, said in a statement.

Chacon is overseeing implementation of the health department’s newly debuted, “Strategic Plan to Achieve Health and Wellness Equity.”

“The first step is acknowledging that race matters in Marin,” Chacon said, “and that we all have work to do to raise the bar for all families.”

The strategic plan calls for the county to go beyond providing traditional health care and commits the health department to taking a leadership role in helping to change inequitable conditions such as economic and housing insecurity, lack of educational attainment, trauma and fallout from climate change.

The analysis that accompanied this year’s health rankings by the Robert Wood Johnson Foundation emphasizes the role that high housing costs play in determining people’s health. For example, it notes that among California’s children living in poverty, 65 percent were living in a household that spends more than half of its income on housing.

“It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing,” Dr. Richard Besser, the foundation’s president and CEO, said in a statement. “This leaves them with fewer dollars to keep their families healthy.”

According to the new report, among California’s 58 counties, Marin ranked 39th in housing cost burden and 54th in income inequality.