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County Health Rankings and Local Government Finances: Are Rankings Always Linked to Wealth?

Research Topic(s): Population Health / Health Economics & Policy

Personnel: Mac McCullough, PhD


The County Health Rankings are a popular tool for assessing the health of a community relative to its in-state peers. Our project will challenge a common assumption about the linkage between a community’s wealth and its performance on County Health Rankings (CHR), focus areas, and measures. Rather than focusing on a community’s overall wealth, this analysis will shed light on the importance (or lack thereof) of local investments in health and its determinants. The question of interest is: What is the relationship between a county’s local governmental revenue, level of investment in population health, and social determinants of health and its performance in the CHR?

It is well known that socioeconomic status correlates with health status and health outcomes. Anecdotally, many media stories discussing the CHR report that richer areas to rank higher than economically depressed areas. Despite the common refrains of the linkage between area wealth and CHR performance, the true causal nature of the relationship between health status and health outcomes is far more complicated than simply wealth causes health. Indeed there are numerous exceptions—wealthy communities with population health deficits and impoverished communities with strong population health metrics. One particular danger in the tendency to link wealth to health is that it can offer communities little in the way of hope or guidance for improved health status indicators. Community wealth is a largely non-modifiable factor for most health practitioners. Focusing on community wealth as a predictor of community health may therefore leave little perceived opportunity for community leaders to choose effective policies and programs.

It is likely at least some CHR components that are significantly related to local investment in population health and the social determinants of health. This project examines: (a) which forms of local spending on population health, social determinants of health, health care, and other social services are related to a county’s health outcomes ranking and health factors ranking and performance on individual CHR component(s); and (b) which forms are not related.

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