Early last week marked the release of the third annual County Health Rankings, an online report that lets residents in every U.S. county learn more about their communities’ overall health. The rankings, which are published by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, consider both traditional health factors, such as premature death, and social and economic factors, such as education and poverty. Released this year during National Public Health Week, the rankings can help residents and policymakers take a broader view of the factors that influence health as well as the opportunities that lead to better health.
Below, Public Health Newswire talks with rankings researcher and APHA member Patrick Remington, MD, MPH, a professor and associate dean at the University of Wisconsin School of Medicine and Public Health and an author of Chronic Disease Epidemiology and Control from APHA Press. We asked him what’s new in this year’s rankings and how people can use the rankings to make a difference.
Q: This year marks the third annual release of the County Health Rankings. What are the most significant and surprising take-away lessons for you after three years of working on this report?
The County Health Rankings serve as the annual check-up for the more than 3,000 counties across the United States. The most significant finding is that the healthiest counties in each state — those with people who live the longest and healthiest lives — not only have access to high-quality health care, but also have healthy behaviors, sound educational and economic systems, and an environment that supports healthy living.
The rankings are hoping to build a movement toward a healthier nation — county-by-county — one that focuses on prevention rather than only on sickness care. The model of population health used in the County Health Rankings serves as a way to involve more than just public health and health care leaders in these conversations.
Q: Anything new about this year’s County Health Rankings?
We’ve made a few minor changes to several measures in the health factors category. We improved our measures related to obesity by adding rates of physical inactivity and a measure of the fast food environment. We also improved the measure of limited access to healthy foods to be more closely aligned with the idea of food deserts. In addition, we improved the high school graduation measure and expanded the measure of the uninsured to include children. Finally, we’ve added graphs showing 10-year trends in premature mortality rates, so that in addition to following their ranks, counties can see whether they’re moving in the right direction.
Q: What are the great advantages of narrowing down health rankings to a county level as opposed to stopping at the state level? Can many of the factors used to determine a county’s ranking be effectively addressed at a county level?
When we look at the health of populations, our interpretation of the results depends entirely on the lens that we use. If we use a national lens, then we see that the states and counties that are the least healthy are located primarily in the southeastern United States, and those with the best health are located in the Northeast and Upper Midwest. However, when using the state lens — as we do with the rankings — we see that health outcomes vary even more within each state than between states. This makes the information relevant for every county across the nation, as people are more likely to compare themselves to others in their own state than across the nation.
Similarly, this question of geography matters when you’re considering ways to improve population health. National policies are clearly important to address the dramatic health disparities that we see across the entire United States. But statewide and local policies are often more effective when addressing policies to improve health care access and quality, educational outcomes and economic development. And perhaps even more important, leaders in local communities can come together to make the changes at the local level, where the rubber meets the road!
In Hernando, Miss., an employee wellness program encouraging exercise, healthy diets and regular medical check-ups helped reduced the city’s health insurance premiums by 15 percent — a total savings of $130,000. The city was then able to reinvest a portion of that savings back into their employees in the form of a 2 percent raise. Citywide, investments have been made to establish the largest farmers market in the state of Mississippi, create a parks department and implement a complete streets policy.
Q: In addition to traditional health indicators like premature death, the County Health Rankings also depend on social determinant factors, such as high school graduation and unemployment. How significant are such social determinants in calculating a county’s overall ranking? Also, do you hope the County Health Rankings can spark a larger national discussion about the social determinants of health?
The County Health Rankings model emphasizes the importance of the social and economic determinants. The determinant measures that we use count for 40 percent of the overall weight of the health factors ranking. But they really contribute more than that, since counties with strong economies and educational systems also have healthier lifestyles and better access to high-quality health care. So, we say that without a strong foundation of good jobs and great schools, it’s really hard to grow a healthy community.
Now in the third year, we’ve been surprised by the continued interest in the rankings. We had more than 1 million page views of our website on the April 3 release date. And we’ve seen more reference to the social determinants of health, such as this New York Times article entitled “Longevity Up in U.S., But Education Creates Disparity, Study Finds.”
Q: Are there particular indicators that you’ve seen improvement in during the last three years? What about indicators that seem to be getting worse?
Rankings are not useful for following trends. If every community in a state makes changes that improve health outcomes then all boats will rise, but the rankings won’t change. There will always be a “healthiest” and “least healthy” place in a state.
Therefore, we recommend that communities move the discussion from where their county ranks to how they are progressing over time by using absolute measures of health outcomes and health factors. For example, Healthy People uses a standard of a 10 percent improvement in objectives over the decade. A county can set targets for each of the measures used in the rankings and follow progress annually to see where they are making progress and where they are going in the wrong direction.
Q: How do you hope public health practitioners, as well as the residents they serve, will use the County Health Rankings? To influence policy? Inform health promotion activities?
We hope that the County Health Rankings serve as a call to action to come together with others in your community, to focus on the core of public health — assuring conditions in which people can be healthy. Everyone knows that we don’t invest enough in health promotion and disease prevention, given the demand for more access to high-quality health care.
Differences in health outcomes — premature death rates, quality of life measures and low birthweight rates — call attention to tremendous disparities between counties in each state. By showing how health factors also vary between counties, our model encourages people to change the conversation about health, from one focused on providing more health care to more people to one that addresses all the factors that affect health. By changing the conversation, we hope to bring more people to the table and diversify our investments in healthy communities.
Visit the County Health Rankings site to learn more.