Social Associations

Number of membership associations per 10,000 population.

The 2022 County Health Rankings used data from 2019 for this measure.

Reason for Ranking

Minimal contact with others and limited involvement in community life are associated with increased morbidity and early mortality.[1,2] Research suggests that the magnitude of risk associated with social isolation is similar to the risk of cigarette smoking.[3] Furthermore, social support networks have been identified as powerful predictors of health behaviors, suggesting that individuals without a strong social network are less likely to make healthy lifestyle choices than individuals with a strong network. A study found that people living in areas with high levels of social trust are less likely to rate their health status as fair or poor than people living in areas with low levels of social trust.[4] Researchers have argued that social trust is enhanced when people belong to voluntary groups and organizations because people who belong to such groups tend to trust others who belong to the same group.[5]

Key Measure Methods

Social Associations is a rate

Social Associations measures the number of membership associations per 10,000 population. Rates measure the number of events in a given time period (generally one or more years) divided by the average number of people at risk during that period. Rates help us compare health data across counties with different population sizes.

Measure limitations

Data and business codes are self-reported by businesses in a county. This measure uses the primary business code of organizations, which in some cases may not align with common understanding of a civic organization.

There is not currently a reliable, national source of data for measuring social or community support at the local level. This measure does not account for important social connections offered via family support structures, informal networks, or community service organizations, all of which are important to consider when understanding the amount of social support available within a county. It also does not account for perceived support. For instance, an individual can be a member of numerous social associations, but feel they receive no social support from those organizations.


The numerator is the total number of membership associations in a county. The associations include membership organizations such as civic organizations, bowling centers, golf clubs, fitness centers, sports organizations, religious organizations, political organizations, labor organizations, business organizations, and professional organizations. These associations are identified by NAICS codes 813410, 713950, 713910, 713940, 711211, 813110, 813940, 813930, 813910, and 813920.


The denominator is the total resident population of a county.

Can This Measure Be Used to Track Progress

This measure can be used to measure progress with some caveats. In understanding and tracking progress in social support in a community, social associations as a measure is incomplete and simply one piece of the whole picture, as described in the limitations above.

Data Source

Years of Data Used


County Business Patterns

County Business Patterns provides data on the total number of establishments, number of establishments by nine employment-size classes by detailed industry, mid-March employment, and first quarter and annual payroll for all counties in the United States and the District of Columbia.

Digging Deeper
Subcounty Area1

Data from County Business Patterns can be accessed at the ZIP code level.


[1] House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988 Jul 29; 241(4865):540-5.
[2] Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. American Journal of Epidemiology. 1979 Feb; 109(2):186-204.
[3] House JS. Social isolation kills, but how and why? Psychosomatic Medicine. 2001; 63:273-274.
[4] Kawachi IK, Bruce P, Glass R. Social capital and self-rated health: A contextual analysis. American Journal of Public Health. 1999; 89:1187-1193.
[5] Rupasingha A, Goetz SJ, Freshwater D. The production of social capital in US counties. The Journal of Socioeconomics. 2006; 35(1):83-101.

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When it comes to developing and implementing solutions to problems that affect communities, evidence matters. The strategies below give some ideas of ways communities can harness evidence to make a difference locally. You can learn more about these and other strategies in What Works for Health, which summarizes and rates evidence for policies, programs, and systems changes.

Offer group educational, social, creative, musical, or physical activities that promote social interactions, regular attendance, and community involvement among older adults
Support locally-based visual, media, and performing arts initiatives for children and adults; also called participatory arts programs
Support community venues that facilitate local residents’ efforts to socialize, participate in recreational or educational activities, gain information, and seek counseling or support services
Create communities that promote interaction and cooperation between individuals of different ages and focus on the needs of all residents, especially children and older adults
Establish voluntary formal groups of residents who work together to create a unified voice, enhance living conditions in their neighborhood, and address neighborhood concerns

The County Health Rankings provide a snapshot of a community’s health and a starting point for investigating and discussing ways to improve health. Select a state and a measure below to see what’s happening locally.