Healthiest Communities: How They Were Ranked

Take a look at the data and methods behind our rankings.

By U.S. News Staff March 26, 2018, at 12:01 a.m.
U.S. News & World Report

Healthiest Communities: How They Were Ranked

(Derek Davis/Portland Press Herald/Getty Images)

The Healthiest Communities rankings from U.S. News & World Report show how nearly 3,000 U.S. counties and county equivalents perform in 80 metrics across 10 health-related categories.

Creating the Framework

The broad framework of categories and subcategories is based on factors key to evaluating community health that were identified by the National Committee on Vital and Health Statistics – a policy advisory board to the head of the U.S. Department of Health and Human Services – as part of its Measurement Framework for Community Health and Well-Being. U.S. News adapted the NCVHS model in consultation with leading population health experts, resulting most notably in the inclusion of an equity category.

To determine the weights assigned to each category, more than a dozen experts in population health and well-being participated in an online survey in which they assessed each category's relative importance to community health. Each individual distributed 100 points across the 10 health-related categories, assigning more points to categories they perceived to be more important. The total points assigned to each category were then averaged to create final category weights. Subcategories were weighted equally within each category, as were individual metrics within each subcategory.

The categories and subcategories in the Healthiest Communities framework, along with their weights, are:

Population Health: 14.2 percent

  • Access to Care
  • Health Behaviors
  • Health Conditions
  • Health Outcomes
  • Mental Health

Equity: 12.23 percent

  • Educational Equity
  • Health Equity
  • Income Equity
  • Social Equity

Education: 12.15 percent

  • Educational Achievement
  • Education Infrastructure
  • Education Participation

Economy: 11.1 percent

  • Employment
  • Income
  • Opportunity

Housing: 9.5 percent

  • Housing Affordability
  • Housing Capacity
  • Housing Quality

Food & Nutrition: 8.8 percent

  • Food Availability
  • Nutrition

Environment: 8.6 percent

  • Air & Water
  • Natural Environment
  • Natural Hazards

Public Safety: 8.5 percent

  • Crime
  • Injuries
  • Public Safety Capacity

Community Vitality: 7.6 percent

  • Community Stability
  • Social Capital

Infrastructure: 7.5 percent

  • Community Layout
  • Transportation

See below for a full list of the 80 individual metrics used.

Collecting the Data

U.S. News collaborated with the University of Missouri Center for Applied Research and Engagement Systems (CARES) – a research institution skilled in understanding natural resource systems, public health risks and community health assessment – to collect and analyze data.

County-level data were collected from well-recognized and validated sources including the Centers for Disease Control and Prevention, the Institute for Health Metrics and Evaluation, the U.S. Census Bureau, the Dartmouth Atlas of Health Care and the U.S. Environmental Protection Agency.

Publicly available data sets were prioritized, as were measures that were available for the great majority of U.S. counties and county equivalents in the 50 U.S. states.

Data used to develop the Healthiest Communities rankings came from sources including:

County-type divisions known as boroughs in Alaska and parishes in Louisiana are included in the analysis, as are independent cities in Maryland, Missouri, Nevada and Virginia that are treated as county equivalents by the Census Bureau. The analysis also encompasses the District of Columbia. For simplicity, "county" or "counties" may be used in Healthiest Communities content to refer to all communities scored in the project.

Scoring the Communities

For each of the 80 metrics, raw values for each county were rescaled relative to the average among counties assessed for that metric using a z-score distribution. Outliers were capped at three standard deviations – or steps – away from the mean, which resulted in ties in some metrics.

The average of a county's z-scores for each of the metrics within a subcategory created its score for that subcategory, and the average of subcategory scores created a county's category score.

A county's overall score was calculated using the average of category scores as weighted in collaboration with industry experts. The final rankings of the 500 Healthiest Communities in the U.S. are based on this overall score.

Metric, subcategory and category z-scores also were translated to an index score in which the top-performing counties received 100 points, the bottom-performing counties received scores starting at zero points and other counties were indexed proportionately.

