Howard County helps lead Maryland as the second-healthiest county in the state, according to an annual study by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The county came in first the first three years of the survey, from 2011through 2013, but for the past five years has come in second to neighbor Montgomery County.

The survey showedwealth asone of the biggest determinants of community health. In 2017, the U.S. Census Bureau ranked Howard County as the fourthwealthiest county in the country based on median household income. Montgomery County ranked19th.

Forsome, thatsuggestsHoward County should still be No.1.

“Really, Howard County should be beating the pants off of Montgomery and we’re not, so the message is we really need todoubledownonhealthinthecommunity,” said Nikki Vernick, CEO of Columbiabased community health nonprofit the Horizon Foundation.

“In many ways, because of our wealth and affluence and educational status, we should be doing better than the rest of the state,” she said.

Thesurvey, releasedlastweek, lookedat 30 factors that contribute to overall community health, including access to clinical care, physical exercise, air pollution, poverty levels and obesity.

Elizabeth Kromm, vice president of Population Health and Advancement at Howard County General Hospital, called the survey a “playbook” to show counties what they’re doing well and how they can improve.

“Do we have that foundation in place for people to achieve healthy lives?”

Kromm said.

While the county has done well at investing in public health infrastructures suchasaccesstoclinicalcare, Krommsaid, more is needed to improve access to other things that influence overall health, such as affordable housing. It’s a problem that she said plagues both younger families in thecountyandtheelderly, whomaynotbe able to afford necessary modifications to their homes to make them safe.

Fourteen percent of county residents suffer from “severe housing problems” according to the survey, which includes overcrowding, high housing costs or lack of kitchen or plumbing facilities. Both MontgomeryCounty andthestateaverage is17 percent.

“When housing isn’t affordable and there are multiple families living in a single family unit, that is not great for good health,” Kromm said. “If you’re spending more of your income on housing, then you have less left in terms of savings, maybe some other things to make healthier choices.”

The County Council approved legislation in February making it easier to build affordable housing units in other-