How CHR&R Measures Are Selected

The County Health Rankings & Roadmaps measures describe community conditions that can be modified, called Health Factors. Health Factors influence Health Outcomes, or how long and how well people live within that community. 

Not all measures are used to calculate a county’s rank. Ranked measures contribute to the annual county rank calculations. Unranked measures provide additional community context. Demographic data are included for every county to provide context for the place and its data. Demographic data for a county include: age groups, racial composition, and rurality for county and state. 

Measures of Health Factors and unranked measures are expanded, pared, or revised annually based on the considerations below. These considerations ensure that the CHR&R dataset remains consistent, salient, legitimate, credible and grounded in equity. Measures may not meet all considerations due to data source, geographic and time limitations. To operationalize these considerations, we regularly evaluate data sources and methods and seek expert input and review from scholars, practitioners and external advisors.  

Considerations for County Health Rankings Measures

Strategic Considerations
Alignment with CHR&R goals 

  • The measure speaks to a current or emerging population health issue and increases the value of CHR&R tools.
  • The measure reflects aspects of population health that can be influenced through local, state, or national policies, practices, and systems change.  
  • The measure provides quantitative or qualitative information to explain concepts in the County Health Rankings Model. 
  • The measure supports data fluency and alignment in the field of data-to-action initiatives (e.g., America’s Health Rankings, City Health Dashboard). 
  • The measure is of interest to community members, leaders, advocates, community health activists, equity champions and field actors in public health and health care.

Theoretical Considerations
Connection of the measure to health and equity 

  • The measure and its association with population health are scientifically supported through peer reviewed literature or expert opinion and a strong evidence base. 
  • CHR&R internal analyses (quantitative and qualitative) support the measure's connection to health. 
  • The measure clarifies the existence of health disparities and the potential for unfair, unjust differences. 
  • The measure centers learning from the wealth of knowledge, experiences, and priorities of a socially marginalized group. 

Source Considerations
Assessment of data sources and their methodology  

  • The measure draws from a data source that has transparent methodology and underlying assumptions.  
  • Source data are available for free or low cost.  
  • Source methods are valid. Data quality is maintained and updated regularly (within the past 3-5 years), where applicable.

Analytical Considerations
Feasibility of quantitative and qualitative analysis for evaluation and production 

  • The measure draws from data that are available at, or can be aggregated to, the county level.  
  • Data can be disaggregated among population groups with an emphasis on groups that have historically or currently experience social disadvantage (e.g., race, ethnicity, gender, sex, education, disability status, family type, neighborhood, income, or wealth).  
  • The measure and its association with health and health disparities are validated internally and consistent with scholarly literature or expert evidence.
  • The measure is numeric, ordinal, or binary to quantify differences that capture advantage or disadvantage between counties.  
  • The measure uses data that are available for most counties nationwide.  
  • The measure uses data that are representative locally and comparable across jurisdictions within a state. 

Communication Considerations
Ability to meaningfully communicate and apply the measure to improve health and equity  

  • The measure and its association with health and equity can effectively be communicated. 
  • The measure is recognized and documented by public health, healthcare, adjacent fields, or marginalized communities to have the ability to make change or have influence within systems of oppression.  
  • CHR&R can communicate limitations of the data and methods to audiences who want to interpret and apply the measure. 
  • The measure reflects a distinct concept and “call to action.”