In 2002, United Health Foundation, in concert with the American Public Health Association (APHA) and Partnership for Prevention, commissioned the School of Public Health at the University of North Carolina at Chapel Hill to undertake an ongoing review of America`s Health RankingsTM. The Scientific Advisory Committee, led by Thomas Ricketts, Ph.D., M.P.H., was charged with conducting a thorough review of the current index and 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. Minor issues with data are always addressed immediately and incorporated into the contents of the next edition of the report. However, more significant issues, such as new measurements of health conditions, require more in-depth study and analysis.

The Scientific Advisory Committee continues its review, and its input is reflected in this Edition. The Committee emphasizes the importance of this tool as a vehicle to promote and improve the general discussion of public health and, also, to encourage balance among public health efforts to benefit the entire community.

This Edition includes several suggestions discussed by the committee including:

• Changing the method of scoring individual metrics from a change relative to the national mean to a change measured in units of standard deviation of the measure (Z-score). This method represents a major change to America`s Health RankingsTM and required a recalculation of all prior years of rankings.
• Revising the Air Pollution measure to better accommodate non-reporting areas of states. Non-reporting counties were assigned a baseline value of exposure to fine particulate matter equal to the average of the lowest annual readings for fine particulate matter for the last three years in their Air Quality Control Region or, if not available, in their state.
• Geographic Disparity was reviewed and suggested that counties with a low number of deaths and deemed unreliable should be handled separately. The current calculation assigns the state`s average total mortality rate to those counties that are unreliable.

In addition, the committee continues to work on issues concerning improved environmental health indicators, methods of expressing variability within the rankings, oral health indicators, mental health indicators, improved health disparities, improved cost measures, quality of care measures and international benchmarking. (Some of these measures are included in the expanded detail of each state`s health snapshot.) The committee also stresses the importance of focusing on health determinants, as improving these measures can improve the healthiness of the states and the nation. This year, the overall ranks for combined determinants, as well as outcomes are presented in each state snapshot.

The methodology review group represents a variety of stakeholders, including representatives from state health departments and the Centers for Disease Control and Prevention, members of APHA, as well as experts from many academic disciplines. Scientific Advisory Committee members include:

Thomas C. Ricketts, Ph.D., M.P.H. Chair
Professor of Health Policy and Administration and Social Medicine
School of Global Public Health
University of North Carolina at Chapel Hill

Dennis P. Andrulis, Ph.D., M.P.H.
Associate Dean for Research
Director, Center for Health Equality
Drexel University School of Public Health

Jamie Bartram, Ph.D.
Professor and Director of Global Water Institute
Gillings School of Global Public Health
University of North Carolina at Chapel Hill

John M. Booker, Ph.D.
Bureau Chief, Injury and Behavioral Epidemiology
Epidemiology and Response Division
New Mexico Department of Health

William Dow, Ph.D.
Associate Professor of Health Economics
School of Public Health
University of California-Berkeley

Paul Erwin, M.D., M.P.H.
Director, Center for Public Health Policy and Research
University of Tennessee

Jonathan Fielding, M.D., M.P.H., M.B.A., M.A.
Professor of Health Services and Pediatrics
UCLA School of Public Health
Director of Public Health and Health Officer, Los Angeles County

Marthe Gold, M.D.
Logan Professor and Chair
Department of Community Health
CUNY Medical School

Dave Kindig, M.D., Ph.D.
Professor Emeritus
Senior Adviser, Population Health Institute
University of Wisconsin-Madison, School of Medicine

Sheila Leatherman, M.S.W.
Research Professor and Gillings Visiting Professor
School of Global Public Health
University of North Carolina at Chapel Hill

Glen P. Mays, Ph.D., M.P.H.
Associate Professor, Vice Chair, Director of Research
Department of Health Policy and Management
Fay W. Boozman College of Public Health
University of Arkansas for Medical Sciences

Matthew McKenna, M.D., M.P.H.
Captain, U.S. Public Health Service
Director, Office on Smoking and Health
Centers for Disease Control and Prevention

Christopher J. L. Murray, M.D., D.Phil.
Professor of Global Health
Director, Institute for Health Metrics and Evaluation
University of Washington

Patrick Remington, M.D., M.P.H.
Associate Dean for Public Health
School of Medicine and Public Health
University of Wisconsin-Madison

Barbara Rimer, Dr.P.H.
Dean, Gillings School of Global Public Health
University of North Carolina at Chapel Hill

William L. Roper, M.D., M.P.H. Chair Emeritus
Dean, School of Medicine
University of North Carolina at Chapel Hill

Leiyu Shi, Ph.D.
Professor
Department of Health Policy and Management
Co-Director, Primary Care Policy Center for the Underserved
Johns Hopkins University School of Public Health

Steven Teutsch, M.D., M.P.H.
Chief Science Officer
Los Angeles County Department of Public Health

Tom Eckstein, M.B.A.
Principal
Arundel Street Consulting, Inc.