BACKGROUND: Communicating state-level health data to stakeholders including the public and elected officials can be difficult, but it is necessary to create public health priorities and promote change. America’s Health Rankings (AHR) has published a state-by-state comparison of population health for 26 years by combining 29 metrics that represent behaviors, community and environment, policy, clinical care, and health outcomes to form a comparative ranking of each state’s health. State-level data often masks inequalities by subpopulation. AHR now includes subpopulation data for most metrics, facilitating the examination of differences within populations. To improve communication we created two tools: a Core Measure Impact Tool that visually highlights each state’s strengths and weaknesses, and a Starburst Disparity Visualization Tool that distributes subpopulation differences in one graph.
METHODS: Each state has a metric impact diagram where the circle size represents how each metric impacts the state’s overall rank. Green circles have a positive impact; red circles a negative. (Impact=metric z score * metric weight * direction of impact, if >0 green, if=<0 red.) The Starburst displays state and national data as a pie chart on a scale relevant to the form of measurement, namely by percentage or number. Where data allowed, six metrics representing health determinants and outcomes were stratified by state and by age, education level, gender, income, race/ethnicity, and urbanicity. Adults younger than 25 years were excluded from the education and income subpopulation groups.
RESULTS: Using Alaska as an example, glancing at the Core Measure Impact diagram shows violent crime, high school graduation rates, and lack of health insurance are challenges while air pollution, public health funding, and low birthweight are strengths. The smoking Starburst highlights the largest disparity in smoking--education. Among adults aged 25 and older with less than a high school education, 35.3% (CI: 26.9-43.7%) smoke, compared with 7.9% (CI: 5.9-9.8%) of those with a college education.
CONCLUSIONS: The Core Measure Impact Tool allows users to identify at a glance state health strengths and challenges. The Starburst Disparity Visualization Tool provides a uniform way of looking at disparities across metrics and states; it also converts complex data into a readily digestible visual, allowing users to examine differences within all state subpopulations. The Starburst draws attention to important disparities otherwise concealed in state-level data, and it complements AHR’s ability to identify priorities in each state when developing actionable interventions.