Counties missing data for at least half of the metrics within a subcategory were not scored in that subcategory, and counties missing data for at least half of the subcategories within a category were not scored in that category.

Counties missing data for eight or more total metrics or two or more total subcategories were excluded from the analysis, as were counties with populations of fewer than 2,000 people for statistical considerations. This resulted in a total of 2,974 counties or county equivalents assessed of the roughly 3,140 in the 50 states.

Creating Fair Comparisons

In addition to the overall national comparison, counties were placed into peer groups to allow communities to be evaluated against more fairly competitive benchmarks. These peer groups were based on their urban-rural status as tied to population density and the robustness of their economies.

The four peer groups – with economic performance described as either "high-performing" or "up-and-coming" – are titled:

Urban-rural distinction was based on government standards applied to Census Bureau data. Counties were considered urban if they were metropolitan or micropolitan – areas with substantial central populations and integrated adjacent communities – and were home to at least 20 people per square mile. All other counties were considered rural.

The economic distinction was based on the economy category in the Healthiest Communities rankings, which includes measures involving household income, public assistance income, unemployment, labor force participation, weekly wages, employment diversity, job proximity and business growth. Communities were designated as "high-performing" throughout the Healthiest Communities platform if they scored in the top half of this category. In the top 100 peer group rankings, "up-and-coming" applies to communities that did not score in the top 50 percent of economies nationwide but did outperform other communities of similar economic status. Overall, "up-and-coming" also is meant to designate communities that have more room to build and strengthen their economies, but that may face more complex challenges or have fewer resources available compared with others.

An Honor Roll also highlights top-performing counties within each of the four peer groups in each of the nine Census regional divisions: East North Central, East South Central, Middle Atlantic, Mountain, New England, Pacific, South Atlantic, West North Central and West South Central.

Learn More

See the answers to some frequently asked questions here, and contact healthiestcommunities@usnews.com to reach U.S. News.

Special Thanks

The Healthiest Communities analytics team consisted of Chris Fulcher, director of the Center for Applied Research and Engagement Systems at the University of Missouri; Chris Barnett, assistant CARES director; and CARES geographic information systems specialist Angela Johnson, who managed the project and carried out much of the analysis.

U.S. News also is grateful for the critical role played by Monte Roulier, president of the Colorado-based Community Initiatives and co-founder of the Community Commons platform, who helped define project objectives and establish a meaningful framework with achievable goals.

U.S. News additionally would like to acknowledge vital contributions made by Dr. Robert Phillips, vice president of research and policy at the American Board of Family Medicine Inc., and Bruce Cohen, a member of the National Committee on Vital and Health Statistics. Phillips and Cohen co-chair the NCVHS Subcommittee on Population Health, which created the framework that formed the foundation for the U.S. News Healthiest Communities analysis.

The Healthiest Communities platform would not exist without the generous support of the Aetna Foundation and its dedication to community health improvement. The foundation's president, Dr. Garth Graham, and his team played an essential role in assuring the project fairly assessed communities throughout the United States, including those with the greatest challenges.

The 80 metrics used to determine America's Healthiest Communities, along with their applicable categories and subcategories, are:

POPULATION HEALTH:
Access to Care

  • Population With No Health Insurance: Reflects the percentage of the total population without medical insurance (2011-2015 ACS 5-year estimates)
  • Hospital Bed Availability: Reflects the number of CMS-certified beds within active hospitals per 1,000 total population (2016)
  • Primary Care Doctor Availability: Reflects the number of primary care physicians per 100,000 total population (2014)

Health Behaviors

  • Adults With No Leisure-Time Physical Activity: Reflects the percentage of adults who did not participate in leisure-time physical activities or exercise within a past month (2013)
  • Smoking Rate: Reflects the percentage of adults age 18 and older who smoke (2015)
  • Medicare Beneficiaries With Recent Primary Care Visit: Reflects the percentage of Medicare beneficiaries with at least one primary care visit within the past one year (2014)

