County health rankings lose their order

The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute in Madison released their 2024 county health assessments — but this time, without an ordinal ranking. 

County Health Rankings & Roadmaps is a program of the University of Wisconsin Population Health Institute with support from the Robert Wood Johnson Foundation. For more than a decade, it ranked counties within each U.S. state ordinally by analyzing more than 90 health factors at the county level. Comprehensive county rankings data was searchable by state, county or ZIP code. 

Users to the 2024 report will find representation of county health has changed significantly. Rather than a numerical ranking, each county in a state is represented by a dot, shaded a certain color and placed on a scale from least healthy to healthiest in the nation. The new visual tool then shows where one county falls on a "continuum" of health nationally, compared to the least healthy and most healthy counties, which are unnamed in the visualization.

"Instead of seeing that you're ranked, say, 82nd healthiest county out of 83, you'll now see your county's health on a continuum and be able to determine where there are meaningful similarities or differences from one county to the next," Bethany Rogerson, co-director of the County Health Rankings & Roadmap, said in a March 12 webinar about the changes. "This can help people working to improve the health of their counties identify and connect with others who share similarities and challenges." 

Ms. Rogerson said the change was informed by "feedback from the field" and "allows for more nuance in the assessment of a county's health."  

Metrics included in the assessment include adult obesity, alcohol-impaired driving fatalities, mammography screening rates, preventable hospitalizations, primary care physician supply, and dozens of other metrics related to clinical care, social and economic factors, health behaviors and physical environment. 

The County Health Rankings & Roadmaps program is also continuing to focus on civic engagement measures in its scoring of health. In 2023, it added the percentage of households in a county that participated in the 2020 U.S. census and percentage of voting-age population that cast a ballot in the 2020 U.S. presidential election to its ranking. 

County Health Rankings & Roadmaps is one more outlet for rankings of health that has moved away from ordinal rankings to represent performance, outcomes and health within the past year. U.S. News & World Report announced last summer that it would stop ranking its Honor Roll hospitals. The Honor Roll was made up of the top 20 hospitals in the country, ranked and including ties. In its latest edition, and in response to criticism, the outlet grouped 22 hospitals together as honor rollees, but without individual ranks.

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