ATLANTA — The statistics are sobering and clear: Across the U.S., obesity, cancer and a slew of other health problems hit African-Americans harder than whites, ultimately cutting short millions of lives.

Fueling the cycle of disparity almost assuredly are factors dating to the founding of the nation itself: slavery, racism and discrimination that have led to segregation, creating communities that are separate and unequal in nearly every aspect of society that feeds into health, from poverty and education to housing and public safety.

“Residential segregation is as American as apple pie,” says David Williams, a public health and African-American studies professor at Harvard University. “It has these pervasive negative effects of producing social inequality and putting caps on the achievements and opportunities of African-American communities. … Virtually everything that drives health and opportunities to be healthy in American life is determined by place.”

An analysis of U.S. News Healthiest Communities data – used to assess the well-being of nearly 3,000 counties nationwide, and consisting of dozens of metrics that extend beyond insurance coverage and doctors’ visits to social determinants of health such as income, food accessibility and natural environment – reinforces this disturbing conclusion, as communities with larger shares of black residents tend to score and rank lower than those with larger shares of white residents.

Yet there are signs of progress and hope. Of 682 counties with a black population share above the nearly 13 percent national average, 75 land among the top 1,000 Healthiest Communities overall. Among them are four Georgia counties – Cobb, Columbia, Fayette and Paulding – featuring common threads that have helped propel them into the upper tier.

Though these four counties are distinct – Cobb, Paulding and Fayette surround Atlanta but vary in size, while Columbia lies 130 miles east of the city known as the South’s “black mecca” – their residents have access to jobs and high incomes. Many also hold college degrees, indicating some economic and education factors can be more critical than race when it comes to predicting health outcomes.

Of course, even in counties that have larger African-American populations and appear to be doing better than anywhere else, longstanding Southern traditions and racial tension aren’t absent, shaping the nuanced roles race, affluence and other social factors play in creating a community’s overall quality of life.

“So I think the apparent contradiction is best understood in light of the economic, educational and social opportunities for African-Americans in Atlanta, which has attracted high-achieving individuals from all over the country and supported its own. This population is spilling over into neighboring counties such as Cobb and Paulding,” she says.

That’s also been the case in Fayette and Columbia counties. But by visiting and talking with locals in all four places, it becomes clear that their health and well-being hinge on some relative intangibles as well: a sense of community, and a dedication to improving life for all.

Scan the numbers and interview experts, and it’s easy to find consensus: African-Americans who live in Paulding County and have above-average health outcomes probably have a good job and own a home – and likely moved there from somewhere else.

Count Marc Townsend among them.

“It’s a different kind of living out here. It’s nice, it ain’t bad,” says Townsend, proprietor of Barber World & Salon, a comfy and thriving tonsorial center in a converted house with three rooms, three chairs and four waiting customers on a recent weekday afternoon. He says there’s a lot to like in the community – leafy parks, decent schools, plenty of trees and a laid-back, exurban lifestyle.

But the list of positives, Townsend says, starts with housing.

“I know people who live in Cobb who come to buy a house out here because the prices are so good,” says Townsend, a former New Yorker who moved to Paulding by way of Atlanta around 16 years ago. “When I bought, the same-design home was $450,00 in Cobb County. Mine was $220,000.”

Paulding added more than 4,000 new residents to its rolls between 2016 and 2017, placing it among the fastest-growing counties in the state. Homes this summer had a median sticker price of about $227,400, compared with the $335,000 median price tag in the city, according to Zillow, the online real estate hub. Newly built gated subdivisions, with names like Regency Park and Darby’s Run, have sprouted like kudzu along the forest-lined U.S. 278 corridor.

Indeed, Paulding County slightly outperforms other communities with high-performing economies and above-average shares of black residents in housing capacity – a measure encompassing the availability of affordable housing for low-income people and the percentage of overcrowded households – according to an analysis of data compiled by U.S. News. Analysts consider stable housing – and thriving communities – drivers of improved health outcomes.

But while Paulding County’s black population is substantial at approximately 20 percent, the county is still largely white. And to be black and live in Paulding, several people say, is to live with the tension between the county’s halting racial progress and its lingering, bigoted past.

“You can have a relatively high income, but your cost of being a minority can be very expensive,” says the Rev. C.L. Day, an official with the West Metro Branch NAACP, which serves Paulding and Douglas counties. “There are some troubles there.”

Several residents, including Townsend’s waiting customers, say they’re used to seeing Confederate flags flying, people sporting Ku Klux Klan regalia and police racially profiling black motorists. Yet Townsend and other African-Americans say the blatant racism residents faced under Jim Crow has mostly receded.

