BY EMERSON SMITH

How do hospitals rate in Charleston? If you want to check on ratings of a specific hospital in the Charleston area, you'll find a variety of rating sources on the Internet, such as Hospital Compare, Leapfrog Group, Healthgrades, US News and World Reports, Carechex and Consumer Reports, sometimes giving different ratings for the same hospital on incomparable scales. And then there are blogs and tweets about hospitals. It's confusing.

Does a high rating for one hospital, like MUSC University, and a lower rating for others mean that you should go to MUSC and avoid the lower rated hospitals? Probably not. It's complicated.

Most people don't look at hospital ratings, don't pay attention to hospital websites and don't choose their hospital. It's most likely a physician who recommends or selects a hospital for you or me. In fact, depending on your health issue, one hospital is best for someone who has a severely injured head in an automobile accident while another might be best for identifying a stroke, and still another might be best for treating diabetes. And another might be best for delivering babies. Ask your doctor. Ask a nurse. It varies.

However, the rating that should be most important to people in Charleston is health outcomes, as measured by "healthy" longevity rates: that is, how long people live a healthy, high-quality life. Most people don't aspire to be the oldest person in South Carolina's oldest city unless they can be alert, active and happy in their daily lives.

What factors, other than getting long-life genes from your parents, lead to long happy lives? You know the answers. Quit smoking or do not start. Lose weight. Be physically active. Have a diet low in sugar but full of vegetables and fruits. Drink plenty of water. Get plenty of sleep. Drink alcohol in moderation, if at all. Be a positive example to children.

A Robert Wood Johnson (RWJ) study in 2013, "F as in Fat," shows 31.6 percent of South Carolinians as obese, the seventh fattest state in America. In 2014, RWJ says the adult obesity rate is 39.0 percent in Berkeley County, 29.0 percent in Dorchester County, and 28.0 percent in Charleston County.

Local groups are working to reduce obesity and improve the health of the community, including the Charleston County School District.

But the primary players in creating healthy communities are our hospitals. Within the provisions of the Affordable Care Act is the responsibility of a hospital to improve the health of the population, not just to fix people when they get sick. Even as more people get health insurance, hospitals have a financial interest in having healthier people in the community who are more likely to see a primary care physician during the day than to come directly to the hospital's emergency department at midnight. More hospitals have a financial incentive to prevent illness, reduce disease in the community and promote a healthy lifestyle - as a part of the health care delivery system.

That's a dramatic change in the role of hospitals. But because it is tied to reimbursement, linked to the bottom line and the right thing to do, hospitals will take more time working within the community while still providing acute care in the hospital.

In the near future, we will rate our hospitals primarily on the health status of the people in Charleston. Hospitals won't be working alone. They will be working with schools, banks, restaurants, grocery stores, recreational groups, churches, small businesses, major employers, public health agencies, clinics and other hospitals to get rated and reimbursed as hospitals that have the healthiest, thinnest, happiest and longest living people in specific geographic areas.

Let's work with our hospitals to set a goal to get South Carolina out of the top ten fattest states in the next five years, to increase life expectancy at birth from 77 to beyond the national average of 78.6, and to assure that those who live long live well.

Emerson Smith, PhD., is a medical sociologist, president of the Metromark Healthcare Research Center in Columbia and a clinical research assistant professor of internal medicine in the School of Medicine, University of South Carolina. He can be reached at emsmith@metromark.net.