County Health Rankings 2011: Reporting the Smart (Not Boosterish) Story

From my Feb. 18, 2010 post:

We're Number 6! Hurray!

There has been quite a flurry of quick-hit news stories about the Robert Wood Johnson Foundation's health rankings of the nation's counties. Apparently, at one point on the day they were released, "county health rankings" was the top search term in Google News.

Too bad a number of these stories were boosterish (or defensive) pieces, devoid of context, about where individual counties ranked in comparison to the one next door.

An exception was this USA Today piece, which offered context and a caution:

The researchers don't recommend making state-to-state comparisons. The reason: Data collection methods vary by state, says Bridget Booske, project director for the rankings and a senior scientist at the University of Wisconsin's Population Health Institute.

Yet some nationwide generalizations can be made, Booske says. Healthier counties tend to be urban and suburban, while most (84%) of the 50 least-healthy counties are rural, sparsely populated areas where care is poor and the economy is depressed. Rates of premature death are also significantly higher (2.5 times) in low-ranked counties.

In a local daily story, it's admittedly hard to delve into, or even critique, the methodology used to create an overall picture of health for the nation's 3,141 counties. So here's some context and ideas for follow-up stories.

First, the context: The Robert Wood Johnson Foundation worked with the University of Wisconsin Population Health Institute to develop a ranking methodology for each state's counties, building on a model the Institute used to rank the health of Wisconsin's counties over the past six years.

That model is based in part on the idea that where you live has an enormous effect on your health. As a result, it includes data on air pollution, access to healthy food, income inequality, unemployment, crime, and liquor store density in addition to more traditional measures of a population's health, such as obesity and teen birth rates. (For more information on the model and how it was developed, check out the extremely detailed health ranking FAQs.)

RWJF's county health ranking project, while grand in scope and the first to examine the health of every county in the nation with the same methodology, isn't the only effort to measure the health of large populations by geographic region. America's Health Rankings has analyzed state-level health indicators and ranked states for 20 years. In addition, many counties and states use the federal government's Healthy People 2010 project to see how residents' health stacks up against objectives set by public health experts.

Now, for the story ideas. What does your audience need to know besides the rank of your county compared to the ones nearby?

1. Start by looking at what the rankings measured – and what they didn't. Jodie Jackson Jr., county government reporter for the Columbia (Miss.) Daily Tribune, astutely pointed out in a blog post that while researchers examined liquor store density, air quality and access to healthy food to come up with a ranking for "physical environment," they didn't look at his county's wealth of parks and bike trails. Why not?

"We had to look for data that were available in all 3,141 counties," (Julie Willems Van Dijk, associate scientist for the University of Wisconsin Population Health Institute) said. "There just wasn't any standardized way of measuring" parks, bike trails, a community's "walkability" and other recreation.

"That's exactly why this says 'Snapshot for 2010,'" Van Dijk said, referring to the study's title page. "We're not suggesting this is a be-all and end-all" for determining a county's health needs or health status.

2. Do these measures take into account the quirks of your own county? What's the missing piece of the puzzle? Temper the rankings with your on-the-ground knowledge of health issues in your community. Don't give county leaders, who may be crowing about a good ranking, a pass on your community's other pressing health issues.

For example, Santa Clara County, Calif., where I live, ranks high on health outcomes compared to other Calif. counties, but it also has nearly double the rate of tuberculosis cases compared to California as a whole (and the county's major city, San Jose, once was the U.S. city with the highest TB rate). Although the actual number of cases is small compared to the county's population, controlling TB is a big public health priority here – not only because it's a highly contagious disease, but because if a dreaded XDR-TB case appears in the United States, it could very well be in this county.

In addition, San Jose is the largest U.S. city without fluoridated water, leading to high rates of tooth decay, particularly in low-income children without access to dental care. Dental disease has been linked to heart disease and stroke.

3. What happens next? The Robert Wood Johnson Foundation is very explicit about the goal of its nationwide county health rankings, and it's not to give you an easy story for the day. From the rankings' FAQ page:

The major goal of the Rankings is to raise awareness about the many factors that influence health and that health varies from place to place. We encourage communities to focus on the strengths and challenges within their own community and use the Rankings as a call to action.

Will your community really use the rankings as a "call to action?" Do the questions raised by individual rankings coincide with your local health officials' priorities for improving community health? Does your community really need another ranking when local health officials already are using Healthy People 2010 goals as a planning tool?

Ask your local officials and health advocates what kind of conversations or advocacy might take place as a result of the new county health rankings. You might get a concrete plan – or some hemming and hawing.

Either way, the answer will speak volumes.