1. County Health Rankings & Roadmaps 101
KEY POINTS
County Health Rankings & Roadmaps is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
The County Health Rankings show us where we live matters to our health. The Rankings motivate community leaders and citizens to work together in new and creative ways to build a culture of health.
The Roadmaps offer communities practical help to move from awareness to action.
The purpose of this presentation is to provide you with an general overview of County Health Rankings & Roadmaps.
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NOTE TO PRESENTER:
The most important takeaway from this presentation is that Rankings are a starting point for mobilizing community ACTION toward health improvement.
Mel Downey-Piper, MPH, CHES
Durham County Department of Public Health, Director of Health Education

2. Rankings: Understanding the Data
OUTLINE
Why this matters
Rankings: Understanding the Data
Roadmaps: Moving Forward with Action
KEY POINTS
By the end of this presentation you will know:
Why this work matters
What we rank, and how to understand your data
How to use Roadmaps to move from awareness to action
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3. Transition: Let’s look at the thinking behind the County Health Rankings & Roadmaps program.
KEY POINTS
At the County Health Rankings & Roadmaps, we’re building a culture of health, county by county. This logic model helps us explain WHY we create the Rankings.
We gather population based data. All data for Rankings are already collected somewhere else.
We compute County Health Rankings & release them. The release attracts media attention.
Local public health officers and other community leaders use County Health Rankings as call to action for community.
They bring together community members from wide variety of sectors to look further at community’s needs.
Community members identify evidence-informed health policies and programs that can be implemented locally.
As a result, ultimately the health of the community improves.

4. County Health Rankings: 2 Rankings
Today’s Health
Health Outcomes
Tomorrow’s Health
Health Factors
KEY POINTS
The County Health Rankings ranks the health of nearly every county in every state.
For each county, you will find two Rankings, one for Health Outcomes and one for Health Factors.
There are two separate sets of messages to convey.
How healthy a county currently is (Health Outcomes)
How healthy a county might be in the future based on the many factors that influence health (Health Factors).

5. 1. Health Outcomes: “Today’s health” (the green boxes)
KEY POINTS
Rankings model shows:
1. Health Outcomes: “Today’s health” (the green boxes)
Length of life – tells whether people are dying too early
Quality of life – tells how well people feel while living
2. Health Factors: “Tomorrow’s health” (the blue boxes)
Health behaviors
Clinical care
Social and economic factors
Physical environment
These are factors that determine how long people live and quality of their lives. The blue boxes are things communities can work on now to help improve their future health.
3. Policies and Programs impact health factors and ultimately health outcomes. (orange box)
Alternative: WALK THROUGH THE MODEL
Starting from the bottom, we believe … Effective local, state, and federal Policies and Programs (orange box) can improve a variety of factors that, in turn, shape the health of communities.
Many Health Factors (the blue boxes) shape our communities' health outcomes. We specifically look at health behaviors, clinical care, social and economic factors, and the physical environment.
We measure two types of Health Outcomes (the green boxes) to show how healthy each county is: length of life and quality of life.
Example: a clean indoor air policy is a policy that can influence health factors, such as tobacco use, which in turn influences health outcomes.
We often point to this image as one of our most important, because it outlines what we use to determine the County Health Rankings and what influences health in a community. Because much of what affects our health happens beyond medical care, the Rankings underscore how important it is to build a culture of health where getting healthy, staying healthy, and making sure our kids grow up healthy are top priorities.
-As an example, expanding early childhood education improves academic achievement. Higher levels of education lead to higher levels of income which then influence other health factors such as access to healthy foods, clinical care, and quality housing, which in turn influence health outcomes.
-Stepping back, you’ll note that we don’t include race or ethnicity in our health factors. We’ve selected health factors that reflect aspects that communities can improve. Race and ethnicity are not modifiable while poverty is something we can take action on, so you will see “income” as a key health factor. We do provide data, tools and resources that can help communities address health disparities, and we’ll show you later where to find these on our site. The bottom line is that factors such as one’s race, ethnicity and socioeconomic status should not play a role in how healthy we are or how long we live, but unfortunately, for many people across the nation, they do . If we are going to build a Culture of Health in every community, reducing health disparities needs to be a top priority - because everyone in our society deserves an equal opportunity to pursue a healthier life.  
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NOTE TO PRESENTER:
This is THE MOST IMPORTANT SLIDE in the deck. It’s as important as the numbers that go into the Rankings. It helps people tell important story about the many factors that determine health.

