By: Jennifer Chubinski, in collaboration with Susan Sprigg, a public health consultant to Interact for Health
What are the County Health Rankings?
The County Health Rankings are part of an annual report that ranks the health of each county in the country. Every year the release of the rankings creates a tremendous amount of media interest about which counties are doing better or worse. When I am out in the community, I hear about a lot of groups using the rankings to measure progress on their work. While I am thrilled at the use of high quality data, I often have to caution community groups about tracking their progress based on changes in their year-to-year ranking. Please continue reading to understand why.
Who produces the Rankings?
The Rankings are released annually by the University of Wisconsin Population Health Institute and are funded by the Robert Wood Johnson Foundation.
So how do the Rankings work?
There are two ranks assigned to every county:
Health Outcomes could be thought of as the “outputs” of health – if people in your county are healthy, they are more likely to live longer and with a better quality of life. This rank looks at five categories related to length of life and quality of life.
Health Factors could be thought of as the “inputs” to health – if your county has high scores in these categories, people in your county are more likely to be healthy. This rank is based on 30 categories focused on health behaviors, clinical care, social and economic factors, and the physical environment.
For both Health Outcomes and Health Factors, each category is weighted based on its perceived importance to health. For example, social and economic factors are assigned a higher weight, and therefore have more influence on the final county rank, than the measures of physical environment (see model below). Each category contains several specific data points, such as the rate of people dying before age 75, high school graduation rates, unemployment, limited access to healthy foods, air and water quality, income, and rates of smoking, obesity and teen births, etc. The data used for the Rankings come from reputable national data sources, such as the American Community Survey (ACS), Behavioral Risk Factor Surveillance System (BRFSS), Dartmouth Atlas of Health Care, National Center for Health Statistics, and County Business Patterns, among others.
The County Health Rankings Model
Source: University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2015. www.countyhealthrankings.org.
Once all of the counties in the state are given a score, they are ranked from the best county in the state (#1) to the worst county in the state. The ranking is done twice: once for Health Outcomes and again for Health Factors.
It is important to remember that the differences between one rank and the next are minimal. The county ranked #1 is about the same as the county ranked #2. So counties are also grouped into Quartiles – Quartile 1 is the highest ranked (healthiest) 25% of counties in the state, Quartile 4 is the worst (least healthy) 25% of counties, based on the health measures included.
What are the strengths and weaknesses of the Rankings?
The Rankings are a great way to start a community discussion about health and health issues at the county level. The Rankings are designed to help communities understand that issues beyond medical care influence health outcomes and to help “…mobilize action on the part of governmental public health and in other sectors that can influence and are affected by health.” They are not designed to be used to measure a county’s progress toward improving health or to measure changes year to year, nor can they be used to compare counties across state lines. In fact, the creators of the Rankings encourage “…any community that has not already done so to use the Rankings as a stimulus to engage community members in a more detailed community health assessment, using whatever additional data sources they have available. The Rankings can be used as a pointer to suggest areas where more in-depth analysis might be helpful.”
Below is a table comparing rankings in our region for 2015 to rankings from 2014. In Ohio, there were only very minor changes to a few rankings, and all of the quartiles remained the same. In Indiana and Kentucky, there were a few counties with more substantial changes for both better and worse. The counties that got better by 10 or more ranks are highlighted in green and those that got worse by 10 or more ranks are highlighted in red.
How do the region’s counties rank?
Use with caution!
You should use caution when interpreting the Rankings. To get county-level measures, multiple years’ worth of data were combined, going back as far as 2006 in some cases. Counties with smaller populations may see substantial variation in measures year-to-year and large swings in rank because of the limited amount of data available. When counties are missing measurements, they are assigned the state average for that measurement.
You cannot compare ranks of counties in different states.