America's health rankings: Identifying and selecting a leading health indicator

Background: America's Health Rankings (AHR) has been used as a tool to improve population health status for 20 years. AHR's annual publication ranks each state on overall health and selected indicators, providing individuals, elected officials, public health professionals, medical professionals, and educators with resources that can be used to stimulate change. Methods: America's Health Rankings has established a Scientific Advisory Committee consisting of academics and practitioners that evaluate measures used for specific health indicators. A literature review is conducted; data on potential indicators is collected and evaluated. The committee evaluates current measures, other possibilities and selects the appropriate health indicator. Recent indicator reviews include leading health indicators such as obesity. Results: 35 potential indicators that addressed obesity/healthy weight, physical activity, and nutrition were identified and 15 measures were presented to the Scientific Advisory Committee for review. Review criteria included the data source, frequency of data collection, availability of state level data, and the implication of the measure on overall health.The correlation between healthy weight and obesity was evaluated and the committee discussed framing this indicator in a different manner. The obesity measure currently used ignores the overweight population, which is also a health concern. Discussion / Conclusions: America's Health Rankings' publication as a tool of measurement is becoming a consistent tool to assist in the transition of the population's health from subpar to satisfactory. Shedding light on leading health indicators like obesity may hopefully assist the country in taking accountability for its current health status.