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In the 30 years since America’s Health Rankings began publishing, the understanding of health from a holistic, population-based perspective has changed considerably. Accordingly, the role of measuring population health must evolve.
This shift is characterized as moving from Public Health 1.0 to Public Health 2.0 and then to Public Health 3.0. When America’s Health Rankings began, public health was on the cusp of moving from Public Health 1.0, characterized by tremendous growth in knowledge and tools, to Public Health 2.0, which is characterized by the development of public health agency capacity and implementation of many traditional public health programs. Public health is now firmly in Public Health 3.0, characterized by agreement on the profound impact social determinants have on health and engagement with multisector stakeholders to collectively improve health. Figure 27 shows this evolution and the fact that all stages of public health will continue into the future; earlier stages are not replaced by subsequent ones, but are additive.
Like public health practices, the America’s Health Rankings model must evolve to remain relevant. Three years ago under the guidance of the America’s Health Rankings Advisory Council and report-specific advisory committees, discussions began on the revision of the rankings model. Valuable insights were also gained from other ranking and health models, particularly County Health Rankings, Healthy People 2020 and Healthy People 2030.
The new rankings model will be introduced in all 2020 reports. The new rankings model (Figure 28) consists of four drivers or determinants of health: behaviors, social & economic factors, physical environment and clinical care. These influence health outcomes, shown in the center of the diagram.
The most notable change is the enhanced focus on the social determinants of health, represented by two categories: social & economic factors and physical environment. Policy, a category in the current ranking model, will be removed, and the measures representing the influence of policy on health will be distributed to other categories.
The list of measures in each model category is being finalized. Early in 2020, visit www.AmericasHealthRankings.org to view the measures and how they will impact the state rankings.

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