6. Health equity
Attainment of the highest level of health for all people.
Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. (Healthy People 2020)
KEY POINTS: To create a Culture of Health county by county, everyone in a community needs to have an equal opportunity to enjoy good health--in other words, health equity.
Health equity includes a shared commitment to identifying and addressing gaps in opportunity that tend to disproportionately and negatively affect certain populations . Health equity is a basic principle that all people, despite race/ethnicity, limited English skills, gender, age, religion, income, educational level, geographic location, sexual orientation, or ability have equal opportunity to lead healthy lives. It also means creating a sense of community where all individuals, especially those most affected by poor health outcomes, feel they have a voice and a role to play in creating and implementing solutions. Healthy People 2020 calls for “valuing everyone equally,” “addressing avoidable inequalities,” and “eliminating health and health care disparities.” 
Durham Public Schools Farm Hub, Durham County, NC – 2014 RWJF Culture of Health Prize winner

7. Rankings: Understanding the Data
OUTLINE
Why this matters
Rankings: Understanding the Data
Roadmaps: Moving Forward with Action
KEY POINTS
Transition slide.
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NOTE TO PRESENTER:
The Rankings : Understanding the data section includes:
example of a county’s snapshot from the website
Tools to help you further explore and understand your data

8. www.countyhealthrankings.org KEY POINT
Transition: Having looked at the model, now we will take brief look at a county example – what does it look like on our website?
KEY POINT
For purposes of this presentation, we will go to Wisconsin and then to Dane County, WI (UW Population Health Institute is in Madison, WI which is in Dane County).
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NOTE TO PRESENTER:
The following slides are screenshots taken from the website. You may want to create your own slides with a different state/county or use the hyperlink in the title of this slide to go directly the website.

9. KEY POINTS –If you go to Wisconsin, you see the Health Outcomes map on the left and the Health Factors map on the right; both maps show how Wisconsin’s 72 counties compare to each other.
Health Outcomes = “today’s health” includes the length of life and quality of life
Health Factors = “tomorrow’s health” includes health behaviors, clinical care, social and economic factors, and physical environment.
Counties with less shading are healthier and the more deeply shaded counties are less healthy.
If you go to Dane County, you will see more data behind the rank.

10. KEY POINTS
If you go to the Dane County snapshot, you will see that in 2016 it ranks 11th out of 72 counties for Health Outcomes and 3rd for Health Factors. Not the best in the state but in the top quartile.
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NOTES TO PRESENTER:
The example slides are “hand waves” only to help the audience understand what’s on their snapshot. If audience wants to get into detail about data, we suggest going to the actual web site.
People can also find archived webinars on the site at
County Health Rankings & Roadmaps 101
Take Action (features communities working to improve health, often focused on specific steps in the Take Action Cycle)

11. Measures Two Ranks Health Outcome Ranks Health Factors Ranks
KEY POINTS:
Let’s walk through the type of data you’ll find on your County Snapshot.
[Click] In the first column, you’ll find our measures – we have 35 measures in Because this is a screen shot, you only see a portion of the snapshot here.
[click] Two Overall Ranks: Health Outcomes (today’s health) and Health Factors (tomorrow’s health)
[click] You’ll also find ranks for each health outcome and health factor in this far column.
Check out your county’s snapshot at
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NOTES TO PRESENTER:
Slide Note: This slide is animated.
The example slides are intended to help the audience understand what’s included on their snapshot.
Health Factors Ranks

12. Kahoot.it

13. Error Margin 95% confidence interval
County Data
Error Margin 95% confidence interval
Top U.S. Performers Only 10% of counties nationally do better than the given number
State overall
KEY POINTS
Your snapshot contains four columns of data.
[click] First, you’ll find your County Data – Here we see data specific to Dane County, WI. Next you’ll see a trend column, which we’ll come back to in just a moment.
[click] Next you’ll see the error margin. We use a 95% confidence interval. Basically, this means that we are 95% sure the actual number for your county is in the given range.
[click] In the fourth column, you’ll find Top US Performers. This is the 10th percentile (for measures we are trying to decrease, such as smoking rates) or the 90th percentile (for measures we are trying to increase, such as high school graduation rates), it’s included as an aspirational value (i.e. only 10% of counties in nation do better than the given number).
[click] Finally, you will see your state column. This allows you to compare your county’s numbers to your state overall.
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NOTES TO PRESENTER:
Slide Note: This slide is animated.
The example slides are intended to help the audience understand what’s included on their snapshot.

