Methodology

The methodology underlying America’s Health Rankings™ reflects the evolving expectations and role of health in our society and our ability to measure various aspects of health.  The methodology has evolved over the report’s 17-year history to capture these changes, however, we have strived to maintain comparability among editions and to provide a useful resource for tracking and evaluating progress.   

The tables that present each component contain three columns: rank, data and score.  They are calculated as follows: 

The data are the raw data as obtained from the stated sources and adjusted for age, race and/or population as appropriate.  All age-adjusted data utilizes the population profile for the middle year of data.  For example, if the data are from 2000 to 2002, the standard population is set at 2001. 

The score for each state is based on the following formula.  The score is stated as a percentage.

This calculation results in a score of 0.0 for a state with the same value as the national average.  States that have a higher value than the national average will have a positive score while those with lower values will have a negative score. 

To prevent an extreme value from excessively influencing a final score, the maximum score any state could receive for a component is limited to the national norm plus or minus two standard deviations. 

For several measures, such as Infant Mortality and Infectious Disease, the data from multiple years are combined to provide sufficient sample size to be meaningful. 

Where a value for the United States overall is not available, the national average is set at the average value of the states measured. 

The overall score was calculated by adding the scores of each component multiplied by its weight or the percent of total overall ranking.  (Note:  Scores reported for individual components may not add up to the overall scores due to the rounding of numbers.) 

The ranking is the ordering of each state according to score.  Ties in scores are assigned equal rankings.

Components adjusted for race include black and white races only.  Other races have been excluded due to data limitations.  Where mortality data for blacks is unreliable due to low counts, the national average for blacks is used.  These states are marked by an asterisk in the Component Tables.

All earlier results have been revised to correct any errors discovered since the release of prior editions.

 

Methodology Review

In 2002, the United Health Foundation, in concert with the American Public Health Association (APHA) and Partnership for Prevention, commissioned the School of Public Health at the University of North Carolina at Chapel Hill to undertake an ongoing review of the America’s Health Rankings™.  The Scientific Advisory Committee, led by Thomas Ricketts, Ph.D., 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.  Minor issues are always addressed immediately and incorporated into the contents of the next edition of the report.  However, more significant issues, such as new measurements of health conditions, require more in-depth study and analysis.  Several changes in the methodology were made to the 2002, 2004, 2005 and 2006 Editions at the recommendation of the Committee.   

The group continues their review through this Edition.  The group emphasizes the importance of this tool as a vehicle to promote and improve the general discussion of public health and to encourage balance among public health efforts to benefit the entire community.   

The Scientific Advisory Panel made several suggestions regarding the 2006 Edition.  They recommended:

• Expanding the model (see inside front cover) to include five major factors (personal behavior, community environment, health and public policy, medical care, socioeconomic) that will affect health outcomes.  This edition does expand the definition to four of these components but does not isolate socio-economic factors from community environment.

• Replacing the term “risk factors” used to describe the measures within these factors and replace with “determinants” – a better descriptor.  That is implemented in this edition.

• Downweighting mortality and replacing it with morbidity measures.  As such, a measure of total mortality has been eliminated and limited activity days is replaced by two components; poor mental health days and poor physical health days.  (See Components for a more complete definition of the components in this Edition.)

• Discussing the effect the compression of mortality has upon measurement of health.  The commentary by Dr. Ricketts provides these insights.

In addition, the panel continues to work on issues concerning genetics/genomics, methods of expressing variability within the rankings, oral health indicators, mental health indicators, environmental health indicators, health disparities, improved cost measures, quality of care measures and international benchmarking.

The methodology review group represented a variety of interests ranging from state health offices, CDC and APHA, as well as the academic disciplines.  Scientific Advisory Committee members include:

Thomas C. Ricketts, Ph.D., M.P.H. Chair
Professor of Health Policy and Administration and Social Medicine
School of Public Health
University of North Carolina at Chapel Hill

Dave Kindig, M.D., Ph.D.
Professor of Population Health Sciences and
Director, Wisconsin Institute for Public Health and Health Policy
School of Medicine
University of Wisconsin-Madison

Patrick Remington, M.D., M.P.H.
Associate Professor in the Department of Population Health Sciences
Associate Director of the Comprehensive Cancer Center for Outreach and Population Studies
Department of Population Health Sciences
University of Wisconsin-Madison

Jonathan Fielding, M.D., M.P.H., M.B.A., M.A.
Professor of Health Services and Pediatrics
School of Public Health
Department of Health Services
University of California – Los Angeles
Director of Public Health and Health Officer
Los Angeles County, California

Matthew McKenna, M.D., M.P.H.
Director, Office of Smoking and Health
Centers for Disease Control and Prevention

Leiyu Shi, Ph.D.
Associate Professor
Department of Health Policy and Management
Associate Director, Primary Care Policy Center
School of Public Health
Johns Hopkins University

Marthe Gold, M.D.
Logan Professor and Chair
Department of Community Health
Medical School
City University of New York

John Booker, Ph.D.
Associate Director, Public Health Practice
Institute for Public Health
University of New Mexico

Glen P. Mays, Ph.D., M.P.H.
Associate Professor, Vice Chair, Director of Research
Department of Health Policy and Management
Fay W. Boozman College of Public Health
University of Arkansas for Medical Sciences

Catherine Michaud, M.D., Ph.D.
Senior Research Associate
Center for Population and Development Studies
Harvard University

Steven Teutsch
Executive Director
Outcomes Research and Management
Merck & Co., Inc.

Dennis P. Andrulis, Ph.D., M.P.H.
Associate Dean for Research and
Director, Center for Health Equality
Drexel University School of Public Health

John Lynch, Ph.D., M.P.H., M.Ed.
Assistant Research Scientist
Department of Epidemiology
School of Public Health
University of Michigan

William Dow, Ph.D.
Associate Professor of Health Economics
408 Warren Hall #7360
Division of Health Policy and Management School of Public Health
University of California, Berkeley

Jeffrey Koshel,
Deputy Division Director,
MCHB/DSCH
Health Research and Services Administration
Department of Health and Human Service

William L. Roper, M.D., M.P.H. Chair Emeritus
Dean of the School of Medicine
University of North Carolina

Georges Benjamin, M.D.
Executive Director
American Public Health Association

Tom Eckstein, M.B.A.
Principal
Arundel Street Consulting, Inc.