Roanoke is surrounded by localities with populations that are significantly healthier, according to a report released Wednesday that ranks nearly every city and county in the nation.

The counties of Roanoke, Franklin, Montgomery, Floyd, Craig, Botetourt and Bedford and the city of Salem all ranked as healthier than Roanoke. Among those, Craig County outranked the others, coming in as the 20th best in the state.

Roanoke County was 29 and Montgomery County was 39. By comparison, Roanoke ranked 116.

Dr. Stephanie Harper, health director for the Roanoke City Health Department and the Alleghany Health District, said the results are not surprising and can be used to involve the public in addressing the factors that caused the city's low ranking.

"This is truly about community mobilization," she said. "I think it is a snapshot, and I think it is useful information because it gives us an opportunity to think through and see how best to mobilize as a community."

The County Health Rankings are based on how long people live and how healthy they are when factors such as smoking, obesity, binge drinking, education and access to primary care are considered. The rankings, which were released Wednesday by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, are the first of its kind to analyze health for nearly every county in the country. The Virginia rankings included 132 localities, but do not include Lexington or Highland County.

"For the first time, people have a tool to help identify what is making people in every county unhealthy," said Dr. Patrick Remington, associate dean for public health at the University of Wisconsin School of Medicine and Public Health in a news release.

The healthiest place in Virginia was Fairfax County, and in general the counties in Northern Virginia ranked much higher than those in the rest of the state.

Dr. Jody Hershey, health director of the New River Health District, which includes Montgomery County, said that in general the further west you go the worst the health outcomes are in the state.

"These are rural areas, they have less resources, access is an issue," Hershey said. "Individuals in rural areas such as Southwest Virginia don't have the resources that are available in other parts of the state."

Buchanan County, which straddles the West Virginia and Kentucky state lines, ranked the lowest in the state.

Hershey cautioned that the rankings, while helpful, are just a snapshot of a very complex situation. He said health outcomes are based on a combinations of environmental, genetic, behavioral, economic, educational and access care.

Hershey also noted that anything that causes people to die before age 75 accounted for 50 percent of the overall rating. That means that areas with high levels of diabetes, heart disease and infant mortality would receive a worse rating.

While the overall health ranking offers one picture of the situation, the report also ranked localities on a number of subcategories. The results varied significantly, with some localities that ranked high seeing a low ranking in certain subcategories. For instance, Roanoke's clinical care, which included things such as hospice use, access to primary care and uninsured adults, ranked 37th in the state. Montgomery County ranked 127th in clinical care.

Researchers noted that the results in general show that people who live in healthier counties tend to have higher education levels, are more likely to be employed, have access to more health care providers, and have more access to healthier foods, parks and recreational facilities.

Harper echoed this finding, suggesting that a need to focus on education, housing and law enforcement issues all could help raise the health of the city.