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| Introduction to Outcomes |
| Poor Mental Health Days |
| Poor Physical Health Days |
| Infant Mortality |
| Cardiovascular Deaths |
| Cancer Deaths |
| Premature Death |
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Components Four primary considerations drove the design of America’s Health Rankings™ and the selection of the individual components: 1. The overall rankings had to represent a broad range of issues that affect a population’s health, 2. Individual components needed to use common health measurement criteria, 3. Data had to be available at a state level and 4. Data had to be current and updated periodically. While not perfect, the measures selected are believed to be the best available indicators of the various components of healthiness at this time and are consistent with past reports. The Methods Review Group suggested that for discussion purposes, the components be divided into two categories; determinants and outcomes. For further clarity, determinants are divided into four groups: Personal Behaviors, Community Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of a state, and improving these inputs will eventually improve outcomes. Most individual measures are actually a combination of activities in all four areas. For example, the prevalence of smoking is a personal behavior that is strongly influenced by the community environment in which we live and by policy, including taxation and restrictions on public places and by the care received to treat the chemical and behavioral addictions. However, for simplicity, we placed each measure in a single category. For America’s Health Rankings™ to continue to meet its objectives, it must evolve and incorporate new information as it becomes available. The Scientific Advisory Committee provides guidance for the evolution of the rankings, balancing the need to change and the desire for longitudinal comparability. Over the last few years, change is being driven by: 1) the acknowledgement that health is more than years lived but includes the quality of those years, 2) data about quality and cost of health care delivery are becoming available on a wide scale, comparable basis and 3) measurement of the additional determinants of health are being initiated and/or improved. Changes continue to be made on this basis going forward. Health outcomes are traditionally measured using mortality measures including premature death, infant mortality, total mortality, cancer and cardiovascular mortality. Obviously, these measures overlap significantly, but they do present different views into the mortality outcomes of the population. However, health is more than just the length of life but must include the quality of life. In prior years, limited activity days (number of days unable to do normal activities of living) was incorporated as a reflection of the loss of quality of life and included as a proxy for disabilities. In this edition, this measure was broken into the two component measures of life quality, poor mental health days and poor physical health days. (Number of days in the previous 30 days when a person indicates their activities are limited due to mental or physical health difficulties.) Their total weight in the index was increased and is discussed as a health outcome. The total mortality measures used in prior editions was removed. This change reflects the importance of quality of life as well as length of life as a measure of health outcomes. In 1990, when the rankings began, almost no information existed about the quality or cost of care delivered to the population, either in a clinical or a public health environment. Now, data is being collected and analyzed about the quality and cost of care and is beginning to be used to shape the health care delivery system. This year, an article (page number here) by Dr. Elliot Fisher presents possible measures to be used in future editions of the rankings to represent both quality of the care provided to the population and delivery cost efficiency. As with all indices, the panel had weighed the positive and negative aspects of each component when choosing and developing them. These aspects for consideration include: 1) the interdependence of the different measures; 2) the possibility of the overall ranking disguising the effects of individual components; 3) an inability to adjust all data by age and race; 4) an over-reliance on mortality data; and 5) the use of indirect measures to estimate some effects on health. These concerns cannot be addressed directly by adjusting the methodology, however, assigning weights to the individual components can mitigate their impact (Table 15). Each component is assigned a weight that determines its
percentage of the overall score. The weights are based on input from a panel of
health experts. Determinants account for 60 percent of the results, and
outcomes account for 40 percent. Table 12 is a summary of each of the components in America’s Health Rankings. A short discussion of each component immediately follows. The data for each year are the most current data available at the time the report was compiled. Table 12 - Summary Description of Components
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