Sarasota County continues to ride high as a very healthy place to live in Florida, according to the ninth annual national analysis of 30 elements that determine longevity and well-being, known as the County Health Rankings and Roadmaps.

The report suggests that we could do better, however, given our fortunate circumstances: The county came in second to St. Johns in terms of the social and economic factors that contribute to a long and healthy life, but sixth — after St. Johns, Collier, Martin, Seminole and Miami-Dade — when it comes to the actual health of our residents.

In this compilation of data by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute — intended to help county-level public health officials track their performance and plan improvements — the actual rankings fluctuate slightly from year to year, but overall patterns are difficult to budge. Sarasota County has consistently remained near the top in Florida since 2010, and on a par with the highest performers nationally.

Manatee and Charlotte counties have also earned scores that are above average for the state. Manatee ranks 23rd this year in health factors, but an impressive No. 17 in outcomes. Charlotte is No. 17 in factors and 27th in outcomes.

One especially relevant measure in this complex interplay of data is the "quality of life" metric, which takes into account residents' self-reported days of sickness and health — as well as birthweights, which are a reliable statistical shorthand for a community's overall well-being. By this standard, Sarasota County ranks fifth in the state, Manatee is seventh and Charlotte is 18th.

While health outcomes can depend on individual circumstances and choices, the purpose of the county rankings is to encourage local leaders to invest in changes that will drive better health and longevity results for the population as a whole.

"Social and economic factors, like connected and supportive communities, good schools, stable jobs, and safe neighborhoods, are foundational to achieving long and healthy lives," the 2018 report's authors write. They "impact our ability to make healthy choices, afford medical care or housing, and even manage stress leading to serious health problems. The choices we make are based on the choices we have."

The rankings are compared by state instead of nationally because many health decisions at the state level, such as spending on education and Medicaid programs, place constraints on the improvements each community can make. For example, a lackluster high school graduation rate across Florida of 78 percent, as well as a high level of residents who lack health insurance — 16 percent — are reflected in the statistics for Sarasota, Charlotte and Manatee.

Sarasota County's impressive "quality of life" showing is offset in the rankings by its share of premature deaths, which is slightly better than the state average but much worse than the nation's as a whole. This may seem surprising in a community where so many residents live to be 100 or more, but the county's measures in the areas of excessive drinking, alcohol-impaired driving deaths and injury deaths may provide an important clue.

Manatee County's health issues that merit attention, according to the report, include adult obesity and smoking rates, teen births, injury deaths and violent crime. For Charlotte, smoking and obesity are also highlighted as problems, as well as a higher-than-average number of children living in poverty.