Robert Wood Johnson Foundation County Health Rankings

Robert Wood Johnson Foundation County Health Rankings
Name	County Health Rankings
Type	Program
Founded	2010
Founder	Robert Wood Johnson Foundation
Headquarters	Princeton, New Jersey

Robert Wood Johnson Foundation County Health Rankings is an annual assessment that compares health status across counties in the United States. The project produces comparative measures intended to guide decision-makers, stakeholders, and researchers in public health, population health, and health policy. The Rankings are produced through a partnership of the Robert Wood Johnson Foundation and the University of Wisconsin–Madison Population Health Institute, and they are widely cited by Centers for Disease Control and Prevention, state health departments, and community coalitions.

Overview

The County Health Rankings translate complex measures into county-level summaries to support local action in United States, assisting entities such as state health department, local health department, community-based organization, hospital, health system, county commission, and nonprofit organization. The annual release highlights relative positions among more than 3,000 counties and equivalents, enabling comparison across jurisdictions like Los Angeles County, California, Cook County, Illinois, Harris County, Texas, Maricopa County, Arizona, and King County, Washington. Outputs include reports, interactive maps, and data downloads used by practitioners in Centers for Medicare & Medicaid Services, researchers at Harvard T.H. Chan School of Public Health, Columbia University Mailman School of Public Health, and advocacy groups such as AARP and American Public Health Association.

Methodology

The methodology synthesizes multiple measures into composite indices labeled "Health Outcomes" and "Health Factors." This approach employs statistical techniques similar to those used at World Health Organization and in Global Burden of Disease studies, drawing on empirically validated indicators and weighting schemes. Analytic partners at the University of Wisconsin–Madison apply standardization, imputation, and ranking processes akin to methods promoted by Agency for Healthcare Research and Quality and National Center for Health Statistics. Peer-reviewed methods papers have been discussed in venues such as The Lancet, American Journal of Public Health, and Health Affairs.

Data Sources and Indicators

Indicators are drawn from federal, state, and private data systems including the Behavioral Risk Factor Surveillance System, National Vital Statistics System, American Community Survey, Youth Risk Behavior Surveillance System, Medicare, and commercial sources. Specific measures include premature mortality from National Center for Health Statistics death files, self-reported poor health from Behavioral Risk Factor Surveillance System, smoking prevalence from Centers for Disease Control and Prevention, obesity estimates linked to National Health and Nutrition Examination Survey, and access metrics informed by Health Resources and Services Administration. Socioeconomic indicators incorporate data from U.S. Census Bureau's American Community Survey, while clinical care measures may draw on Area Health Resources Files and Medicare Provider Utilization and Payment Data.

Rankings and Findings

Annual rankings consistently show geographic patterns: counties in regions such as the Appalachian Mountains, the Mississippi Delta, and parts of the Deep South often rank lower, whereas counties in the Upper Midwest, the Pacific Northwest, and parts of the Northeast United States often rank higher. The Rankings identify associations between health and determinants like income from U.S. Census Bureau, education from National Center for Education Statistics, employment from Bureau of Labor Statistics, and insurance coverage tied to Affordable Care Act implementation. Scholarly analyses using Rankings data appear in journals such as JAMA, American Journal of Preventive Medicine, and PLOS ONE and inform reports by organizations like Kaiser Family Foundation and Commonwealth Fund.

Impact and Uses

Stakeholders use the Rankings for community health needs assessments required by Internal Revenue Service for nonprofit hospitals, to guide grantmaking by foundations including The Rockefeller Foundation and Kaiser Permanente, and to inform policy discussions in state legislatures and county boards. Public health programs at institutions such as Johns Hopkins Bloomberg School of Public Health and University of California, Berkeley deploy Rankings data for curriculum and research. Nonprofits and civic coalitions, including United Way chapters and Local Initiatives Support Corporation, use the tool to prioritize interventions, while local media in outlets like the New York Times and Los Angeles Times report on county standings.

Criticisms and Limitations

Critiques focus on ecological inference risks highlighted by scholars at London School of Hygiene & Tropical Medicine and Harvard University, potential biases in self-reported surveys like Behavioral Risk Factor Surveillance System, and the challenges of data timeliness relative to rapidly changing local conditions such as those seen during the COVID-19 pandemic in the United States. Methodological debates mirror critiques leveled at composite indices produced by Organisation for Economic Co-operation and Development and World Bank regional rankings. Limitations also include suppression of small-area estimates, variability in administrative data quality across states, and the potential for misinterpretation by stakeholders unfamiliar with statistical uncertainty.

History and Development

The project was launched in 2010 as an initiative of the Robert Wood Johnson Foundation with analytic leadership from the University of Wisconsin–Madison Population Health Institute. Over subsequent years the Rankings evolved through collaborations with federal agencies like Centers for Disease Control and Prevention and academic partners including Duke University, University of Michigan School of Public Health, and Yale School of Public Health. Methodological updates have responded to feedback from National Academies of Sciences, Engineering, and Medicine panels and practitioners in state health agencies. The tool has expanded its web-based dissemination alongside innovations in geographic information system mapping and open data practices championed by Sunlight Foundation and other transparency advocates.

Category:Public health