In the last decade, public health has evolved to emphasize the need to improve social and economic drivers of health in order to achieve health equity and improve population health. The public health sector cannot do this work alone, the support and participation of other public and private sectors and community partners is necessary to make meaningful change.
This year, we reveal a new America’s Health Rankings model (Figure 1). The new model reflects the growing understanding of the impact of social determinants on health and the need for cross-sector collaboration from fields such as agriculture, economy, education, housing, justice and transportation, to improve health outcomes and population health.
The new model serves as a framework for identifying and quantifying health drivers and outcomes that impact state and national population health. It was developed by the America’s Health Rankings’ advisory council and report-specific committees, with insights from other rankings and health models, particularly County Health Rankings & Roadmaps and Healthy People.
The new model consists of four drivers of health: behaviors, social & economic factors, physical environment and clinical care. These drivers influence health outcomes, shown in the center of the diagram. The new model divides the original model’s community & environment category into two categories: social & economic factors and physical environment. The policy category from the original model was removed, and measures in the original categories were shifted to a relevant category in the new model or dropped. Twelve topics were added to group measures within each of the five model categories. For example, substance use and physical activity and nutrition are two topics within the behaviors category.
The America’s Health Rankings Senior Data 2020 Update has 44 measures, including 18 new measures such as exercise, pneumonia vaccination and severe housing problems. Ten measures have been retired. See Measures Selection and Changes for a detailed description of measure changes.
The new model better aligns with current public health best practices by elevating the social determinants of health. It better recognizes that working, living, learning and playing conditions are vitally important to the health and well-being of a population. The result is a more comprehensive model that can help states, policymakers and advocates include broader influences of health in discussions and actions that improve population health.

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