14. Trend KEY POINTS Let’s go back to the trend column now.
For each of the measures where sufficient trend data is available, you can view a detailed graph of the trend data by clicking the graph icons. We have color-coded each icon to help you quickly see whether your county’s estimate is increasing, decreasing, or staying the same over time.
Red graph icons indicate your county is getting worse for this measure
Yellow indicate your county is staying the same for this measure
Green indicates your county is getting better for this measure
[click] Let’s take a look at the trend graph for Adult Obesity in Dane County, WI. You’ll see your county’s trend in BLUE, your state’s trend in GREEN, and the national trend in ORANGE.
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NOTES TO PRESENTER:
Slide Note: This slide is animated.
Measuring Progress ( provides additional guidance on how communities can their measure progress.

15. Areas to Explore KEY POINTS
“Areas to Explore” highlights potential challenges a community may want to examine more closely. When you turn this feature on, orange boxes will highlight “Areas to Explore” based on Health Factor measures that seem to have the greatest potential opportunity for improvement based on the following:
- Measures where there are meaningful differences between a county’s values and the state average, the top US performers, or the state average in the best state
As with a county’s ranks, these Areas to Explore are just one starting point to consider in the journey toward improving health in your community.
Here we can see that Dane County may want to look at additional national, state and local data related to Adult Smoking and Excessive Drinking to determine if these are areas on which to focus their efforts.
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NOTE TO PRESENTER:
The Rankings are just a starting point for assessing your county’s health. Depending where you live in, there may be more current data available or there may be data for important drivers of health that are not included in the Rankings. Measuring Progress ( and Using the Rankings Data ( provides some pointers for what to look for and where.

16. Areas of Strength KEY POINTS
In addition to Areas to Explore, we also have Areas of Strength. Areas of Strength shows arears that are assets in your community already. Accounting for the relative influence of each measure on health outcomes, the County Health Rankings team used a variety of techniques to identify the Health Factor measures for your county that seem to have the greatest potential opportunity for improvement (the Areas to Explore) or are the assets your community might want to build on (the Areas of Strength). We identified measures where there are meaningful differences between your county's values and either your state average, the national benchmark, or the state average in the best state.

17. Measuring progress Use ranks as tool Change and data take time
Learn more about what you can do measure progress at measuring-progress
KEY POINTS:
Many communities around the nation are working to improve their health. But how can they measure progress? There are many ways to do this and one size may not fit all. We’ve included some guidance on our site to help you see if you’re on the right track.
Use ranks as a tool
Ranks are great for garnering attention, simplifying a lot of complex data, and making comparisons between one community and another at a point in time -- but they shouldn’t be used alone to measure a single community’s progress. Rather, look at them as one tool among many.
Because ranks are relative, they aren’t as helpful in isolation -- your county’s rank depends not only on what is happening in your county, but also on what happens in all the other counties in your state. In fact, if every county in a state improved its health, their ranks would all stay the same. So look for ranks to inform you progress measurement, not drive it. 
Change and data take time
Be realistic about how quickly you can move the needle—it will take time for your efforts to improve your health outcomes.
For example:
When you reduce your adult smoking rates significantly, it will still take some time before this positive change reduces the number of preventable deaths due to smoking.
When you increase high school graduation rates, some effects will be immediate but it will be years before premature deaths are reduced.
Also, most data collection (via census or survey) has lag times. For example, the County Health Rankings premature death rates represent a lag of more than three years, and to be sure that we have reliable data for communities of all sizes, we use three years of data. So, the premature death rates you see for the current Rankings reflect premature deaths from 4-6 years ago.

18. Rankings: Understanding the Data
OUTLINE
Why this matters
Rankings: Understanding the Data
Roadmaps: Moving Forward with Action
KEY POINTS
Transition slide
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NOTE TO PRESENTER:
The Roadmaps: Moving Forward with Action section includes:
The Roadmaps to Health Action Center
Community examples
Policies & programs examples

19. KEY POINTS
Transition: The County Health Rankings are intended to serve as a call to action, to ignite action in communities across the country. Our primary goal is to build a culture of health, county-by-county. We do that by taking action. The Roadmaps offer communities resources to move from awareness to action.
This is our Take Action Cycle. The Take Action Cycle is the HOW within County Health Rankings & Roadmaps.
We know solving issues like low high school graduations rates, excessive drinking, or poor healthcare requires the wisdom and resources of people from all walks of life. You’ll see several potential community partners in the blue circles in the center of the cycle.
The Take Action Cycle lays out a series of steps that communities take to work together to create healthier places to live, learn, work, and play, but this series of steps isn’t always as clear and simple as they appear in this graphic. Making changes to improve health in communities is messy and complicated and building relationships across sectors can be challenging.
We’ve designed a series of guides to help communities take the next step, where ever they might be in the Take Action Cycle. Communities can improve health by using the steps of the cycle – assessing needs and resources, focusing on what’s important, choosing effective policies and programs, acting on what’s important, and being sure to evaluate those actions.
At the core of this model are people working together to improve health in a community. Health is everyone’s business, and we believe people from a wide variety of sectors have a role to play in improving a community’s health.
Throughout this work, it’s important to continually communicate with partners, policy makers, your community, and know how to use media effectively to tell your story.

