The County Health Rankings & Roadmaps (CHR&R) is a well-established analytic framework that assesses health on a variety of clinical access and outcome measures, social determinants of health metrics, and prevalence of individual health-related behaviors. CHR&R has generated substantial interest and has important strengths. CHR&R was an early adopter of a social-ecological model of health. The University of Wisconsin’s Population Health Initiative made accessible dozens of community health variables that were otherwise difficult to incorporate into health-related analysis, especially among low-resources research teams.
The overall rankings, however, have important methodological limitations. Among rural communities, data reliability is low. Many variables included in the CHR&R were computed to accommodate for high missingness or poor data quality. This, among other methodological concerns, creates an element of randomness and error in CHR&R rankings that reduce the useability of the metric for real-world applications. Despite these limitations, CHR&R has been increasingly used by local and state public health agencies and academic researchers for publications in peer-reviewed literature.
In research settings, CHR&R has been used to publish peer-review literature spanning multiple cross-disciplinary topics, including health services research, health policy research, social determinants of health work, COVID-19 evaluations, health-related behaviors research, built environment research, among others.
In policy settings, CHR&R is used frequently as a communication tool for public health departments. This includes communications with both media, policy makers, and the general public.
In recent years, other geographic-level ranking systems based on measures of health have been developed, many of which have been sponsored by federal resources like the Agency for Healthcare Research and Quality. Moving forward, for CHR&R to continue providing value for public health, policymaking, and research, several important modifications may be necessary. Access the full report to learn more.