America’s Health Rankings® Annual Report is the longest-running annual assessment of the nation’s health on a state-by-state basis. For nearly 3 decades, America’s Health Rankings Annual Report has analyzed a comprehensive set of behaviors, community and environmental conditions, policies, and clinical care data to provide a holistic view of the health of the nation. America’s Health Rankings Annual Report is the result of a partnership between United Health Foundation and the American Public Health Association.

1. Introduction & Purpose

Health is a result of our individual genetic predisposition to disease, behaviors, community and environment, policies, and clinical care. Each of us—individually, as a community, and as a society—strives to optimize these health determinants so that all can have a long, disease-free, and robust life regardless of race, ethnicity, gender, or socioeconomic status.
This report looks at the 4 groups of health determinants that can be affected:
  1. Behaviors include everyday activities that affect personal health. Behaviors include habits and practices we develop as individuals and families that influence our personal health and the use of health resources. Individuals can modify these behaviors with support of community, policy, and clinical interventions.
  2. Community & Environment influence quality of life and life expectancy. Healthy and safe communities include those with clean water and air, affordable and secure housing, sustainable and economically vital neighborhoods, and support structures such as violence-free places to be physically active.[1]
  3. Policy influences availability of resources to encourage and maintain health. Policy also influences the extent that public and health programs penetrate the general population. Policies can have a wide reach throughout a state, and they promote healthy living and judicious consumption of health care resources.
  4. Clinical Care reflects the access, quality, appropriateness, and cost of care we receive at doctors’ offices, clinics, and hospitals.
Health determinants are intertwined and must work together to be optimally effective. For example, an initiative that addresses tobacco cessation requires individual effort and community support in the form of policies promoting non-smoking and effective counseling and care at clinics. Similarly, reducing the risk of low birth weight babies requires individual effort, education, access to and availability of prenatal care, and high quality health care services. Addressing obesity requires individual actions complemented by food producers and distributors, restaurants, grocery and convenience stores, exercise facilities, parks, urban and transportation design, building design, educational institutions, community organizations, social groups, health care delivery, and insurance.
The America’s Health Rankings Annual Report combines individual measures of each of these determinants with the resultant health outcomes to produce a comprehensive view of the overall health of each state.
The America’s Health Rankings Annual Report employs a unique methodology developed and reviewed annually by a panel of leading public health scholars. This methodology balances the contributions of various factors to state health such as smoking, obesity, physical inactivity, binge drinking, high school graduation rates, children in poverty, access to care, and incidence of preventable disease. The report is based on data from the US Department of Health and Human ServicesCommerceEducationJustice, and Labor; US Environmental Protection AgencyUS Census Bureau; the American Medical Association; the American Dental Association; the Dartmouth Atlas of Health Care; the Trust for America’s Health; and the World Health Organization.
The 2015 America’s Health Rankings Annual Report is considered a benchmark of the relative health of states due to its longevity and its sound model. Numerous states incorporate this report into their annual review of programs, and several organizations use this study as a reference point when assigning goals for health-improvement programs.


The ultimate purpose of America’s Health Rankings Annual Report is to stimulate action by individuals, elected officials, health care professionals, public health professionals, employers, educators, and communities to improve the health of the US population. The report promotes public conversation concerning health in our states and provides information to facilitate citizen, community, and group participation. Participation is encouraged regarding behaviors, community and environment, clinical care, and policy. Each person as an individual, employee, employer, educator, voter, community volunteer, health care professional, public health professional, or elected official can contribute to the advancement of state health. Proven, effective, and innovative actions can improve the health of people in every state no matter where it is ranked.
[1] National Prevention Council. National Prevention Strategy Healthy and safe community environments. Accessed December 2, 2014.

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