25 Year Evolution of State Health Rankings - a retrospective review of the change in methodology

America’s Health Rankings has measured geographic disparity in overall population health since 1990. During this time, the precise definition of health has changed with the availability of new data sources, public health theory, and refined methodology. This retrospective review of the rankings will detail these changes.

In 1990, determinants or risk factors for health accounted for 50% of the ranking index; in 2014, determinants accounted for 75% of the index. Changes have also occurred at the individual metric level as the prevalence of smoking was 10% of the index in 1990 and is now 7.5% of the index.

The metrics also reflect changing knowledge of public health. In 1990, neither obesity nor physical inactivity were called out as specific metrics but included as part of a “risk for heart disease” determinant. In 2014, the two metrics are present individually and together account for 7.5% of the weight of the final index, acknowledging the immense importance of these risk factors.

A major change in the conceptual model of the index occurred in the early 2000’s with the adoption of the current five part model (behaviors, community, clinical care, policy and outcomes). Prior to this model, the metrics were loosely categorized into risk factors and outcomes.

This presentation highlights the changes over time and how these changes have both improved the comparative measurement of health and presented the challenge of creating a longitudinal comparison.