Health Conditions

  • Cancer Prevalence Among Medicare Beneficiaries: Reflects the percentage of Medicare beneficiaries diagnosed with cancer (2015)
  • Heart Disease Prevalence Among Medicare Beneficiaries: Reflects the percentage of Medicare beneficiaries diagnosed with heart disease (2015)
  • Preventable Hospital Admissions: Reflects the rate of hospitalizations among Medicare beneficiaries per 100,000 population for preventable conditions like asthma, diabetes, dehydration and pneumonia (2015)

Health Outcomes

  • Babies Born With Low Birth Weight: Reflects the percentage of live births where the infant weighed less than 2,500 grams (2008-2014)
  • Life Expectancy: Reflects the average life expectancy at birth for the population in each county (2014)
  • Adults in Poor or Fair General Health: Reflects the percentage of adults who self-reported having fair or poor general health (2015)
  • Teen Birth Rate: Reflects the percentage of females ages 15 to 19 who gave birth within a past 12-month period (2011-2015 ACS 5-year estimates)

Mental Health

  • Deaths of Despair: Reflects the rate of deaths due to suicide, alcohol-related disease and drug overdoses per 100,000 population (2009-2015)
  • Medicare Beneficiaries With Depression: Reflects the percentage of Medicare beneficiaries diagnosed with depression (2015)
  • Poor Mental Health Days per Month: Reflects the average number of days per month that mental health is "not good," according to self-reported survey responses among adults (2015)

EQUITY:
Educational Equity

  • Racial Disparity in Educational Attainment: Reflects the relative difference or disparity in educational attainment rates across racial/ethnic population groups, with a higher score on a scale of zero to 1 reflecting more disparity. The following population subgroups are used in the calculation: non-Hispanic white; Hispanic or Latino; and black or African-American. (2011-2015 ACS 5-year estimates)

Health Equity

  • Air Toxics Exposure Disparity Index Score: Reflects information about the relative difference or disparity in air pollution exposure across racial/ethnic population groups, with zero representing more equality on a scale of zero to 100. The following four racial/ethnic categories are included: non-Hispanic white; Hispanic or Latino; black or African-American; and other race. (2011)
  • Premature Death Disparity Index Score: Reflects information about the disparity in premature mortality rates across racial/ethnic groups. Zero represents perfect equality on a scale of zero to 1. The following population subgroups are used in the calculation: non-Hispanic white; Hispanic or Latino; and black or African-American. (2011-2015)

Income Equity

  • Gini Index Score: Reflects income inequality through an index score in which zero represents perfect equality on a scale of zero to 1 (2011-2015 ACS 5-year estimates)
  • Poverty Disparity Index Score: Reflects the relative difference or disparity in poverty rates across racial/ethnic population groups, with zero representing perfect equality on a scale of zero to 1 (2011-2015 ACS 5-year estimates)

Social Equity

  • Disability Employment Gap: Reflects the relative disparity in unemployment rates between the total population and the disabled population, with a higher score reflecting more disparity (2011-2015 ACS 5-year estimates)
  • Segregation Index Score: Reflects racial segregation using the Theil Index, in which a score of 1 indicates a more diverse society and a score of zero indicates less diversity (2010)

EDUCATION:
Educational Achievement

  • Children Meeting Standards in Grade 4 ELA: Reflects the percentage of fourth-grade students who performed at or above the "proficient" level on English Language Arts standardized tests (2014-2015)
  • Population With Advanced Degree: Reflects the percentage of the population age 25 and older with an associate, bachelor's, master's, professional or doctorate degree (2011-2015 ACS 5-year estimates)
  • High School Graduation Rate: Reflects the cohort graduation rate (2014-2015)

Education Infrastructure

  • Accredited Child Care Facilities: Reflects the rate of child care facilities accredited by the National Association for the Education of Young Children, per 100,000 total population (2017)
  • Per-Pupil Expenditures: Reflects per-pupil expenditures in public elementary and secondary schools (2013-2014)
  • Youth Within 5 Miles of a Public School: Reflects the percentage of youths ages 5 to 17 living within 5 miles of a public elementary school, middle school or secondary school (2014-2015)

