2012 County Health Rankings Launch Today: Q&A with Patrick Remington
The 2012 County Health Rankings, a joint project of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute, were released this morning. For the third year in a row, the reports rank the health of nearly every county in the nation and show that much of what affects health occurs outside of the doctor’s office. The County Health Rankings confirm the critical role that factors such as education, jobs, income and environment play in how healthy people are and how long they live. NewPublicHealth spoke with Patrick Remington, MD, MPH, County Health Rankings Project Director and Associate Dean at the University of Wisconsin School of Medicine and Public Health, about this year’s release.
NewPublicHealth: What’s new for the County Health Rankings this year?
Dr. Remington: The County Health Roadmaps are new. The County Health Roadmaps project includes several efforts to build connections with local communities and national partners and leaders, including grants to coalitions across the U.S. that are working to improve the health of people in their communities; grants to national organizations to activate local leaders and affiliates to improve health; a prize program to recognize communities taking action whose promising efforts will likely lead to better health; and tools and resources to help groups working to improve the health of people in their communities.
The County Health Roadmaps is our response to the demand that has arisen by communities to help them find solutions. We were pretty good in the first two years at pointing out problems. Over the last year, we heard loud and clear that’s not good enough to just point out problems. The Roadmap is just one tool. It’s certainly not the automobile; it’s not the vacation plan. It is just a tool that communities need to use to come together and decide where they want to go and the Roadmap can tell you how to get there.
But an even better question is what is the same. We want the County Health Rankings to be an annual check-up that can be counted on by communities to provide residents with a way to compare the health of where they live to other counties in their state. Although we might add a measure or two each year, I think the most important message is that we’ve continued to use the same approach to measure and rank the health of counties.
NPH: What is that approach?
Dr. Remington: Just as an individual might go to the doctor and get a checkup, we think of the current health of the community as measured by how long and how well people live. We have five measures to summarize the health of a county. But that’s not enough to give you an idea of what can be done to improve the health of the community. So we have another set of 25 measures that we use to measure the factors that influence health. Together those two sets of measures give a good snapshot of the current and future health of a community.
NPH: How widely known have the County Health Rankings become?
Dr. Remington: Now in our third year, we’ve discovered tremendous interest at all levels in the Rankings from individuals to health professionals to business leaders in every county and every state. In our first and second year we had over half a million visitors to the website, and we’re expecting more this year. So I think the fact that right at your fingers with the click of a mouse you can find out how you rank overall and then click once more to see how you rank in all the different factors is really important.
NPH: What are some counties you have your eye on as emerging models of improvement, and why?
Dr. Remington: We’re definitely keeping our eye on the dozen communities that RWJF is funding through County Health Roadmaps Community Grants. But maybe more importantly, we want to keep an eye on places that are moving ahead on their own. There are many stories that have emerged. San Bernardino is quite a story. That’s an example of spontaneous action that was catalyzed by the County Health Rankings.
>>VIDEO: Watch a video on San Bernardino's use of the County Health Rankings as an opportunity to persuade policymakers of the need for change and get every community in the county to launch a Healthy Communities initiative.
In our state, Wisconsin, the least healthy county is Menominee County, which is also an Indian Reservation. They have taken the County Health Rankings model and asked all units of government to measure and develop plans for how they can address all of the different factors that are measured. That includes the educational, environmental, health care system and the business community. The entire community now is using the Rankings model as a health improvement strategy. They have specific measures and are developing specific plans, so that taking this holistic plan, they hope to start moving in the right direction and seeing improvement in all of the different parts that make a healthy community.
NPH: Why are measures beyond traditional health factors so important?
Dr. Remington: A hundred years ago, many of the pressing public health problems could be solved through governmental public health interventions—policies, regulations and laws such as safe water, safe food and immunization programs. But we’ve learned that those approaches are not sufficient to address today’s leading public health problems—things like obesity, violence and mental illness. Those problems have complex causes and require really comprehensive approaches and solutions. So we need a new system of partnerships that build on collaboration, not competition, and that share accountability for improving public health.
What the County Health Rankings do is tie all of these pieces together. If we have one of the measures ranking poorly, it’s going to be the responsibility of the entire community to address it, not just government or public health.
NPH: Do you see having these measures in one place as a catalyst to work together?
Dr. Remington: No question. The internet is a two-edged sword. On the one hand it has so much information, you don’t know what to believe or trust and you sometimes can’t find it the second time you look. So we feel by putting into one place data from credible sources, a county can literally by visiting one website get a picture of the health of their entire community. This is an example where technology has helped us take complicated information from dozens of sources and different agencies from CDC to EPA, to the Census, for example, and we’ve put it in one place for one-stop shopping for health improvement.
NPH: What, for you, does success look like for the County Health Rankings?
Dr. Remington: One of the advantages of rankings is that they call attention to the problem. People are interested. The media like to write stories about almost any kind of ranking. The disadvantage of the Rankings is that it’s a relative measure. It won’t help a community know if they’re moving in the right direction. So we recommend using the Rankings as a catalyst to start a conversation. But progress is better measured using the specific indicators that a community decides will indicate success. So if they’re focusing on increasing the number of children enrolled in childhood education, they’ll use that and look for improvement over time. It may be everyone in the state is improving, so a community’s rank may not change.
The Rankings offer a time once a year to call attention to the fact that some places are healthy and some are not. Every place has something they can work on. For the other 364 days, communities should develop measures for success, develop partnernerships and measure progress. I think it would be success to say that even though our Ranking has not improved, we’re moving in the right direction. It’s one way we can call attention to the problem. Some communities that rank fairly well in their state have set aspirations to become the healthiest county in the state. That’s a worthy goal, but a better strategy is to find areas where you can make progress.
NPH: What's next for the Rankings in 2012 and beyond?
Dr. Remington: First, communities can count on the County Health Rankings being an annual release. It provides an opportunity for each community at least once a year to come back together and check in to see how we’re doing relative to other counties in the state. It is a good opportunity to keep the public’s eye focused on improving the health of entire communities. We won’t be changing how we measure the health of communities because we want to be able to have a set of measures that can be used to monitor trends over time.
Most of the benefit of the County Health Rankings is what happens after we issue the annual report. It’s really the conversations, the partnerships, the initiatives and the improvement that happens in communities all across the nation.
>>Check out our earlier post about San Bernardino, where they used their County Health Rankings as a catalyst for efforts to create a healthier community.