Taking Health To The Next Level: The Wisconsin County Health Rankings

Patrick L. Remington, M.D., M.P.H. and Bridget C. Booske, Ph.D., M.H.S.A.
University of Wisconsin Population Health Institute

Building on America’s Health Rankings’ model, the University of Wisconsin Population Health Institute released the first Wisconsin County Health Rankings in 2003.  These annual reports provide county level indices of population health and its determinants in order to stimulate discussion among Wisconsin public health practitioners, policy makers, and communities.   

The conceptual framework underpinning the County Rankings is based on a model of population health improvement where health outcomes are influenced by a set of health determinants, which in turn can be influenced by policies and programs.  The County Rankings are based on two main health outcomes (years of potential life lost under age 75 and percent of the population reporting poor or fair health) and four categories of health determinants (health care, health behaviors, socieconomics, and the environment).  Selection of specific health determinant measures was guided by Wisconsin State Health Priorities. Each measure selected was a direct measure or a proxy of an important aspect of public health, based on publicly available data collected consistently across the state at the county-level, of sufficient quantity to provide stable county-level estimates, and current and periodically updated.

County Rankings were surveyed to determine awareness, solicit feedback, and gain input for future releases.  The primary target audience for the County Rankings initially was the 72 county public health officers, but the audience has now expanded to include local city health departments as well as regional consortia of epidemiologists who serve multiple counties.  In addition to providing feedback via the user surveys, this year’s development process has included a series of teleconference calls with past County Rankings users, who provide input on their content, presentation, and dissemination.  One example of a change based on user feedback is that in 2006, for the first time, we will expand the rankings to include 73 places (72 counties and the City of Milwaukee).  Other user input includes the need for balancing access to appropriate statistical detail for interpreting the rankings (such as confidence intervals) along with the need for clear and simple presentation and the need for increased time before public release of the County Rankings to allow time for developing specific local responses for the media and for County Board members.

Like America’s  Health Rankings, the County Rankings attract considerable attention with widespread media coverage throughout the state including a segment on Wisconsin Public Radio (with lively listener call-ins) and articles in the state’s major daily newspapers.  The high level of interest in the County Rankings among public health stakeholders, the media, and the public is clearly a desirable step toward stimulating discussion among broad audiences and promoting awareness of the multiple factors that determine Wisconsin’s health and the fact that there is much that can be done to improve health.  Our experience in initiating a statewide program of health assessment and improvement based on data such as those contained in America’s Health Rankings may be useful to other communities as a call to action to enhance their health.