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What We Really Do – and Don’t – Know About Health in This Nation

What do we know about the levels of population health and the state of medical care and the many other determinants of health across the United States? Despite years of data collection, it has been difficult to gain a comprehensive view of population health. As Atul Gawande wrote last year in the New Yorker,

“The poverty of our health-care information is an embarrassment…The most recent data are at least three years old, if they exist at all, and aren’t broken down to a county level that communities can learn from. It’s like driving a car with a speedometer that tells you only how fast all cars were driving, on average, three years ago.”

While Gawande was referring specifically to medical care, the same is true for all health outcomes and health determinants. Without this monitoring and measuring, it is impossible to know if we are making any headway, if we are investing our resources in the right places to improve health and reduce disparities, or if some areas are falling irrevocably behind. But new work is starting to lift this veil of ignorance. Here’s how.

For the last six years the University of Wisconsin Population Health Institute has released rankings of the health of each county in Wisconsin. While calling attention to the counties with the highest and lowest health can be controversial, we have learned that the rankings often have raised awareness about the opportunities for action and improvement.

But this year, with a grant from the Robert Wood Johnson Foundation, the Wisconsin model was used to rank the health of almost all 3,140 counties in all 50 states. Why would the Robert Wood Johnson Foundation invest significant resources to spread the Wisconsin model around the country? Isn’t being first or last pretty straightforward? Don’t we see rankings every week about how we compare to other states and nations on different measures, such as the environment or the economy?

The answer is that the Wisconsin approach is far more thorough. It does not just label a county as high or low but assists in showing the path to improvement. Each county is not only ranked on its health outcomes – such as mortality and how many days we are unhealthy – but also on the factors that produce these outcomes. Importantly, these factors include medical care, as well as the other contributions from our health behaviors, like the physical environment and such social factors as income and education. Many people are not aware that nonmedical factors are as important as medical care in the health outcomes of individuals and communities. Also, counties vary in how well they are doing across these factors. In a particular county, lifestyle factors may be poor while health care access and quality rank high. The Wisconsin model of ranking allows counties to see where specific priorities for improvement exist.

Over the past six years in Wisconsin, this ranking model has stimulated a much better understanding of the multiple factors producing health, as well as the recognition that many sectors have to be involved – not just doctors and hospitals, but also schools, businesses, state and local government, and community advocacy groups. We are hopeful that using this model around the country will create similar understanding and action nationwide.

Since the February 17 release of information on every county in the nation, there have been more than 400,000 unique hits on the web site with the data, with most viewers viewing multiple pages. One government official from another state has already asked us, “Could we devise an incentive program for our counties that rewards them for advancement in their ranking scores or for advancement in particular indicators? I think we might be amazed at what we could stimulate in terms of action if we put a little structure around this and stimulated a competition among them.”

That’s a good point. These rankings have enormous potential to mobilize community leaders to see what is making their residents sick or unhealthy and develop solutions that would give everyone healthier choices. Everyone in a community has a stake in this. We all need to work together to  find solutions such as supporting early childhood education, making health care more affordable, providing more walking paths, promoting affordable access to healthier foods, or enacting smoke-free laws.
We are pleased to have our Wisconsin rankings method recognized and adapted for all 50 states. Now that we can see how fast we are going, to use Gawande’s metaphor one more time, perhaps we can begin to engage in a new conversation about where we are headed, whether we really want to go there, and maybe even where else we might like to go instead.
 

All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Read more.

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