— Wake County has been deemed the healthiest in North Carolina for the fifth consecutive year, according to an annual study released Wednesday by the Robert Wood Johnson Foundation.

Orange County, ranked second since the study started in 2010, fell to third this year behind Watauga County.

Rankings are determined by examining each county’s physical environment, social and economic factors, clinical care and health behaviors.

The annual study, a partnership between the foundation and the University of Wisconsin Population Health Institute, examines a variety of issues that affect health, including high school graduation rates, access to healthy foods, smoking, obesity and teen births for nearly every county nationwide.

"We rank because it brings attention to a lot of factors that influence health in our communities," said Joe Marx, foundation spokesperson. "It's not just health care. Education, obesity, how active we are. But also things like housing and transportation. It brings that big picture to health and allows community leaders to act on that to make things healthier for the people in our communities."

Wake County maintained its top spot by ranking first in health outcomes (how long people live and how healthy people feel while alive) and second in health factors (health behaviors, clinical care, social and economic factors and physical environments).

Orange was the only other Triangle county in the top 10. Chatham (11), Moore (13) and Durham (17) also made the top 20.