America's Health Rankings

From Wikipedia, the free encyclopedia
Jump to: navigation, search
AHR Icon.png

Introduction[edit]

The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.[1] America’s Health Rankings® , which started in 1990, is the longest- running complete annual assessment of the nation’s health on a state-by-state basis that uses the World Health Organization’s holistic definition of health. America’s Health Rankings® is a partnership between United Health Foundation, American Public Health Association, and Partnership for Prevention™. [2] The report provides state-specific rankings from 1 to 50 across a variety of national health metrics, as well as a variety of subgroups and different populations. [3] America’s Health Rankings® releases an annual report on the overall health of the general population as well as an annual Senior Report focused on the population age 65 and above. [4] State rankings are determined by combining four major groups of determinants: behaviors, the environment and the community in which people live, the decisions made by public and health policies and practices of the government, clinical care received, and metrics related to outcomes. America’s Health Rankings® employs a methodology that balances the contributions of various factors such as smoking, obesity, physical inactivity, binge drinking, high school graduation rates, children in poverty, access to care, and incidence of preventable disease, to a state’s health.

Purpose[edit]

The report states that its ultimate purpose is to stimulate action by individuals, elected officials, health care professionals, public health professionals, employers, educators, and communities to improve the health of the population of the United States. The rankings do this by promoting public conversation concerning health in the United States, as well as providing information to facilitate citizen, community, and, government participation and action. [5] The rankings, both Senior and Annual, encourage participation in all elements: behaviors, community and environment, clinical care, and policy. [6] Each person individually, and in their capacity as an employee, employer, educator, voter, community volunteer, health care professional, public health professional, or elected official, can contribute to the advancement of the healthiness of their state. [7] Proven, effective, and innovative actions can improve the health of people in every state whether the state is ranked first or 50th.[8] [9]

History[edit]

The general population rankings were first published in 1990 and ranked the relative healthiness of state populations based on 16 measures of health. As of 2013, 27 core measures and 20 supplemental measures were used to evaluate a comprehensive profile of the overall health of each state in the Annual edition.[10] The rankings of senior population started in 2013 and used 34 different core measures as well as 5 supplemental measures. America’s Health Rankings® is released in partnership with United Health Foundation, American Public Health Association and Partnership for Prevention.

Scientific Advisory Committee[edit]

In 2002, United Health Foundation, in concert with the American Public Health Association and Partnership for Prevention, commissioned the University of North Carolina at Chapel Hill School of Public Health to undertake an ongoing review of America’s Health Rankings®. The Scientific Advisory Committee, currently led by Anna Schenck, PhD, MSPH, was charged with recommending improvements that would maintain the value of the comparative, longitudinal information; reflect the evolving role and science of public health; utilize new or improved measures of health as they become available and acceptable; and incorporate new methods as feasible. The Scientific Advisory Committee represents a variety of stakeholders, including representatives from local health departments and the Centers for Disease Control and Prevention, members of APHA, as well as experts from many academic disciplines.

Measure Selection[edit]

Four primary considerations drove the design of America’s Health Rankings® and the selection of the individual measures:

  1. The overall rankings had to represent a broad range of issues that affect a population’s health.
  2. Individual measures needed to use common health measurement criteria.
  3. Data had to be available at a state level.
  4. Data had to be current and updated periodically.

Components of health[edit]

Americas Health Rankings looks at the four main groups of health determinants that can be affected:

  1. Behaviors include everyday activities that affect personal health habits and practices individuals and families develop that have an effect on our personal health and our utilization of health resources. These behaviors are modifiable with effort by the individual supported by community, policy and clinical interventions.
  2. Community and environment reflects the reality that the daily conditions in which we live our lives have a great effect on achieving optimal individual health.
  3. Public and health policies are indicative of the availability of resources to encourage and maintain health and the extent that public and health programs reach into the general population.
  4. Clinical care reflects the quality, appropriateness and cost of the care we receive at doctors' offices, clinics and hospitals.

