For the second year in a row Dukes County comes out on top in a statewide health ranking. Islanders, it seems, have low rates of premature death and obesity, and the Vineyard rates high when it comes to recreational facilities and low in fast-food options. But in some health measures, the picture is not so rosy. Dukes County (which consists of Martha’s Vineyard and the Elizabeth Islands) had the highest number of residents reporting excessive drinking, and the highest number of those uninsured. Both measures, some said, could be attributed to the seasonal culture.

The County Health Rankings data were released this week by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, ranking the health of almost every county in the country.

Dukes County was ranked first out of Massachusetts’s 14 counties on “health outcomes,” an overall rank that takes length and quality of life into consideration. Martha’s Vineyard has the lowest rate of premature death in the commonwealth. In a category that includes health behavior and socioeconomic factors, the Vineyard came in fourth.

The rankings are compiled using data from the National Center for Health Statistics, Behavioral Risk Factor Surveillance System, the Bureau of Labor Statistics and several other organizations. When it comes to quality of life, the number of babies born with a low birth weight and people reporting overall poor or fair health are below the state and national averages. The Vineyard has the highest graduation rate in the state at 93 per cent, and the second lowest violent crime rate, with 217 violent crimes per 100,000 people. According to the data, there were 35 violent crimes in Dukes County annually.

The Island also boasts the highest rate of recreational facilities per 100,000 residents. On the flip side, the Vineyard has the lowest number of fast food restaurants in the state — 15, or 21 per cent of all restaurants.

In perhaps a related measure, Dukes County has the second lowest adult obesity rate in the state, at 19 per cent.

However, the average number of people reporting poor physical and mental health days was higher in Dukes County than it was elsewhere in the nation and the country: 3.7 per cent of residents reported poor physical health days in the last 30 days, compared with a 3.2 per cent state average. And 3.4 per cent of respondents reported poor mental health days, compared with 3.2 per cent average in the rest of the state.

The Vineyard also scored below the state average when it came to water safety, with 28 per cent of the population getting water from a public water safety facility with at least one health-based violation. The state average was eight per cent.

Statewide, the Vineyard reported the highest rates of excessive drinking: 28 per cent of the adult population reported binge drinking (consuming four or five drinks on one occasion in the last 30 days), or heavy drinking, which is drinking one or two drinks a day on average.

Theresa Manning, coordinator for the Martha’s Vineyard Youth Task Force, said the high rates of adult drinking is something the task force considers when trying to address underage drinking, and could be tied to the Vineyard’s high tourism rates.

“Part of the culture of the Island is built around recreation, so that concern is something that on many planes adults are dealing with,” she said.

“That’s really important information for us to have to guide our work,” she said of the drinking rates.

The number of those without health insurance was also the highest in the state, tied with Nantucket: eight per cent of people under 65 do not have health insurance.

“Probably the number one reason is the seasonal nature of employment on the Island, and the fact that people have fewer jobs through large employers that offer insurance than in urban communities,” said Sarah Kuh, director of the Vineyard Health Care Access Program, which helped 3,300 people enroll in insurance programs in 2012.

She also cited a large number of small businesses and people who are self-employed who might not purchase health insurance because they can’t afford it, and said the immigrant community could also be a factor. To qualify for state insurance programs, one has to prove citizenship. Others might not be aware of programs available to those without employer-provided insurance, she said, and some people are involuntarily un-enrolled from insurance programs.

Another factor, she said, is an affordability gap tied to the cost of living on the Island: people who earn too much income to qualify for subsidized plans but don’t get insurance through their employers. And unless they are particularly well-off, she said, they may not be able to afford high monthly premiums for private health care, “particularly because the cost of living is definitely higher than the mainland.”

“When people are uninsured, they don’t seek preventative health care at the same rate as people with health insurance,” she said. “Obviously the ability to get medical care in a timely manner affects people’s health.” For example, she said, people might not get needed medications, like insulin for diabetes.

She also noted another statistic from the county rankings that shows a low ratio of dentists to residents. There are 1,858 residents per dentist on the Island, with nine total dentists. The ratio, lower than the state average of 1,222 people per dentist, is “somewhat striking,” she said. “It doesn’t surprise me because it’s a huge issue for people.”

“I like the fast food restaurant [number],” she added. “That’s definitely good for our health.”