Chuck Maxwell, 57, a short-haul truck driver and Paulding native, says discrimination is still around, but “you have to know where to go and not go.” He also exemplifies another apparent phenomenon: the differences between the health of “legacy” residents – African-Americans who have lived in Paulding since childhood – and transplants who moved to the area as adults.

Notably, Paulding scores poorly on Healthiest Communities metrics assessing access to health care, with a low availability of both hospital beds and primary care physicians.

“Just living in and around Paulding County don’t make you healthy,” says Maxwell, whose tidy home sits on an acre of wooded land in a mostly African-American enclave near the Douglas County border. “I been to 25 funerals this year, and this year ain’t over. People younger than me, people older than me. Cancer, aneurysms, blockages.”

“Some people say, ‘Aw, you got a little gout. Oh, you got some arthritis,'” says Maxwell, who underwent surgery to open clogged arteries in his legs a few years back and lost his wife to cancer in 2015. “No – go to the doctor, see what it is. Paulding County ain’t no different than anywhere else. Something bothers you, you need to go see about it. That’s the key.”

Mark Anthony Alexander was born in 1956 in Los Angeles to parents who, like so many other black Americans, were pushed from the South by racial hostility and pulled elsewhere by economic opportunity.

“My mom was born in Fayette County, but they left because of the racism and segregation,” says Alexander, an independent hairstylist and lead singer in The Upscale Band, which performs in the Atlanta area. “Everybody went west to have a so-called better life.”

Alexander visited the Atlanta area when he was 15 to meet his grandmother. In 2000, he found his way back permanently to Fayetteville, the Fayette County seat, once again following a migration of African-Americans – this time to the region rather than from it.

Today, about a quarter of Fayette County’s 112,500 residents are black, a share greater than the national average but below that of most of the surrounding counties. Yet Fayette’s population growth in recent years has been driven by African-Americans moving there, U.S. Census Bureau estimates show: Between 2010 and 2017, the black population grew by about 23 percent while the white population stayed relatively stagnant.

A combination of social factors have helped shape the county’s above-average performance in Healthiest Communities measures such as life expectancy, preventable hospital admissions and healthy food access.

Nearly half of adults in Fayette have at least a bachelor’s degree, and about 40 percent of households earn $100,000 or more annually, census estimates show. Public schools rank among the best in the state, Atlanta is close by, and the city’s international airport is even closer.

“Fayette County, because of its proximity to Atlanta, is a nice landing spot. We have people who are CEOs of companies, own their own businesses, some sports figures and some actors, but also just people who are doing well,” longtime resident Dawn Oparah says. “Then there are people who have retired here for the same reasons. … When crime rates are low and schools have good scores, it indicates it’s a good community to live in.”

The county also is home to an abundance of medical facilities, and most people have access to health care: Just 7.7 percent of all residents – 6.6 percent of black residents – were uninsured in recent years, according to census estimates.

And where affluence, knowledge and access to care go, health follows, residents and public health experts say.

“They are willing to invest in their health and well-being,” says Fayette County Commissioner Charles Rousseau. “You’ll find them being health-conscious – they avail themselves of exercise, medication, proper treatment and monitoring their overall health status.”

Rousseau’s election in 2015 was its own marker of change, representing sustained victory in a yearslong civil rights lawsuit between the county and the NAACP over how the county elected its representatives. In 2014, the county was forced to abandon its exclusive use of at-large voting, which the NAACP said disenfranchised black voters.

The lawsuit, debate over a controversial town mural depicting a Confederate soldier and people picking cotton, and a since-nixed plan to proclaim April “Confederate History and Heritage Month” illustrate that while Fayette County may be one of America’s healthiest communities for African-Americans, it’s not immune to the identity crises and tensions confronting communities across the U.S.

Still, Carolyn Edwards, a retired Johnson & Johnson manager who moved to the county in 2006, says black residents feel less “invisible” as the area diversifies and race issues increasingly enter the spotlight.

“Fayette County always has been a sleepy bedroom community, which means the status quo has always been maintained,” says Malcolm Hughes, a certified public accountant who has lived in the county for more than two decades and serves with Edwards on the local NAACP chapter’s executive committee.

“That’s starting to be challenged and naturally there’s some resistance, but it’s a matter of time before things change,” Hughes says.

Residents point to the area’s high level of political and civic engagement as one of Fayette County’s strengths. Despite the relatively few people in need compared with neighboring areas – approximately 6 percent of residents were below the poverty line in 2017, according to census estimates – the county has hosted roughly twice the number of nonprofits per capita than the state median, U.S. News data show.

One such nonprofit, the Fayette CARE Clinic, provides free primary and specialized care for more than 750 uninsured and low-income adults. And the Real Life Center, which also serves neighboring Coweta County, gives food and clothing to families in need and helps them with financial planning and goal-setting.

Both organizations are staffed largely by volunteers who say tight coordination among the area’s nonprofits ensures people get the services they need, regardless of whether they have the means to pay.

