NEVADA, Mo. — A person has to scroll a long way down Missouri’s list of health rankings to find Vernon County.

Of 115 counties, it comes in at 88th for overall health.

For premature death, it ranks 95th.

Nevada, the county seat and largest city, also scores poorly in health rankings. The percentage of adults who smoke is more than twice the national benchmark. Obesity and diabetes are problems. The numbers for sexually transmitted infections and for teen births also are double the national rate.

But the city did score well in one category that got the attention of Erik Gallimore, director of rural health programs at Cerner Corp. It scored high marks for its desire to try to turn things around, he said. That’s why the Kansas City-based provider of electronic medical systems selected Nevada as a partner in building a new model of health in rural America.

The goal of the private-public partnership is to determine whether a rural community that ranks low on many health indexes can improve its rankings, help doctors work more efficiently and cut health care costs. Local officials are talking about building new sidewalks and bike trails, offering wellness classes, and encouraging people to swap sodas for apples.

“In five years, we want to go from the bottom third to the top third on the health rankings by the Robert Wood Johnson Foundation,” said City Manager J.D. Kehrman.

Healthy Nevada

Stakeholders from the city of 8,500 people, including representatives of the school district and Nevada Regional Medical Center, are among those who have been meeting this summer to kick off the experiment, called the Healthy Nevada Project.

Heading the group are Tricia Bridgewater, a psychologist who runs a local mental health office called The Wellness Company, and Denise Nelson, a retired director of school nursing.

“We’ll be looking at what do our citizens want to work on,” Bridgewater said. “What do they see as the needs of the community? What can we do to address those needs?”

Cerner’s Gallimore, the project director, and Katie Cox, the project coordinator, have been on the ground in Nevada several times to help local leaders outline a plan.

“For the next several months, we are going to be in planning for a number of events — and not just what is going to happen in the next couple of months, but what is going to happen in the next couple of years,” Gallimore said. “This is not a sprint; this is a marathon. To actually have long, sustainable change, we’ve got to approach it that way.”

Cerner is equipping the hospital — operated by the city and governed by a nine-member board appointed by the City Council — with a $10 million electronic health records system, making it easier to track patients’ health.

“They have proven to us that it should be easy to use, particularly for physicians,” said the hospital’s chief executive officer, Judy Feuquay. “They enter medical information on a touch screen, and the information can be shared among departments. It’s comprehensive.”

The hospital — the city’s second largest employer, with 425 employees — launched its own employee wellness program three years ago. It offers discounts on health insurance for non-tobacco use, and teams up with the local YMCA to provide reduced membership fees as incentives to get employees exercising. The cardiac rehab lab is open after hours for employee use, and classes and screenings are offered with an emphasis on prevention.

“There is internal awareness; these are well-used programs,” Feuquay said. “But it’s time to take it outside the hospital walls.”

Feuquay said the area’s high rates of obesity, diabetes, tobacco use and heart disease are directly linked to lifestyle. She believes that by educating residents, those percentages will, over time, decline.

“The big thing is awareness. It’s all about education,” she said. “We have to create a climate where health is important to us.”

Feuquay said Nevada is not unusual compared with many other rural areas, but she believes the city is unusual because it is making an effort.

“We want to make a change; we want to make a difference,” she said.

Apples vs. soda

At the Community Center, Parks and Recreation Director Dana Redburn envisions adding wellness classes for parents and children, and offering snacks like apples and granola bars at the concession stand, which currently features a menu of candy bars and soda.

“My vision is to provide our community with all of the tools they need in their toolbox for a healthy lifestyle,” Redburn said. “It could be as simple as demonstrating how many teaspoons of sugar are in a Mountain Dew. Then people might say: ‘Oh wow, this is what I’m putting into my body.’”

Bridgewater wants to keep the project fun by pairing health screenings and nutrition tips with friendly competitions that offer prizes for such things as walking and weight loss. She envisions working with local restaurants and grocery stores, as well as the farmers market, to promote healthy choices.

The city of Nevada, where a sales tax for parks and recreation recently was approved, is discussing improvements such as sidewalks, and biking and hiking paths. Additional funding may be available through grants, officials said, because of the new initiative.

“It’s opening doors, a week or so out of the gate,” said Kehrman, the city manager.

‘Individual choice’

Nevada resident Mark Mason, 61, said he believes the project isn’t necessary, and that individuals should take the initiative to improve their own health.

“As far as health goes, people have to take that on themselves and not be dependent on the city or the government or a group,” he said. “I think this is a problem across rural America. But it’s an individual choice not to rely on an entity to get you healthy. There are walking paths at Walton Park and Radio Springs. There are fast-food choices we could say ‘no’ to. We have the choice as individuals, and I think it’s up to us to take the initiative.”

By contrast, Kelsey Harrison, a junior at Nevada High School, said she notices people around town who “could lose a few pounds” and who need motivation.

“Motivation is the key. I think we need it here,” she said. “It’s not something you hear much about, other than maybe a few little posters at the YMCA.”

In addition to reversing poor health indicators, the Healthy Nevada Project also aims to decrease by 10 percent the current health care spending in Vernon County. That can come from decreasing the demand for services by placing an emphasis on health, wellness and prevention, according to the project leaders.

According to an analysis by the Robert Wood Johnson Foundation, for example, the area far exceeds the national benchmark in the number of preventable hospital stays each year. Feuquay said that by making mammograms and diabetic screenings accessible and encouraging people to have them, those numbers could be reduced.

Jeff Townsend, Cerner executive vice president, said a project of this size and scope has never been done before.

Feuquay said that if the project is deemed a success, the model could be transferred or generalized to other rural communities.

“Our success will make it easier for other communities to do the same thing,” she said. “The worst thing we could do is end up the same. We have everything to gain.”

Health rankings

Physical inactivity

Vernon County    32 percent

National    21 percent

Missouri    28 percent

Children in poverty

Vernon County    27 percent

National    13 percent

Missouri    21 percent

Adult obesity

Vernon County    34 percent

National    25 percent

Missouri    31 percent

Source: Robert Wood Johnson Foundation