Frequently Asked Questions
We are happy to provide copies of both of these graphics for your use: County Health Rankings model and our Take Action graphic. If you use these images in a publication, please use the following citation:
University of Wisconsin Population Health Institute. County Health Rankings 2013. Accessible at www.countyhealthrankings.org.
- Raising awareness in the general community about the multiple factors that influence health via media interviews and follow-up conversations.
- Initiating community health assessment and planning efforts where none previously existed
- Celebrating successes and promoting existing community health improvement efforts
- Informing policy makers, particularly Local Boards of Health, about the many factors that affect a community's health and about community health improvement planning
- Revitalizing or refining existing community health assessment and improvement plans
- Citing the County Health Rankings as justification in securing grant funding to conduct community health improvement efforts and/or to address the determinants of health
- Providing feedback to the University of Wisconsin Population Health Institute to improve the Rankings methodology and report.
There is not one formula for where communities should put their efforts. Because the County Health Rankings are based on broad measures and include multiple years of data, it is important for communities to look at further information prior to making a decision about next steps. Learn more about how to assess your community's needs and resources via the Roadmaps to Health Action Center.
We encourage states and communities to use the Rankings tool as a compelling case to educate your communities that the health system is really everyone in the community. Health is everybody's business, and we can't improve health in communities by simply looking at more health care or more services delivered by governmental public health.
America’s Health Rankings already ranks the health of states -- we have tried to align our measures as closely as possible with these Rankings.
The purpose of the County Health Rankings is to compare counties within states. We discourage comparisons between states for several reasons:
- The County Health Rankings is not intended to be a national report that finds the 10 or 15 least healthy counties in the nation and focuses only on that. The Rankings are intended to provide a tool for each state to identify counties where health disparities exist.
- Our effort is to focus on state-specific county rankings, and we won't actually provide any county rankings across state boundaries.
- Some of the measures that we use are state-specific and make comparisons across state boundaries difficult.
The County Health Rankings are designed as a call to action – the use of ranks can often serve as a more effective tool for drawing attention to community health issues than lengthy listings of indicators. We encourage any community that has not already done so to use the Rankings as a stimulus to engage community members in a more detailed community health assessment, using whatever additional data sources they have available. The Rankings can be used as a pointer to suggest areas where more in-depth analysis might be helpful.
We believe that there are two separate sets of messages to convey. One set addresses how healthy a county currently is and the other addresses how healthy a county might be in the future based on the many factors that influence health. However, if a single ranking of the “healthiest” counties is desired, we use the health outcomes rank.
To serve as a call to action for communities to
- Understand the health problems in their community
- Get more people involved in improving the health of communities
- Recognize that factors outside medical care influence health
Ranking the health of counties using not only traditional health outcomes, but also the broad range of health factors, can mobilize action on the part of governmental public health and in many other sectors that can influence and are affected by health.
The county-level estimates based on BRFSS data are calculated for the County Health Rankings by staff at the Centers for Disease Control and Prevention. They use seven years of data (wherever possible), thus their estimates represent an average over the seven years. The BRFSS measures in the 2013 County Health Rankings are based on data from 2005-2011. Except for 2011, the public use final weight variable was used to produce estimates. These weights ensure state level estimates reflect the age-sex-race distributions of the state. These weights might not always provide accurate county level estimates; particularly when county age-sex-race distributions vary greatly from that of the state. For 2011 BRFSS data, a post stratification weight was calculated using the aforementioned approach for landline respondents -only. Other publically available BRFSS data for 2011 include cellphone respondents and are based on a revised weighting methodology—consequently these estimates should not be compared to data from prior years or to the estimates produced for the County Health Rankings.
Prison inmates are included in county-level counts for the following ranked measures:
- Premature death
- Motor vehicle crash deaths
- Low birthweight births
- Teen births
No, many of the measures were calculated for the County Health Rankings by other organizations. For example, measures from the National Vital Statistics System and the Behavioral Risk Factor Surveillance System were calculated by staff at the National Center for Health Statistics/Centers for Disease Control and Prevention. Similarly, the health care quality measures were calculated for us by the Dartmouth Institute.
The most frequent reason why numbers of the Rankings web site may not match other numbers that states have will be due to different definitions of measures, different time periods, or different samples or denominators. Communities should rely on their own state's data for their own more detailed community health assessments.
Each year's data are weighted equally.
Some counties in the nation are too small to have reliable measurements for health outcome measures. Those counties are not ranked. If a county has data for enough measures to be ranked but is missing data for any individual measure, we assign the county the same value as the state mean for that measure. One way to overcome unstable and unreliable estimates due to small numbers, such as with the measures from the Behavioral Risk Factor Surveillance System (BRFSS), is to combine multiple years of data. This means that although the Rankings are useful for differentiating between places that are and are not healthy, they are not a good tool for setting objectives and tracking progress from year to year.
In part, the County Health Rankings aim to show that where you live matters to your health and that disparities exist within every state. But disparities exist within most counties as well. We encourage communities to use the Rankings as a starting point to delve more deeply into data that may highlight disparities within counties. Communities can do this by initiating a community health assessment or using the Rankings to draw attention to thorough assessments that have already been done. We have provided information in our Data Guide for communities that need help getting started.
Each county's ranks are calculated within a specific state so you cannot compare your county's ranks with those for a county in a different state. However, you can compare the values for the Health Outcomes measures from one state to another. We advise caution in comparing the Health Factors measures across states because our measures for Health Factors are only uniform within states not across states. Users should refer to our guidelines for comparing measures across states to find the differences that occur for some measures (such as high school graduation rates and violent crime). Although the County Health Rankings data tool does not include an online feature for comparing counties in different states, users can print out the “snapshots” for adjoining counties in different states to look for similarities and differences in the measures across the counties.