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Use and Perceived Impact of the County Health Rankings Report in Florida and North Carolina

Winterbauer, Nancy L. PhD; Rafferty, Ann P. PhD; Tucker, Ashley MPH; Jones, Katherine PhD; Tucker-McLaughlin, Mary PhD

Journal of Public Health Management and Practice: November/December 2016 - Volume 22 - Issue 6 - p E1–E7
doi: 10.1097/PHH.0000000000000320
Original Articles

Objective: Examine overall level of and variation in local health department (LHD) use and perceived impact of the County Health Rankings report (Rankings) in Florida (2010, 2011) and North Carolina (2010-2012, 2013).

Design: Two cross-sectional surveys among LHDs.

Participants: Local health directors and relevant staff.

Main Outcome Measures: Use of the Rankings was measured by asking respondents if their LHD had used the Rankings in any of 10 ways and through assessment of community engagement. Perceived impact was measured by amount of attention the Rankings received from various stakeholders and whether they had already produced or would likely produce any of 7 possible results.

Results: Overall, LHDs used the Rankings most often to educate staff in Florida (78%) and North Carolina (56%). Engagement with community groups around the Rankings was variable. Media engagement, through press releases (41%; 40%) or interviews (51%; 36%) in Florida and North Carolina, was moderate. Florida LHDs used the Rankings in more ways and significantly more frequently than North Carolina LHDs. There were few significant differences in perceived impact by state. At least a moderate amount of attention was received from media in Florida (52%) and North Carolina (46%). Twenty-percent of LHDs reported the Rankings received at least moderate attention from the general public in both states and 38% (Florida) and 33% (North Carolina) from policy makers. Tangible benefits to communities from the Rankings, such as having already influenced adoption of new policies, were modest in Florida (3%) and North Carolina (11%).

Conclusions: Results suggest that tangible benefits to communities from use of the Rankings have yet to be fully realized but are encouraging. More effective media engagement could produce the community awareness necessary to maximize the Rankings' potential to mobilize communities for health improvement. State variation in Rankings use suggests that more support to LHDs may be helpful.

This article uses cross-sectional surveys among local health departments (LHDs) to examine overall level of and variation in LHD use and perceived impact of the County Health Rankings report in Florida and North Carolina.

Department of Public Health, Brody School of Medicine (Drs Winterbauer, Rafferty, and Jones and Ms Tucker), and School of Communication (Dr Tucker-McLaughlin), East Carolina University, Greenville, North Carolina.

Correspondence: Nancy L. Winterbauer, PhD, Department of Public Health, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Mailstop 660, Lakeside Annex 8, Greenville, NC 27834 (

The authors are grateful for the generous support of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute in the conduct of this research. The authors are also thankful for the time and insights shared by participants.

The authors declare no conflicts of interest.

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