Determinants and Outcomes

The 23 measures that comprise America’s Health Rankings® are of two types — determinants and outcomes. Determinants represent those actions that can affect the future health of the population, whereas outcomes represent what has already occurred, either through death, disease or missed days due to illness.

For further clarity, determinants are divided into four groups: Behaviors, Community and Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of the population in a state, and improving these inputs will improve outcomes over time. Most measures are actually a combination of activities in all four groups. For example, the prevalence of smoking is a behavior that is strongly influenced by the community and environment in which we live, by public policy including taxation and restrictions on smoking in public places, and by the care received to treat the chemical and behavioral addictions associated with tobacco. However, for simplicity, we placed each measure in a single category.

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 score for determinants than its score for outcomes, it will likely improve its overall health ranking in the future. Conversely, if a state is worse in its score for determinants than its score for outcomes, its overall health ranking will more likely decline over time. The table below presents the overall scores for the determinants, outcomes and implications for the future.

Further down this page, a table displays the top 10 and bottom 10 states for determinants and the top 10 and bottom 10 states for outcomes. When compared to other states, Vermont, Connecticut, New Hampshire and Hawaii have a much higher score for determinants than for outcomes, showing a stronger indication they will improve over time. Texas, Nevada, Arkansas and Louisiana show a stronger indication that they will decline over time compared to other states.