Number of membership associations per 10,000 population.
The 2019 County Health Rankings used data from 2016 for this measure.
Reason for Ranking
Poor family support, minimal contact with others, and limited involvement in community life are associated with increased morbidity and early mortality. A 2001 study found that the magnitude of health risk associated with social isolation is similar to the risk of cigarette smoking. 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. 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.
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.
Data and business codes are self-reported by businesses in a county. We use the primary business code of organizations, which in some cases may not match up with our notion of what should be labeled as 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.
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.
Data from County Business Patterns can be accessed at the ZIP code level.
 House JS. Social isolation kills, but how and why? Psychosom Med. 2001;63:273-274.
 Kawachi IK, Bruce P, Glass R. Social capital and self-rated health: A contextual analysis. Am J Public Health. 1999;89:1187-1193.
 Rupasingha A, Goetz SJ, Freshwater D. "The production of social capital in US counties." The journal of socio-economics 35.1 (2006): 83-101.
See how this component fits into our model
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.