FORSYTH COUNTY — For the fourth year in a row, Forsyth has been ranked the healthiest county in Georgia.

The County Health Rankings, a study conducted annually by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, placed Forsyth at the top of the list that examined factors including quality and length of life.

Those two factors determine a county’s health outcomes ranking, while a health factors ranking includes statistics on health behaviors — smoking, obesity, drinking, etc. — access to clinical care, social and economic factors and physical environment. The last category includes air pollution, long commutes and driving alone to work.

“It shows where our priorities are, in quality of life,” said Brian Tam, Forsyth County commissioner for District 2 in south Forsyth. “The county has tried to do its job with regard to amenities and recreational entities, the greenway, fields, the trail systems we have … They are amenities that will last for generations.”

Forsyth’s top ranking also was due to factors such as low rates of premature death and the amount of people reporting their physical and mental health as poor.

The higher-ranked counties mostly fell in the metro-to-northeast Georgia region, with Oconee, Fayette, Harris and Gwinnett counties filling out the top five.

Among Forsyth’s neighbors, Gwinnett was the closest, followed by Cherokee at sixth, Dawson 13th, Hall 14th and Fulton 25th.

Forsyth recorded 4,200 premature deaths in 2015, compared to the statewide average of 7,300.

While the state average of people saying they were in poor or fair health was at 17 percent, just 12 percent did so in Forsyth.

Along those same lines, 7 percent of Forsyth’s babies were born with a low birthweight, while the Georgia average was 9 percent.

“[The ranking] speaks to the quality of our health care system even more so,” Tam said. “Northside is just second to none, as well as Children’s Healthcare of Atlanta. [Northside has] continued to expand as our population has expanded.”

From the outside looking in, from the top administration levels of the hospital, and even from Ga. 400, the growth of the local hospital is evident.

“Northside Hospital-Forsyth has undergone near-continuous construction since Northside purchased the hospital in 2002,” said Lynn Jackson, administrator of the Forsyth location. “Now we’re adding three additional floors, which will increase our inpatient and observational beds.”

Jackson said those additional floors should be operational by October. However, she noted there is always room to improve.

Forsyth County came in third in health factors behind Oconee and Fayette counties.

“Thirteen percent of Forsyth County residents smoke, one in five admits to being physically inactive and more than a quarter are obese,” Jackson said. “Those are never good numbers, no matter where we place on the list.”

Cherokee County came in sixth in this category, while Dawson came in 15th, Hall in 25th, Gwinnett in 11th and Fulton in seventh.

Forsyth still remained above the state average in most of these categories.

While 21 percent of Georgia residents reported being uninsured, 14 percent of Forsyth residents did.

And the county generally has a higher high school graduation rate, fewer children in poverty and less violent crime than most of the state.

However, Forsyth did come in 146th out of 159 in physical environment, with all of metro Atlanta ranking in the 100s and worse.

Most — 80 percent — of Forsyth residents drive to work alone, just more than the state average of 79 percent, and 48 percent have a long commute, compared to 39 percent statewide.

“As health care providers, we are constantly challenged with how to reach patients and encourage them to make changes that support healthy living,” Jackson said.

“We offer smoking cessation classes and screenings for cancer, heart disease and stroke at the hospital throughout the year. Our mobile mammography van, corporate health fairs and other community partnerships increase the convenience of health care, allowing us to take our services to the community.”