Education Participation

  • Continuing Education Tax Credits as Share of Total Tax Filings: Reflects the number of tax returns claiming adult education tax credits as a percentage of total filed tax returns (2014)
  • Idle Youth (Not Working or Enrolled): Reflects the percentage of youths ages 16 to 19 not enrolled in school and not working (2011-2015 ACS 5-year estimates)
  • Preschool Enrollment: Reflects the percentage of children ages 3 to 4 enrolled in school (2011-2015 ACS 5-year estimates)

ECONOMY:
Employment

  • Average Weekly Wage: Reflects average weekly wage among employees in a given county (2016)
  • Labor Force Participation: Reflects the number of persons in the labor force as a percentage of the total civilian population (2011-2015 ACS 5-year estimates)
  • Unemployment Rate: Reflects the number of unemployed persons as a percentage of the total civilian labor force (2016)

Income

  • Median Household Income: Reflects median household income (2011-2015 ACS 5-year estimates)
  • Poverty Rate: Reflects the percentage of the population below the federal poverty line (2011-2015 ACS 5-year estimates)
  • Households Receiving Public Assistance Income: Reflects the number of households receiving public assistance income as a percentage of total occupied households (2011-2015 ACS 5-year estimates)

Opportunity

  • Business Growth Rate: Reflects the number of new private sector businesses that started as a percentage of total businesses in a community (2013-2014)
  • Job Diversity Index Score: Reflects whether jobs in a community exist in a variety of industries on a 0 to 1 scale; 1 means most diverse (2011-2015 ACS 5-year estimates)
  • Jobs Within a 45-Minute Commute: Reflects the number of jobs within a 45-minute commute via automobile, representing the accessibility from residences to jobs (2010)

HOUSING:
Housing Affordability

  • Change in Housing Value: Reflects the percentage change in median home value (2010/2015 ACS 5-year estimates)
  • Households Spending Over 30 Percent of Income on Housing: Reports the percentage of cost-burdened households, where housing costs (mortgage or rent and utilities) exceed 30 percent of total household income (2011-2015 ACS 5-year estimates)
  • Work Hours Needed to Pay for Affordable Housing: Reflects the number of hours a worker earning the average wage would need to work to afford a one-bedroom rental unit at HUD-estimated Fair Market Rent rates while spending no more than 30 percent of their income on housing costs (2016)

Housing Capacity

  • Affordable Housing Shortfall: Reflects the availability of affordable housing relative to a community's low-income population. Negative numbers indicate a shortfall; positive numbers indicate greater supply than demand (2011-2015 ACS 5-year estimates)
  • Households Overcrowded: Reflects the number of housing units with occupancy greater than 1 person per room as a percentage of total occupied housing units (2011-2015 ACS 5-year estimates)

Housing Quality

  • Vacant Houses: Reflects the percentage of vacant residential addresses (2016)
  • Households With Gas/Electric Utilities for Heating: Reflects the percentage of homes with utility gas or electricity for home heating fuel (2011-2015 ACS 5-year estimates)

FOOD & NUTRITION:
Food Availability

  • Local Food Outlets: Reflects number of local food outlets, including farmers markets, per 100,000 total population (2016)
  • Food Environment Index Score: Reflects an index score measuring the number of healthy and less-healthy food retailers within Census tracts across each state as defined by typical food offerings in specific types of retail stores; index scores range from 0 to 100 (2011)
  • Population With Access to Large Grocery Store: Reflects the percentage of individuals living within 1 mile (urban areas) or 10 miles (rural areas) of the nearest supermarket, supercenter or large grocery store (2015)

Nutrition

  • Diabetes Prevalence: Reflects county-level percentages of diagnosed diabetes among adults, based on self-reported diagnoses (2013)
  • Adults With Inadequate Fruit/Veg Consumption: Reflects the percentage of adults consuming fewer than 5 servings of fruits/vegetables per day (2005-2009)
  • Share of At-Home Food Expenditures on Fruit/Veg: Reflects the percentage of at-home food spending on fruit and vegetables (2014)
  • Obesity Prevalence: Reflects county-level percentages of obesity among adults, based on body mass index of 30 or greater (2013)

