America's Health Rankings as Policy Stimulus

America's Health Rankings have become an important overall measure of the nation's health and a comparative indicator of population health status for states. The rankings have stimulated states and community agencies to modify or implement programs and policies that are designed to improve population health. However, there are emerging trends that require the rankings to be re-assessed: the compression of mortality makes some components, e.g. occupational mortality, of the rankings potentially obsolete. Other trends including rising obesity rates require additional attention. The inability to accurately measure the intensity of public health measures presents another problem for anticipating improvements in health. The relative contribution of prevention versus certain levels of health care delivery challenges us to identify the appropriate inputs for a summary measures of population health. Lastly, the development of genetic and genomic screens and interventions that emphasize both personal choices and environmental controls will present additional future concerns about how to prospectively measure health. This session will describe how those trends have been factored into the Rankings process and how the rankings can then be interpreted by its target audience to help foster more effective policy change. This has been accomplished by expanding the “components of change” model that guides the development of the rankings to give greater emphasis to the two key issues: clinical care and its effects on mortality in later life and genetic and genomic interventions and overall prevention. The policy responses that make use of the Rankings include: 1. Responses to media coverage of first and last place states to highlight state and community level programs to increase visibility and effect; 2. Use in teaching in public health programs to help students learn how to cope with medical attention as they craft management decisions and strategic policy; and 3. Creating locally applicable rankings.