The 22 measures that comprise Americas Health Ranking are of two types - health determinants and health outcomes. Health determinants represent those actions that can affect the future health of the population, whereas health outcomes represent the result of what has already occurred, either through death or missed days due to illness.

For a state to improve the health of its population, efforts must focus on changing the determinants of health. If a state is significantly better in its ranking for health determinants than its ranking for health outcomes, it will be more likely to improve its overall health ranking in the future. Conversely, if a state is worse in its ranking for health determinants than its ranking for health outcomes, its overall health ranking will be more likely to decline over time.

Table 2 presents the overall rankings for the health determinants, health outcomes and implications for the future. If the current trend is positive, the future overall ranking is more likely to increase; if it is neutral, the future overall ranking will probably stay the same; or if it is negative, the future overall ranking is more likely to decline.

The top ten states for strong determinants are, in order from the top ranked state:Colorado ,Connecticut, Hawaii, Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Utah  and Vermont. The states with the weakest determinants, beginning with the lowest listed first, are: Mississippi, Nevada, Oklahoma, Georgia, Texas, South Carolina, Louisiana, Alabama, Tennessee and Arkansas.

The top ten states for strong health outcomes are, in order from the top ranked state: Minnesota, Hawaii, Nebraska, Massachusetts, Iowa, Utah, Connecticut, New Hampshire, Vermont and Washington. The states with the weakest determinants, beginning with the lowest listed first, are: Mississippi, Alabama, West Virginia, Kentucky, Louisiana, Tennessee, Oklahoma, Arkansas, South Carolina and Georgia.

When compared to other states, South Dakota, Maryland and Maine have a much higher ranking for health determinants than for health outcomes, showing a stronger indication they will improve over time. Texas, Nebraska and New York show a stronger indication that they will decline over time compared to other states.

There are many other measures that states can use to compare themselves, especially as action plans are created and implemented. The supplemental measures are described on here and can be accessed by viewing the state`s snapshot at http://www.americashealthrankings.org/StateRank/details.aspx

Health Determinants and Health Outcomes, 2009