Measuring Progress & Change

How do you know if your county’s health is improving or declining? Combine several pieces of information to get the whole picture. You can look at your rank and see how it has changed – but your rank isn’t everything. Progress that you make now can take years to show up in data. You can also look at trends over time for your county to see your progress toward health. 

Changing ranks alone can't show progress

Quartiles and ranks are great for garnering attention, simplifying a lot of complex data, and making comparisons between one community and another at a point in time—but they shouldn’t be used alone to measure a single community’s progress.

County ranks may change for a number of reasons: 

  • Your county experienced health gains or losses: Change in a rank can be due to actual change in the measures that comprise the rank.
  • Other counties experienced health gains or losses: Your county’s rank depends not only on what happens in your county, but also on what happens in all the other counties in your state. Ranks are relative. Your rank might change because health in other counties in your state has improved or declined – even if your county stayed exactly the same. In fact, if every county in a state improved its health equally, their ranks would all stay the same. Ranks are just one piece of information to help you understand your progress. Ranks aren’t everything!
  • Random variation in measures: Since all measures have some variation (which is why we report error margins), a fluctuation in county rank may be caused by random variation in the measures that comprise the rank.
  • Changes in ranked measures or their methods: Ranks can be influenced by the introduction of new measures or a change in the methods for current measures. For instance, the 2021 Rankings were calculated using the measure High School Completion (American Community Survey) where the measure High School Graduation (U.S. Department of Education, EDFacts) had previously contributed that 5% of the Health Factor rank. This change improves data quality and comparability across states, and also increases the potential for change in Health Factors ranks from the previous year.

Progress can take time to show up in data

Change is a long and complex process. It’s important to be realistic about how quickly change happens and how quickly those improvements might show up in the data. 

For example:

  • When you reduce your adult smoking rates significantly, it will still take some time before this positive change reduces the number of deaths due to lung cancer.
  • When you implement an early education intervention it will be years until high school completion rates improve.

Furthermore, most data collection (via census or survey) has lag times. For example, our premature death rates represent a lag of more than two years, and to be sure that we have reliable data for communities of all sizes, we use three years of data. So, the Premature Death rates you see for the current Rankings reflect premature deaths from two to five years ago. As you look at your county data, make sure to keep an eye on the years of data used for each measure.

Trends over time can indicate change

Examining changes in health outcomes over time can provide an overall sense of community progress toward health. Trends in health factors can inform specific health programs and may reflect the impact of local efforts. 

We provide trend graphs for many measures, which are available within your county snapshot.

Each graph icon is color-coded to communicate the direction of the trend: 

2023 Trend Graph Interpretation Icons

These questions can help guide interpretation of the trend graphs: 

  1. Is the county value increasing, decreasing, or staying the same over time?
  2. Is the county trend better, worse, or similar to the state trend?
  3. Is the county trend better, worse, or similar to the national trend?
  4. What worldwide, national, or local events occurred during this time period that may have impacted the measure? 

Download our guide to interpreting trend graphs for additional guidance.