America's Health Rankings is an annual report that measures the overall healthiness of the United States using a comprehensive set of related health determinants and outcomes.[1] The report provides state-specific rankings[2] from 1 to 50 across a variety of national health benchmarks.[3] State rankings are determined by evaluating four factors: behaviors, the environment and the community in which people live, the decisions made by public and health policies and practices of the government and clinical care received.[4] America's Health Rankings is the result of a partnership between United Health Foundation, the American Public Health Association and Partnership for Prevention.[5]
Contents |
The purpose of America's Health Rankings is to stimulate action by individuals, communities, health care professionals, elected officials and employers to improve the health of the population of the United States.[4]
America's Health Rankings was first published in 1990 and ranked the relative healthiness of states populations based on 16 measures of health.[1] As of 2010, up to 40 measures are used to evaluate a comprehensive profile of the overall health of each state.[4] America's Health Rankings is released in partnership with United Health Foundation, American Public Health Association and Partnership for Prevention.[6]
In 2002, United Health Foundation, in concert with the American Public Health Association and Partnership for Prevention, commissioned the University of North Carolina at Chapel Hill School of Public Health to undertake an ongoing review of America's Health Rankings. The Scientific Advisory Committee, currently led by Thomas Ricketts, Ph.D., M.P.H., was charged with conducting a thorough review of the current index and recommending improvements that would maintain the value of the comparative, longitudinal information; reflect the evolving role and science of public health; utilize new or improved measures of health as they become available and acceptable; and incorporate new methods as feasible.
In addition, the committee continues to work on issues concerning improved environmental health indicators, methods of expressing variability within the rankings, oral health indicators, mental health indicators, improved health disparities, improved cost measures, quality of care measures and international benchmarking.[4]
America's Health Rankings employs a unique methodology, developed and annually reviewed by the Scientific Advisory Committee, a panel of leading public health scholars, which balances the contributions of various factors, such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care and incidence of preventable disease, in evaluation of the overall health of a state's population. The report is based on data from the U.S. Departments of Health and Human Services, Commerce, Education and Labor; U.S. Environmental Protection Agency; the American Medical Association; the Dartmouth Atlas Project; and the Trust for America's Health.[3]
The methodology underlying America's Health Rankings reflects the evolving expectations and role of health in society and the ability to measure various aspects of health.[4] The methodology has evolved over the report's history to capture these changes.[7]
For each measure, the raw data as obtained from the stated sources and adjusted for age, as appropriate, is presented and referred to as "value." All age-adjusted data utilizes the population profile for the middle year of data.[7] For example, if the data is from 2006 to 2008, the standard population is set at 2007.
The score for each state is based on the following formula: State value subtracted by national mean, divided by the standard deviation of all state values.
Often referred to as a "Z-score," this score indicates the number of standard deviations a state is above or below the national mean. States with higher value than the national average will have a positive score, while those with lower values will have a negative score.[7]
The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.[8]
This report looks at the four groups of health determinants[3] that can be affected:
The 22 measures that comprise 2009 America's Health Rankings are of two types of health determinants and health outcomes.[5] Health determinants represent those actions that can affect the future health of the population, whereas health outcomes represent the result of what has already occurred, either through death or missed days due to illness.
Behaviors
Community and Environment
Public Health Policies
Clinical Care
Outcomes