Methodology[edit]

America's Health Rankings employs a unique methodology, developed and annually reviewed by the Scientific Advisory Committee, a panel of leading public health scholars, which balances the contributions of various factors, such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care, and incidence of preventable disease, in evaluation of the overall health of a state's population. The report is based on data from the U.S. Departments of Health and Human Services, Commerce, Education and Labor; U.S. Environmental Protection Agency; the American Medical Association; the Dartmouth Atlas of Health Care Project; Centers for Disease Control and Prevention; the Administration on Aging; the National Center for Health Statistics; the Centers for Medicare and Medicaid Services; National Federation to End Senior Hunger; the Kaiser Family Foundation; Brown University; the American Geriatrics Society; the Commonwealth Fund; and theTrust for America's Health.[11]

The overall score for each state is calculated by adding the Z-scores of each measure multiplied by its percentage of total overall ranking (weight) and the effect (positively or negatively correlated) it has on health. Weights for individual metrics vary from 7.5% to 1.5%. The ranking is the ordering of each state according to value.

Description of measures[edit]

Annual America’s Health Rankings 2013[edit]

The measures that comprise 2013 America's Health Rankings for the general population are two subgroups: Core Measures and Supplemental Measures. Core measures consist of health determinants (Risk factors), and health outcomes.[12]

Core Measures[edit]

Behaviors

  • Smoking: Percentage of adults who are current smokers (smoked at least 100 cigarettes in their lifetime and currently smokes). Data from CDC BRFSS
  • Binge drinking: Percentage of adults who self-report having 4 or more (women) or 5 or more (men) alcoholic beverages on at least 1 occasion in the past 30 days. Data from CDC BRFSS
  • Drug Deaths: Number of deaths due to drug injury of any intent (unintentional, suicide, homicide, or undetermined) per 100,000 people. Data from CDC NCHS
  • Obesity: Percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher. Data from CDC BRFSS
  • Physical inactivity Percentage of adults who report doing no physical activity or exercise (such as running, calisthenics, golf, gardening, or walking) other than their regular job in the last 30 days. Data from CDC BRFSS
  • High School Graduation: Percentage of incoming ninth graders who graduate in four years from a high school with a regular degree, as reported by National Center for Education Statistics.

Community and Environment

Policy

Clinical Care

  • Low birthweight: Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth. Data from CDC NCHS
  • Primary Care Physicians: Number of primary care physicians (including general practice, family practice, OB-GYN, pediatrics and internal medicine) per 100,000 population. Data from AMA
  • Dentists: Number of dentists per 100,000 population. Data from ADA
  • Preventable Hospitalizations: Discharge rate among the Medicare population for diagnoses that are amenable to non-hospital based care. Data from Dartmouth Atlas

Outcomes

  • Diabetes: Percentage of adults who have been told by a health professional that they have diabetes (does not include pre-diabetes or diabetes during pregnancy). Data from CDC BRFSS
  • Poor Mental Health Days: Number of days in the previous 30 days when a person indicates their activities are limited due to mental health difficulties. Data from CDC BRFSS
  • Poor Physical Health Days: Number of days in the previous 30 days when a person indicates their activities are limited due to physical health difficulties. Data from CDC BRFSS
  • Disparity in Health Status: Percent difference in adults aged 25 and older who did not graduate high school and adults with at least a high school education who self-report being in excellent or very good health. Data from CDC BRFSS
  • Infant Mortality: Number of infant deaths (before age one) per 1,000 live births. Data from CDC NCHS
  • Cardiovascular Deaths: Number of deaths due to all cardiovascular diseases, including heart disease and strokes, per 100,000 populations. Data from CDC NCHS
  • Cancer Deaths: Number of deaths due to all causes of cancer per 100,000 population. Data from CDC NCHS
  • Premature Death: Number of years of potential life lost prior to age 75 per 100,000 population. Data from CDC NCHS