“We do a lot to close up the gaps,” says Oparah, who has served in leadership roles for several of the county’s nonprofits. “Because we want to keep our community healthy, we’re always doing an environmental scan and seeing what we can do to improve it. I think that’s always top of mind.”

Adriane Randolph chose to trade a comfortable home in an urban neighborhood close to Atlanta for the suburbs, in part because of options – or more precisely, a lack of them.

As a denizen of College Park, a mostly black enclave of single-family homes just southwest of the city, Randolph, who is African-American, noticed the restaurants nearby didn’t serve much that wasn’t fried, and the shelves at the closest grocery store were lacking.

Stopping to pick up a few things on her 45-minute commute from work at Kennesaw State University, “I would notice distinctly different produce, different offerings,” Randolph says. It spurred an epiphany: Supermarkets, she concluded, really do shortchange some communities in favor of others.

“I thought it was a myth,” says Randolph, an information systems professor at Kennesaw State. “I was, like, ‘What? Black people don’t like sparkling water?'”

That was in 2008. The next year, Randolph and her husband relocated north to Vinings, a leafy, affluent and integrated community in Cobb County, just over the Chattahoochee River from the Atlanta city limits. They joined the ranks of newcomers drawn from the city by the county’s new, upscale amenities, along with its good jobs and good schools.

“Everything is here,” says Randolph, ticking off resources within walking distance of her three-bedroom home: shopping, restaurants and even the dentist who treats her family. Her gym (“I do Zumba four times a week,” she says) is on her considerably shorter 20-minute commute.

Randolph – an educator and mother of two – personifies what data suggest: As a white-collar worker and holder of a doctorate, she’s likely to have better overall health.

She also comfortably fits the statistical profile of a Cobb County resident.

According to five-year census estimates, the median household income for Vinings, Randolph’s community, is approximately $75,500, far above the state’s $51,000 and higher than the countywide income of $68,800. Transplants like her fueled Cobb County’s growth, with the total population ticking up an estimated 10 percent between 2010 and 2017. Randolph owns the home she lives in, as many do in a county with a homeownership rate of 64 percent. The median price tag in Vinings this summer was just shy of $400,000. (Randolph says she and her husband paid $500,000 for their three-bedroom house in 2009, adding that she’s seen neighboring homes with price tags approaching $1 million.)

The affluence enjoyed by Cobb residents like Randolph is a far cry from Cobb County’s roots.

Established on Cherokee land in the early 1800s, early residents of the county were subsistence farmers and townspeople, and few residents owned slaves. Nevertheless, Cobb saw its share of Civil War fighting, including the Battle of Kennesaw Mountain in 1864, a Confederate victory. As in other localities in the Deep South, Jim Crow was in effect in the ensuing years, and Leo Frank, a Jewish factory superintendent, was lynched in Marietta in 1915 – a murder that made national headlines.

As civil rights advanced, however, racism yielded to racial progress: Though it’s still majority-white, African-Americans now make up approximately 30 percent of Cobb County’s population, more than double the national figure. And in comparison with other counties that have been home to a black population share above the national average, Cobb scores well on a Healthiest Communities measurement of integration, often considered another positive driver of well-being for black people.

Businesses have found a friendly environment as well.

Bell Aircraft Corp. built B-29 bombers in Marietta during World War II; Lockheed Martin picked up the mantle in the post-war years and still has a plant there. Hardware giant The Home Depot has its headquarters in Cobb, and the Atlanta Braves relocated to SunTrust Park just off Interstate 75. The state-of-the-art stadium anchors The Battery Atlanta, a glittering shopping, residential and entertainment complex that exemplifies the suburban sprawl fueled by the prosperity of Cobb, one of the wealthiest counties in Georgia.

Carol Holtz, chair of the Cobb County Board of Health, says money, lifestyle options and good jobs – as well as proximity to diverse Atlanta – entice black professionals like Randolph, who came to Georgia from Falls Church, Virginia. The middle-class pilgrims to “black mecca,” Holtz says, likely are boosting health outcome data for home-grown residents.

“Education and income play a role, no matter what race it is, in increasing health status,” Holtz says. “That erases the differences in race.”

Still, “I think that education and access to health care are really more important,” Holtz says. “If you can have health care and you can get regular checkups and adequate treatment for problems, you can certainly live longer and live healthier.”

To her point, Cobb County outperforms the state median in most measures of health care access and educational achievement measured on the U.S. News Healthiest Communities platform.

Yet while some African-Americans are thriving, “we have housing projects and we have people in poverty, black and white and Latino,” Holtz says. The county, she says, is trying to improve residents’ health by promoting farmers’ markets in poor communities, as well as education programs geared toward helping the poor make healthier food and lifestyle choices.

