America's Health Rankings

America's Health Rankings started in 1990 and is the longest-running annual assessment of the nation’s health on a state-by-state basis. It is founded on the World Health Organization holistic definition of health, which says health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. America’s Health Rankings is a partnership of the United Health Foundation, and the American Public Health Association.

America's Health Rankings releases two yearly reports, one on the health of the general population in the 50 US states plus a senior report on the population aged 65 and older in each state. Both reports include some health metrics that are stratified by race/ethnicity, gender, age, education, place of residence, and economic status. State rankings are based on a methodology approved by a Scientific Advisory Committee. This methodology balances the contributions of health determinants—including 1) Behaviors; 2) Community and Environment; 3) Policy pertaining to our health care system, government, and numerous prevention programs; and 4) Clinical Care received—and Outcomes such as diabetes and deaths from cardiovascular disease.

Purpose

The ultimate purpose of the two reports is to improve the health of the US population by providing information that stimulates individuals, elected officials, health care professionals, public health professionals, employers, educators, and communities to act and create change. The publication of the rankings stimulates conversations concerning health in each state and across the nation.[1][2][3] The fundamental conviction of America’s Health Rankings is that each person in his or her capacity as an employee, employer, educator, student, voter, community volunteer, health care professional, public health professional, or elected official can contribute to the advancement of the health of his or her state.[4][5]

History

America’s Health Rankings was first published in 1990 and ranked the 50 US states using 16 health measures. The 2014 25th anniversary edition of the report used 27 Core Measures and 22 Supplemental Measures to evaluate the health of each state and the nation. America’s Health Rankings Senior Report started in 2013 and used 34 Core Measures as well as five Supplemental Measures.[6]

Scientific Advisory Committee

In 2002 United Health Foundation and the American Public Health Association commissioned the University of North Carolina at Chapel Hill School of Public Health to do an ongoing review of America’s Health Rankings. The Scientific Advisory Committee, currently led by Anna Schenck, PhD, MSPH, formed as a result and was charged with recommending improvements that maintain the value of the comparative, longitudinal information. Improvements also reflect the evolving role and science of public health as well as include adding and refining health measures as they become available and acceptable. The Scientific Advisory Committee includes representatives from local health departments, the American Public Health Association, current and former state health officers, and experts from many academic disciplines.

Measure selection

Four primary considerations drive the design of America’s Health Rankings and the selection of each measure:

  1. The overall rankings must represent a broad range of issues that affect a population’s health.
  2. Individual measures need to use common health-measurement criteria.
  3. Data have to be available at a state level.
  4. Data must be current and updated periodically.

Components of health

Americas Health Rankings includes in its model of health four groups of Determinants:

  1. Behaviors: Everyday activities that affect personal health habits as well as practices by individuals and families that affect personal health and the use of health resources. Behaviors can be modified especially when individuals are supported by the three other groups of Determinants below.
  2. Community and Environment: Daily conditions for living, working, shopping, exercising, etc., that affect achieving optimal health.
  3. Policy: Availability of resources to encourage and maintain health. Policy also influences the extent that public and health programs penetrate the general population. Policy measures can have a wide reach throughout a state, and they promote healthy living and judicious consumption of health care resources.
  4. Clinical Care: Access to as well as quality, appropriateness, and cost of care received at doctors' offices, clinics, and hospitals.

These four groups of measures influence health Outcomes of a state’s population, and improving these Determinants will improve Outcomes. Most measures are a combination of activities in all four groups. For example, the prevalence of smoking is one of the Behaviors strongly influenced by the Community and Environment, by public Policy including taxation and restrictions on smoking in public places, and by Clinical Care received to treat the chemical and behavioral addictions associated with tobacco.

Methodology

America's Health Rankings employs a unique methodology developed and annually reviewed by the Scientific Advisory Committee, a panel of leading public health scholars. This methodology weighs and balances the contributions of factors such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care, and incidence of preventable disease to evaluate the 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 of Health Care Project; Centers for Disease Control and Prevention; the Administration on Aging; the National Center for Health Statistics; the Centers for Medicare and Medicaid Services; National Federation to End Senior Hunger; the National Institute for Occupational Safety and Health; the Kaiser Family Foundation; Brown University; the American Geriatrics Society; the Commonwealth Fund; and the Trust for America's Health.[7]

The overall score for each state is calculated by adding the z scores of each measure multiplied by its percentage of total overall ranking (weight) and the effect (positively or negatively correlated) it has on health. Weights for individual metrics vary from 7.5% to 2.5%. The ranking is the ordering of each state according to value.[8]

Description of measures

2014 America’s Health Rankings

The measures used in the 2014 America's Health Rankings are in two subgroups: Core Measures and Supplemental Measures.

Core Measures consist of health Determinants (risk factors), and health Outcomes. Determinants are actions that affect the population’s future health, while Outcomes represent what has already occurred through death, disease, or missed days due to illness. There are four groups of Determinants: Behaviors, Community and Environment, Policy, and Clinical Care. The measures in these four groups influence a state’s health Outcomes, and improving the Determinants over time will improve Outcomes.[9]

Supplemental Measures provide additional perspective on the health in a state. Supplemental Measures do not factor into a state’s overall score and ranking, but they are useful in forming a fuller understanding of the health of a state.[7]

Core measures

Behaviors

Community and Environment

Policy

Clinical Care

Outcomes

Supplemental measures

Behaviors

Chronic Disease

Clinical Care

Economic Environment

Outcomes

2015 America’s Health Rankings Senior Report

The measures that comprise 2015 America's Health Rankings Senior Report are in two subgroups: Core Measures and Supplemental Measures.

Core Measures consist of health Determinants (risk factors), and health Outcomes. Determinants are actions that affect the population’s future health, while Outcomes represent what has already occurred through death, disease, or missed days due to illness. There are four groups of Determinants: Behaviors, Community and Environment, Policy, and Clinical Care. The measures in these four groups influence a state’s health Outcomes, and improving the Determinants over time will improve Outcomes.[9]

Supplemental Measures provide additional perspective on the health in a state. Supplemental Measures do not factor into a state’s overall score and ranking, but they are useful in forming a fuller understanding of the health of a state.

Core measures

Behaviors

Community and Environment

Policy

Clinical Care

Outcomes

Supplemental measures

References

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