Sonoma County's clean air and low crime rate are pluses, but adult smoking and excessive drinking pulled down the county's ranking Tuesday on a national scorecard of community health.
Sonoma was ranked as the 12th healthiest county in California based on how long residents live and their quality of life, according to the report, which rated more than 3,000 counties nationwide.
Fifty-six of the state's 58 county's were evaluated.
Marin and Santa Clara counties ranked first and second statewide, with a third Bay Area county, San Mateo, in the top five of the 2012 County Health Rankings released Tuesday by the Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.
"I'd say we're in the top echelon," said Dr. Walt Mills, president-elect of the Sonoma County Medical Association. "On balance, we do better than most."
Mills, a Kaiser Permanente family medicine physician in Santa Rosa, said the rankings confirm that where one lives is "one of the biggest determinants in health."
"The trend is that Sonoma County has a lot going for it," he said.
Peter Rumble, director of health policy for the county Department of Health Services, said there were no surprises in the rankings, which rated counties on 29 factors, including health and behavior as well as economic, social and environmental issues.
Sonoma County's ranking is positive, he said, but "we know there are areas that we can improve."
The county's goal, Rumble said, is to "be the healthiest county in California by 2020."
Sonoma County also was 12th in last year's health rankings and ninth in 2010.
On two behavioral factors - adult smoking and drinking - the county fell below the statewide average.
Statewide, 14 percent of adults smoke and have consumed more than 100 cigarettes, compared with 15 percent in Sonoma County, the report said.
Excessive drinking, including binge drinking and regular heavy drinking, involves 17 percent of adults statewide and 21 percent in the county.
The county's level of adult obesity - a body mass index of 30 or more - is 23 percent, just 1 percent less than the statewide level.
The local rates of smoking, drinking and obesity are "higher than we want them to be," Rumble said.
In such factors as education and health insurance, Sonoma County beats the state average but still has a problem, said Dr. Mary Maddux-Gonzalez, chief medical officer and interim CEO of a collection of clinics and health centers known as the Redwood Community Health Coalition.
While 77 percent of the county's ninth-graders graduate from high school in four years - 3 percent better than the state rate - 23 percent don't graduate, and the number is higher among low-income and Latino families, Maddux-Gonzalez said.
"That's unacceptable," she said, noting education is a "strong determinant" of health.
Local health clinics are seeing an influx of uninsured patients, she said, despite the ranking that said 16 percent of residents under age 65 have no insurance, compared with 20 percent statewide.
The rankings also highlight some public health successes, such as teen birth rate (26 per 1,000 females here compared with 40 statewide) and sexually transmitted infections (180 cases of chlamydia per 1,000 population here and 399 statewide).
The rankings for the first time included the percentage of fast-food establishments among all restaurants, finding 38 percent in Sonoma County and 49 percent statewide.
Rumble said it is important to include behavioral, socioeconomic and environmental factors in a community health ranking.
"What happens in a doctor's office is 10 to 15 percent of what makes you healthy," he said.
In the North Bay, Napa County ranked 14th, Mendocino 39th and Lake County 52nd. Del Norte and Trinity counties had the two lowest health rankings.
UPDATED: Please read and follow our commenting policy: