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Each year the America’s Health Rankings model is evaluated to reflect the evolving understanding of population health, to improve existing data sources, to integrate new data sources, and to adjust to changing availability of information. All proposed changes are explored using modeling to clarify the impact of any change. Final recommendations are made to the Scientific Advisory Committee in early spring. If you wish to receive this information or if you have measure or data source suggestions for America’s Health Rankings, please contact us. In addition to the proposed changes, we continue to explore other indicators that reflect health, with special attention to climate change, built environment, diet, health equity, and socioeconomic status indicators.

Changes Implemented in 2016

The following core measures were replaced or amended:
  • The outcome measures poor mental health days and poor physical health days were replaced by frequent mental distress and frequent physical distress, respectively. The new measures capture the percentage of adults with severe and/or chronic mental and physical health issues and align with County Health Rankings. The frequent distress measures gauge the percentage of adults in frequent poor health (14 or more days in the past 30 days), whereas the poor health days measures reflect the average number of poor health days in the past 30 days. Poor mental health days and poor physical health days have been shifted to supplemental measures to provide continuity of data.
  • The definition of primary care physicians has been amended. The new definition is limited to active physicians, and includes those in general practice, family practice, obstetrics and gynecology (OB-GYN), pediatrics, geriatrics, and internal medicine. The previous definition included total physicians in general practice, family practice, OB-GYN, pediatrics, and internal medicine. The measure now aligns with County Health Rankings. Data were obtained from Redi-Data Inc, a licensed provider of American Medical Association (AMA) data. In prior years, data were obtained from the annually printed AMA publication Physician Characteristics and Distribution in the US which has been discontinued.
  • The calculation for air pollution was amended to correct an error for estimating average emissions in counties without monitors. The previous measure overstated air pollution in each state by 0.1 to 0.2 micrograms of fine particles per cubic meter.
These substitutions and adjustments do not have an appreciable effect on a state’s score or rank.
The following supplemental measures were added:
  • Colorectal Cancer Screening. Colorectal cancer is the third most commonly diagnosed cancer and the third-leading cause of cancer mortality in the United States. Colorectal cancer is easier to treat when detected early through screening. Screening also allows for removal of colorectal polyps before they become cancerous. Colorectal cancer screening is an indicator of preventive care and is an important part of clinical care targeted at early diagnosis and treatment of disease.
  • Seat Belt Use. Seat belt use reduces the severity of injuries from motor vehicle accidents and reduces motor vehicle deaths. Young adults, adults living in rural areas, and men are less likely to wear seat belts. Seat belt use varies greatly by state.
  • Water Fluoridation. Community water fluoridation is an effective way of preventing dental caries--an infectious disease in which bacteria dissolve tooth enamel. Water fluoridation is considered a top 10 achievement in public health in the last century [1]. The percentage of the population served by community water systems who receive fluoridated water from the Centers for Disease Control and Prevention Water Fluoridation System has been added as an indicator for implementation of proven public health policy.
See Tables 5 and 6 for the full definitions, data sources, and data years.

2017 Exploration

The following areas are being explored and will be discussed at the spring Scientific Advisory Committee meeting:
  • Premature Death Excluding Infant Deaths. Currently, the model includes infant mortality in the premature death rate. The exclusion of infant deaths from premature death will reduce the double counting of deaths for those younger than 1 year.
  • Injury Deaths. Injury deaths is currently a supplemental measure. Expanding this measure to include injury from specific causes would shed light on many causes of death, especially among those younger than 65 years. Drug deaths is currently included in the model as one specific cause of injury death, and suicide is included as a supplemental measure.
  • Preventive Clinical Care. Developing a composite measure that includes multiple aspects of preventive care, as recommended by the US Preventive Services Task Force (USPSTF), will allow a broader assessment of the utilization of these services to improve health.
  • Distracted Driving. An emerging issue in public health is the role distracted and/or inattentive driving has on mortality and morbidity. A measure in this area would help describe the role distracted driving has on population health and highlight interventions aimed at reducing the amount of distracted or inattentive driving in a state.
  • Exercise. Currently this is measured in the model with physical inactivity and it only captures lack of physical activity outside of work. The objective of a measure in this area would be to better capture exercise or the lack thereof across different populations. This could include physical activity outside of work, job-related physical activity, prolonged sitting, and/or screen time. This exploration will look at factors including job-related physical activity, screen time, and strenuous exercise.
  • Mental Health Providers. Professional care for mental health is vital. Currently the model contains measures for primary care physicians and dentists, but it lacks an indicator of capacity or availability of mental health providers.
  • Environment. Our home, work, and community environments affect our health. Exploring other environmental measures, such as water quality in recreational lakes, rivers, and/or streams, will provide more depth to the rankings.
  • Dental Health. Extraction of teeth due to disease is both an indicator of adverse current health and a potential determinant of continued adverse health in the future. Full extraction, limited extraction (six or more teeth), and extractions occurring before 65 years will be considered as indicators of oral health.
[1] Ten great public health achievements in the 20th century. Centers for Disease Control and Prevention website. Accessed October 21, 2016

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