Supplemental Measures[edit]

Behaviors

  • Cholesterol Check: Percentage of adults who have had their blood cholesterol checked within the last 5 years. Data from CDC BRFSS
  • Dental Visit-Annual: Percentage of adults who have visited the dentist or dental clinic within the past year for any reason. Data from CDC BRFSS
  • Diet-Fruit: Number of fruits consumed on an average day. Data from CDC BRFSS
  • Diet-Vegetables: Number of vegetables consumed on an average day. Data from CDC BRFSS
  • Teen Birth rate: Number of births per 1,000 mothers aged 15 to 19 years. Data from CDC NVSS
  • Youth Smoking: Percentage of high school youth who smoked cigarettes on at least 1 day during the last 30 days. Data from CDC YRBS
  • Youth Obesity: Percentage of high school students who were greater or equal to the 95th percentile for body mass index, based on sex and age-specific reference data from the 2000 CDC growth charts. Data from CDC YRBS

Chronic Disease

  • Heart Disease: Percentage of adults who have been told by a health professional that they have angina or coronary heart disease. Data from CDC BRFSS
  • High Cholesterol: Percentage of adults who have had their cholesterol checked and been told that it was high. Data from CDC BRFSS
  • Heart Attack: Percentage of adults who have been told by a health professional that they had a heart attack (myocardial infarction). Data from CDC BRFSS
  • Stroke: Percentage of adults who have been told by a health professional that they had a stroke. Data from CDC BRFSS
  • Hypertension: Percentage of adults who have been told by a health professional that they have high blood pressure. Data from CDC BRFSS

Clinical Care

Economic Environment

Outcomes

  • Low Health Status: Percentage of adults who describe their general health as fair or poor. Data from CDC BRFSS
  • Suicide: Number of deaths due to intentional self-harm per 100,000 population. Data from CDC NCHS

America’s Senior Health Rankings 2014[edit]

The measures that comprise 2014 America's Senior Health Rankings are of two subgroups: Core Measures and Supplemental Measures. Core measures consist of health determinants (Risk factors), and health outcomes.[13]

Core Measures[edit]

Behaviors

  • Smoking: Percentage of adults aged 65 and older who regularly smoke (smoked at least 100 cigarettes in their lifetime and currently smoke every day or some days.) Data from CDC BRFSS
  • Chronic drinking: Percentage of adults aged 65 and older who consumed more than 60 drinks in the last 30 days for men and more than 30 drinks in the last 30 days for women. Data from CDC BRFSS
  • Obesity: Percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher. Data from CDC BRFSS
  • Underweight: Percentage of adults aged 65 and older with fair or better health status estimated to be underweight, with a body mass index (BMI) of 18.5 or less. Data from CDC BRFSS
  • Physical inactivity Percentage of adults aged 65 and older with fair or better health status who report doing no physical activity or exercise (such as running, calisthenics, golf, gardening or walking) other than their regular job in the last 30 days. Data from CDC BRFSS
  • Pain Management: Percentage of adults aged 65 and older with arthritis who report arthritis or joint pain does not limit their usual activities. Data from CDC BRFSS

Community and Environment

  • Poverty: Percentage of adults aged 65 and older who live in households at or below 100 percent of the poverty threshold. Data from US Census ACS
  • Volunteerism: Percentage of adults aged 65 and older who report volunteering through or for an organization in the past 12 months. Data from US Census CPS
  • Nursing home Quality: Percentage of certified nursing home beds rated 4 or 5 stars. Data from CMS
  • Social Support: Percentage of adults age 65 and older who receive sufficient social and emotional support. Data from CDC BRFSS
  • Food Insecurity: Percentage of adults aged 60 and older who are marginally food insecure. Data from National Foundation to End Senior Hunger
  • Community Support: Total expenditures captured by the Administration on Aging divided by the number of adults aged 65 and older living in poverty. Data from US Census and AOA