ENVIRONMENT:
Air & Water

  • Air-Quality Hazard: Represents the probability of developing serious respiratory complications such as chronic obstructive pulmonary disease over the course of a lifetime per 10,000 population; below 1 is considered good (2011)
  • Airborne Cancer Risk: Reflects the modeled non-cancer health risks associated with air toxics exposure, and represents the probability of contracting cancer over the course of a lifetime per 10,000 population; below 1 is considered good (2011)
  • Unsafe Drinking Water Exposure: Reflects the percentage of the population potentially exposed to a drinking water system that violated EPA standards (2013-2014)

Natural Environment

  • Natural Amenities Index Score: Reflects a natural amenities scale that measures the natural physical environment qualities most people prefer; index range is -6 to 12 (1999)
  • Population Within 0.5 Mile of a Park: Reflects the percentage of the total county population living within a half-mile of a park boundary (2011/2012/2015)
  • Area With Tree Canopy: Reflects the percentage of land area covered by tree canopy, weighted by population (2011)

Natural Hazards

  • Extreme Heat Days per Year: Reports the relative annual number of high heat days (days above the 95th percentile for heat index values) (2013)
  • Households in Flood Hazard Zone: Reflects the percentage of households in a flood hazard area (2011)
  • Toxic Release Index Score: Represents the relative chronic human health risk from exposure to toxic chemicals as an index score. Zero is best. (2015)

PUBLIC SAFETY:
Crime

  • Property Crime Rate: Reflects the number of property crimes per 100,000 total population, including burglary, larceny-theft, motor vehicle theft and arson (2014)
  • Violent Crime Rate: Reflects the number of violent crimes per 100,000 total population, including murder and nonnegligent manslaughter, forcible rape, robbery and aggravated assault (2014)

Injuries

  • Vehicle Crash Fatality Rate: Reflects the number of motor vehicle crash fatalities per 100,000 total population (2011-2015)
  • Homicide Rate: Reflects the number of homicide fatalities per 100,000 total population (2011-2015)

Public Safety Capacity

  • Population Living Close to Emergency Facilities: Reports the percentage of the total population within 5 miles of a fire station or a hospital with an emergency room (2016)
  • First Responders in Population: Reflects employment in emergency services professions, including paramedics, firefighters, police officers and others, per 1,000 population (2011-2015 ACS 5-year estimates)
  • Per Capita Spending on Police and Fire Protection: Reflects local government expenditures in dollars per capita on emergency services (local fire protection and local police protection) (2012)

COMMUNITY VITALITY:
Community Stability

  • Homeownership Rate: Reflects the number of owner-occupied housing units as a percentage of total occupied housing units, which includes owner-occupied and renter-occupied units (2011-2015 ACS 5-year estimates)
  • Net Migration Rate: Reflects the net migration rate for U.S. counties between 2000 and 2010, accounting for estimated numbers of births and deaths. Expressed as a percent change. (2000/2010)

Social Capital

  • Nonprofits: Reflects the rate of social services organizations with 501(c)(3) status per 100,000 total population (2015)
  • Voter Participation Rate: Reflects the total number of votes cast in the 2016 presidential election as a percentage of total voting-age citizens (2016)

INFRASTRUCTURE:
Community Layout

  • Households With Internet Access: Reflects the percentage of the population with internet speeds of 25 megabits per second or higher (2016)
  • Walkability Index Score: Reflects a county's index score ranging from 1 to 20 (higher is better) on measures of walkable streets, including pedestrian-oriented intersections and the diversity of area businesses (2011)
  • Population Within 0.5 Mile of Walkable Destinations: Reflects the percentage of the total county population living within a half-mile of a destination such as a library, museum or playground (2015-2016)

Transportation

  • Households With No Vehicle: Reflects the percentage of households in a county that do not have access to a personal vehicle at home (2011-2015 ACS 5-year estimates)
  • Workers Commuting 60 Minutes or More: Reflects the percentage of workers in a county with commute times of 60 minutes or longer (2011-2015 ACS 5-year estimates)
Clarified on March 29, 2018: A data reference has been clarified.

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