And though she’s doing well, Randolph says it’s frustrating to know that factors such as income, homeownership and education have emerged as key predictors of better health for African-Americans like her.

Her current lifestyle “is what I know. That’s what I’m used to,” Randolph says. For others who grew up poor, she says, “I’m not sure that there’s an awareness for us to recognize that difference” and act on it.

“It’s a shame,” she says.

In Georgia, the apparent health benefits of affluence and education aren’t limited to the Atlanta area.

About 130 miles away and bordering South Carolina, residents of Columbia County have a life expectancy about two years longer than the median mark in the U.S., with better access to healthy foods and primary care physicians than most, according to Healthiest Communities data. About 35 percent of adults have at least a bachelor’s degree, and new housing is cropping up as the county grows.

But unlike Cobb, Paulding and Fayette counties, Columbia County’s prosperity has emerged in response to a neighboring city, rather than in tandem with it.

The county’s neighborhoods have shifted from rural to increasingly suburban in recent decades as affluent families have exited nearby Augusta, an older community known for hosting the annual Masters golf tournament. Columbia also has drawn out-of-towners who work at Fort Gordon, the growing military base nearby, and at a new cybersecurity center at Augusta University.

In 2000, about 90,000 people called Columbia County home, compared with nearly 152,000 in 2017. By 2035, that number is projected to exceed 210,000, with the growth and subsequent development posing opportunities for residents to access health care services and recreational activities closer to home, as well as challenges for local infrastructure and schools.

“It’s just expanding so much. They’re tearing down trees and building new houses and people are wanting to move here,” says Eleanor Willingham, a retired teacher who has lived and worked in both Columbia County and Augusta. “I think it’s because of the quality of living in Columbia County. I think people are safer.”

Fort Gordon initially brought Deborah Fisher, a native of Washington, D.C., to the area two decades ago. The highly ranked high schools, safe neighborhoods and small-town feel kept her here.

“I never planned to live here, but when I retired from the military I saw this quaint little town and thought, ‘Wow, this might be the place I’d like to live,'” Fisher says of Grovetown, one of the county’s smaller communities with an estimated 14,100 residents last year.

Around 35 percent of Grovetown residents are black, roughly twice the share of the the county overall. Yet Columbia County offers a rare example of a place where some imbalances weigh in African-American residents’ favor: The median household income in 2017, for example, was $73,033 for whites and $95,680 for African-Americans, census estimates show, although the poverty rate was slightly higher for black residents than for whites.

Residents say education and awareness, community engagement, healthy lifestyles and access to care contribute to the area’s strong outcomes. A new hospital – the first to be built within the county – is expected in the coming years to join others that are nearby but outside county borders, including several affiliated with Augusta University, home to the Medical College of Georgia.

“The medical facilities here are next to none, and with a lot of folks here affiliated with the military, they have those benefits,” Fisher says.

But the dichotomy between Columbia County and Augusta – which is consolidated with Richmond County – illustrates that proximity to care isn’t enough to keep people healthy. Augusta has had higher rates of infectious diseases, diabetes and babies born at a low birth weight, according to a 2016 community needs assessment.

More than half of Augusta residents are black. In 2017, the median household income for African-Americans there – $33,220 – was about $6,900 below what it was for white residents, and the black poverty rate was significantly higher than that of whites, census estimates show.

“Downtown Augusta is still very much racially charged, and it’s a poverty thing every bit as much as it is a prejudice thing,” says Carolyn Moore, a white pastor who grew up in Augusta and founded a church and a nonprofit in Columbia County about 15 years ago.

Yet some residents say life in Columbia County can at times be more tense than in Augusta for African-Americans, because the county developed as the result of white flight and only in recent years has begun to diversify. Its population was about 74 percent white alone and 16 percent black alone in 2017, according to census estimates. But between 2010 and 2017, that black population grew about 28 percent while the white population grew 16 percent.

“I’m happy with the neighborhood I live in – people are cordial, they wave, it feels neighborly,” Willingham says of her current home in Augusta. “But I don’t know how much of a reception I would receive in Columbia County if I still lived there. Not with (President Donald) Trump in office. I just feel more comfortable where I am.”

Last year, Fisher became the first African-American to win public office in Columbia County since 1993, calling her election to the Grovetown City Council “a testament to the diversity that’s come into the community.”

She says the county’s suburban locale and Augusta’s urban setting make it difficult to compare the two, especially given their disparities in poverty, education and other social factors that are critical in shaping overall health.

“Race isn’t necessarily the dividing line,” says Robert Bennett, executive director of the county’s development authority. “It’s more about access and socioeconomic status, and Columbia County has leadership that is committed to providing access.”

Galvin reported from Fayette and Columbia counties; Williams reported from Cobb and Paulding counties.