County Health Rankings & Roadmaps, A Healthier Nation, County by County

The County Health Rankings models and measures

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The County Health Rankings model of population health

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Action Center

Explore guides and tools for improving health

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Key findings from the last three years of County Health Rankings and other national reports.

County-by-County Blog

Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.

State Health Gaps

What's driving health differences across the state and how can those health gaps be closed?


Why is there so much difference in the health of residents in one county compared to other counties in the same state? In these reports, the County Health Rankings & Roadmaps program explores how wide gaps are throughout each state and what is driving those differences. This information can help state leaders as they identify ways for everyone to have a fair chance to lead the healthiest life possible. Specifically, these reports can help state leaders understand:

  1. What health gaps are and why they matter
  2. The size and nature of the health gaps among counties
  3. What factors are influencing the health of residents, and
  4. What state and local communities can do to address health gaps.

What are health gaps and why do they matter?

As a country, we have achieved significant health improvements over the past century. We have benefited from progress in automobile safety, better workplace standards, good schools and medical clinics, and reductions in smoking or infectious diseases. But when you look closer, within each state across the country there are significant differences in health outcomes according to where people live, learn, work, and play. It is clear that not all Americans have the means and opportunity to be their healthiest.

Giving everyone a fair chance to be healthy does not necessarily mean offering everyone the same resources to be healthy, but rather offering people specific resources necessary for their good health. For example, consider three children of different heights. Offering them all the same size bench to stand on would mean that shorter children do not have a fair chance to see over the wall. Offering each child a bench to stand on that is the right size for their height gives all children a fair chance to see over the wall.

Health gaps can exist in many dimensions—for residents across neighboring county lines, or between various groups within a community according to race, ethnicity, age, income, education or sexual orientation, among others. For this report, we focus on the gaps in opportunities for health that exist between counties within each state, and provide strategies to address factors that influence these differences.

To continue a conversation about health gaps in your community, check out our new discussion guide!

Gaps in length and quality of life.

Residents in one county are more likely to die prematurely or not be as healthy as residents in another county in the same state if they do not have the same kinds of opportunities to be their healthiest.

Gaps in the factors that influence health.

Health is influenced by every aspect of how and where we live. Access to affordable housing, safe neighborhoods, job training programs and quality early childhood education are examples of important changes that can put people on a path to a healthier life even more than access to medical care. But access to these opportunities varies county to county. This limits choices and makes it hard to be healthy.

Poor health disproportionately burdens people who live in places that limit opportunities to live long and well. These gaps in health outcomes are costly and preventable. Gaps in health could be narrowed, if not eliminated, if we took steps to create more equitable opportunities. Improving education in counties that need it most is one example. That step and others can lead to higher incomes and more lifetime stability.

Find out more about health gaps in your state: