Using County Health Rankings and Roadmaps to Improve Health

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Written by: Ronald C. Dendas, MS, Samantha A. Shaak, PhD , Sherri Brokopp Binder, PhD, Carmen Guzman-McLaughlin, MPH

Since 2010, the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation have released the County Health Rankings and Roadmaps report ( to help communities become healthier places to live, learn, work and play.  The report assesses health outcomes (indicators of how healthy a community is right now) and health factors (indicators that predict how healthy they will be in the future) for more than 3,100 counties across the United States. Counties within each state are then ranked according to eight key indicators.

Health Outcomes Length of Life
Quality of Life
Health Factors Health Behaviors
Clinical Care
Social & Economic Factors

The assessment uses a weighted scale to analyze multiple, publicly available population data sources from the US Census, Centers for Disease Control, and Housing and Urban Development, among others. It uses these data to provide a comprehensive snapshot of community health.  Importantly, the model accounts for the fact that much of what affects health occurs outside of the healthcare system and is reflected in our own health behaviors and in the characteristics of the neighborhoods where we live. Figure 1 provides an overview of the current model. 

Figure 1 University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2019.

The annual rankings and a brief summary are released to announce the latest version of the report and provide a visual measure of how each of the counties within a state compare to one another.  This single point becomes the message highlighted by media, community stakeholders and elected officials.  While helpful, it is only a small part of the rich information provided by the County Health Rankings and Roadmaps.  A deeper dive into what the analysis tells us about health in our region over time allows for exploration of the factors and determinants that give us a more broad understanding of our community health and ways to improve it. 

How are we doing? The 2019 County Health Rankings and Roadmaps reveals that Northampton County (ranked 8th) and Lehigh County (ranked 18th) are both in the top 30th percentile among Pennsylvania counties for overall health outcomes and have been modestly improving since 2011.  A deeper analysis, however, reveals a more nuanced story.  In both counties, our Length of Life (the measure of premature death) rankings are very good, but our Quality of Life rankings (the measure of perceived illness and how people feel over time) are not nearly as good, bringing our overall rankings down.  Essentially, this shows we live long lives, but we have higher than average sickness and illness over the course of our lifetimes.

If we want to be able to change that quality of life ranking over time, we need to address the Health Factors.  The data that drive the Health Factors provide insight into the future direction of health in the Lehigh Valley. Like our Health Outcomes, the Lehigh Valley is better than average (top 35th percentile) overall. One of our greatest strengths is our quality Clinical Care; more people with health insurance, positive trends in preventable hospital stays, and preventive services including flu vaccinations and mammograms are having a positive impact on our overall health. 

Still, deeper analysis in other areas provides us with clear direction for improvement. Although the Lehigh Valley ranks in the top 30th percentile in Health Behaviors, the breakdown of the data suggests that we are not living a healthy lifestyle in many ways.  More than 15% of our residents continue to smoke, more than 30% of our adults are obese, and despite increased access to exercise opportunities, a quarter of our residents are inactive.  While other counties in Pennsylvania are faring worse in this category, the data highlights how community members in the Lehigh Valley are engaging in unhealthy behaviors consistently over time.

Our lowest rankings are in the areas driven by social determinants of health, defined by the Centers for Disease Control as “the range of personal, social, economic, and environmental factors that influence health status”.  Our rankings in Social and Economic Factors, as well as Physical Environmental – specifically poverty (more than 1 out of 6 children in the Lehigh Valley live in poverty), education (urban graduation rates are less than 70%), housing (17% of the population have severe housing problems) and social isolation (the Lehigh Valley’s rates of social associations are 16% lower than state average)- are our biggest impediments to improving health. Other environmental health issues, like quality of air and water, are also concerning.  The metrics used to track these factors have changed during the nine years of this assessment and require a careful local review to better understand their impact on health.

Looking at these data reported over the last nine years, we can easily use the web-based and interactive County Health Rankings and Roadmaps to:

  • Identify areas of strengths and areas of opportunity
  • Look at longer-term trends in health outcomes and factors for an individual county
  • Demonstrate the importance of social determinants and the effect they have on our health
  • Provide alternative data visualization tools in the form of charts, graphs and data tables, allowing us to tailor our reporting of health to specific audiences
  • Access reports, webinars and best practices from other community health experts
  • Offer guidance and tools to support community health improvement
  • Learn from counties that are doing well in areas where we are lacking
  • Identify opportunities for cross-county collaboration on shared challenges
  • Access data used in the report for additional analysis by local experts, including researchers, evaluators and planners.

In summary, the County Health Rankings and Roadmaps have shown that our overall health is improving, driven by our high quality of, and increased access to, health care.  If we want this trend to continue, we must also focus on those areas that we are not so good at- health behaviors and social determinants.  These issues require the attention and involvement from all individuals and all sectors if better health outcomes are to be achieved.  It requires a community-wide approach where we all play a role in creating healthy neighborhoods.  The County Health Rankings and Roadmaps provide us with key metrics and benchmarks, best practices, and a community-focused approach to something that is valuable to every one of us- good health.