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State Responses to America's Health Rankings: The Search for Meaning, Utility, and Value

Erwin, Paul Campbell MD, DrPH; Myers, Carole R. PhD, APRN; Myers, Gail M. MSW; Daugherty, Linda M. MPA

Journal of Public Health Management and Practice: September/October 2011 - Volume 17 - Issue 5 - p 406–412
doi: 10.1097/PHH.0b013e318211b49f

Context: America's Health Rankings (AHR) is a state-level ranking of health determinants and outcomes produced annually by the United Health Foundation.

Objective: The purpose of this study was to determine how states–particularly state health departments (SHDs)–respond to the annual AHR report.

Design: This study utilized a mixed methods approach involving key informant (KI) interviews in selected SHDs and a survey of the 50 state health officials (SHOs).

Setting: Key informants were interviewed at SHD offices in 9 states. The survey was conducted using an online format.

Participants: Key informants included the SHO, senior staff in the SHD, and public health partners outside the SHD organization. Survey respondents were the SHO or designee.'

Main Outcome Measures: Awareness, use, utility, and value of AHR.

Results: Between the interviews and online survey, respondents from at least 40 of the 50 states indicated they were aware of AHR. Fifty-three interview sessions were conducted with 66 different KIs. Of the 37 states providing usable survey information, 20 (54%) reported that AHR was moderately, very, or extremely useful to their agency. Survey respondents indicated that the most common uses of AHR are for problem identification (54%), a source of data (49%), and for grant applications (38%). Regarding overall value of AHR to states, on a scale from 1 to 10, with 1 being no value to 10 being highly valuable, the mean score from survey respondents was 4.7.

Conclusion: Although there is a wide spectrum of knowledge about AHR and responses to the annual report, the majority of SHDs respond in more positive than negative ways. Although the majority of SHOs are aware of AHR, there is less understanding of the methodology in the rankings at the programmatic level. The strongest call for change related to making the report more actionable, especially by identifying best practices.

This study aimed to determine how states respond to the annual America's Health Rankings report.

Department of Public Health (Dr Erwin), College of Nursing (Dr Myers), and College of Social Work (Mss Myers and Daugherty), The University of Tennessee, Knoxville.

Correspondence: Paul Campbell Erwin, MD, DrPH, Department of Public Health, University of Tennessee, 1914 Andy Holt Ave, Knoxville, TN 37996 (

The authors thank Ms Rachael Hadidsaz for assistance in compiling state-level reports and strategic plans, Ms Lisa Haddad and Ms Tracy Jenkins for their assistance in analyzing transcripts, and Dr Tom Ricketts for reviewing an earlier version of the manuscript and Dr Katie Sellers of the Association of State and Territorial Health Officials for assistance with the web-based survey.

Dr Erwin discloses that he is a member of the Scientific Advisory Committee to the United Health Foundation (UHF) for America's Health Rankings but received no remuneration, advice, or direction from UHF during the timeframe of this study. This information was disclosed to all key informants prior to his participation in any interviews.

This study was supported by a grant from the Robert Wood Johnson Foundation on Changes in Health Care Financing and Organization, Public Health Systems Research grant 65719.

Disclosure: The authors report no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.