County Health Rankings 201: Areas to Explore and Trends

BACKGROUND: The County Health Rankings, released annually by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, provide an annual check-up of the health of counties within each state and show that where we live, learn, work and play matters to our health.  The Rankings have been used throughout the nation to both raise the awareness of the multiple determinants of health and ignite action toward improving local community health.  To further assist communities in assessing and prioritizing local health needs, we created two additional Rankings data tools: Areas to Explore and Trends.  Areas to Explore guides communities toward the health factors that offer the greatest opportunities to improve their health. Trends illustrates changes in individual measures, such as premature mortality, over time.

METHODS:  To develop the Areas to Explore tool we conducted key informant interviews with the members of the County Health Rankings & Roadmaps (CHR&R) Community Engagement team to learn about some of the common data and prioritization concerns of community leaders that use the Rankings.  In addition, we utilized the County Health Rankings model and weights to provide analytic guidance.  Based our analysis and key informant interviews we created a unique algorithm for each measure, ran Areas to Explore mock simulations, and conducted several rounds of validation with members of the Community Engagement team to ensure that the results of the simulation matched the assessment and prioritization support that we provide to communities throughout the nation.  To develop our trends we conducted an 10 year trends analysis of Years of Potential Life Lost for nearly every county across the nation and in 2013 are adding trends for the majority of County Health Rankings measures.

RESULTS: Preliminary results suggest that our algorithm for highlighting Areas to Explore correlates well with staff prioritization decisions. Moreover, the CHR&R Community Engagement Team regularly uses the results of the Areas to Explore data tool to help communities assess and prioritize local health concerns. Trends suggest an overall improvement in the years of potential life lost nationally while individual counties experienced widely varying outcomes.  

CONCLUSIONS:   Given the number of individual measures included in the Rankings it is often difficult to determine what health factor(s) should be addressed first within a community.    The addition of Areas to Explore provides a starting point for prioritizing community health needs.  The addition of Trends and Areas to Explore has strengthened the utility of the County Health Rankings in communities’ health improvement efforts.  Ranks do not account for secular trends, leaving communities unaware of absolute changes in data from year to year.  The addition of Trends provide clear information on changes in local health, particularly premature death, over time.