Policy

  • Low-Care Nursing Home Residents: Percentage of nursing home residents who were low care, according to the broad definition (no physical assistance required for late-loss ADLs). Data from Brown University
  • Prescription Drug Coverage: Percentage of adults aged 65 and older who have a creditable prescription drug plan. Data from Kaiser Foundation
  • Geriatrician Shortfall: Percentage of the estimated deficit of geriatricians [estimated shortfall/minimum required number]. Data from AGS

Clinical Care

  • Dedicated Health Care Provider: Percentage of adults aged 65 and older who report having a personal doctor or health care provider. Data from CDC BRFSS
  • Recommended Hospital Care: Percentage of hospitalized patients aged 65 and older who received the recommended care for heart attack, heart failure, pneumonia, and surgical procedures. Data from The Commonwealth Fund
  • Flu vaccine: Percentage of adults aged 65 and older who received a flu vaccine in the last year. Data from CDC BRFSS
  • Health Screenings: Percentage of adults aged 65 and older who have had mammograms and/or fecal occult blood/colonoscopy/sigmoidoscopy screens within the recommended time period. Data from CDC BRFSS
  • Diabetes Management Percentage of Medicare beneficiaries aged 65 to 75 with diabetes receiving a blood lipids test. Data from Dartmouth Atlas
  • Home Health Care: Number of personal, home care, and home health aide direct care workers per 1,000 adults aged 75 or older. Data from US Bureau of Labor Statistics
  • Preventable Hospitalizations: Number of discharges for ambulatory care-sensitive conditions per 1,000 Medicare beneficiaries. Data from Dartmouth Atlas
  • Hospital Readmissions: Number of discharges for ambulatory care-sensitive conditions per 1,000 Medicare beneficiaries. Data from Dartmouth Atlas
  • Hospice Care: Percentage of decedents aged 65 and older who were enrolled in hospice during the last six months of life after diagnosis of condition with high probability of death. Data from Dartmouth Atlas
  • Hospital Deaths: Percentage of decedents aged 65 and older who died in a hospital. Data from Dartmouth Atlas

Outcomes

  • ICU Usage: Percentage of decedents aged 65 and older spending 7 or more days in the ICU/CCU during the last six months of life. Data from Dartmouth Atlas
  • Falls: Percentage of adults aged 65 and older who report they have fallen in the last 12 months. Data from CDC BRFSS
  • Hip Fractures: Rate of hospitalization for hip fracture per 1,000 Medicare beneficiaries. Data from Dartmouth Atlas
  • Health Status: Percentage of adults aged 65 and older who report their health is very good or excellent. Data from CDC BRFSS
  • Able-Bodied: Percentage of adults aged 65 and older with no disability. Data from US Census ACS
  • Premature Death: Number of years of potential life lost prior to age 75 per 100,000 population. Data from CDC NCHS
  • Teeth Extractions: Percentage of adults aged 65 and older full-mouth tooth extraction. Data from CDC BRFSS
  • Mental Health Days: Number of days in the previous 30 days person aged 65 or older indicates their activities were limited due to mental health difficulties. Data from CDC BRFSS

Supplemental Measures[edit]

  • Education: Percentage of adults aged 65 and older who report having a college degree. Data from US Census ACS
  • Multiple Chronic conditions: percentage of Medicare beneficiaries with 4 or more chronic conditions. Data from CMS
  • Cognition: percentage of adults aged 65 and older who report having a cognitive difficulty. This is defined as having difficulty remembering, concentrating, or making decisions (DREM) due to physical, mental, or emotional problems. Data from US Census ACS
  • Depression: percentage of older adults who were told by a health professional that they have a depressive disorder, including depression, major depression, dysthymia, or minor depression. Data from CDC BRFSS
  • Suicide: Number of deaths due to intentional self-harm per 100,000 adults aged 65 and older. Data from CDC NVSS

References[edit]

External links[edit]