20. Foundation of roadmaps
It takes everyone
Move from data to evidence- informed action
Focus across the health factors—including social and economic factors
Policy, systems, and environmental change
KEY POINTS
The Roadmaps offer communities resources to move from awareness to action.
There are 4 foundations of Roadmaps
It takes everyone – all of us working together – to improve the health of a community. [click]
We need to move as quickly as possible from data to action– not get stuck in analysis paralysis or drowning in data. We encourage communities to look to the evidence to inform these actions—and if you innovate, be sure to evaluate [click]
Keep focused across the health factors—including social and economic factors [click]
And don’t be afraid to take on policy, systems, and environmental change which will in the long run create the greatest long term change in health for the children and adults in your community [click]
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NOTE TO PRESENTER:
Slide Note: This slide is animated

21. KEY POINTS
You can learn more about the Roadmaps to Health Coaching under the Roadmaps to Health section.
Roadmaps to Health Coaching provides local leaders anywhere in the country with direct support from community coaches to strengthen their capacity to advance health in their communities. Thanks to the support of the Robert Wood Johnson Foundation, coaching is available at no cost to communities. This service provides guidance in how best to strengthen partnerships, enhance skills in a strategic manner, or navigate challenging policy advocacy choices.
Nearly a dozen community coaches will work with communities in short (one phone call) to long-term (one year of monthly coaching contact) coaching agreements. Most, if not all, coaching is provided through distance learning technology or phone contact. Coaching may be requested through the Contact Us or “Get Help” box on the website.
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NOTE TO PRESENTER:
If you’re demonstrating on the website, you may want to navigate to this page using the Roadmaps to Health dropdown menu on the orange navigation bar and then clicking on Roadmaps to Health Coaching.

22. RWJF Culture of Health Prize
Defining health in the broadest possible terms.
Committing to sustainable systems changes and policy-oriented long- term solutions.
Cultivating a shared and deeply held belief in the importance of equal opportunity for health.
Harnessing the collective power of leaders, partners, and community members.
Securing and making the most of available resources.
Measuring and sharing progress and results.
KEY POINTS
The Robert Wood Johnson Foundation Culture of Health Prize honors communities whose efforts illustrate an enduring commitment toward creating a culture of health for all residents. Winning communities receive a $25,000 cash prize and have their success stories celebrated and shared broadly to inspire locally-driven change across the nation.
The six criteria displayed on this slide drive the selection of Prize winners. We are looking for communities who are able to bring these criteria to life.
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NOTE TO PRESENTER:
The next call for applications for the 2017 RWJF Culture of Health Prize will be released in the summer of You can find the Prize call for applications and additional information about the Prize program and past Prize winners at

23. A nation of communities building a culture of health RWJF Culture of Health Prize Winners
KEY POINTS
In 2013 six communities were award the first RWJF Culture of Health Prize:
-Cambridge, MA -Minneapolis, MN
-Fall River, MA -Manistique, MI
-New Orleans, LA -Santa Cruz, CA
The 2014 Prize winners are:
-Brownsville, TX -Spokane, WA
-Buncombe, NC -Taos Pueblo, NM
-Durham, NC -Williamson, WV
The 2015 Prize winners are:
-Bridgeport, Connecticut -Lawrence, Massachusetts
-Bronx, New York -Menominee Indian Tribe, Wisconsin
-Everett, Massachusetts -Kansas City, Missouri
-Spartanburg County, South Carolina -Lac du Flambeau (Waaswaaganing Anishinaabeg)Tribe, Wisconsin
The 2016 Finalists were announced in March The sixteen finalists are:
- 24:1 Community Region, Missouri - Oakland, California
- Clayton County, Georgia - Philadelphia, Pennsylvania
- Columbia Gorge Region, Oregon & Washington - Rancho Cucamonga, California
- Grand Rapids, Michigan - Santa Monica, California
- Louisville, Kentucky - Shoalwater Bay Indian Tribe, Washington
- Manchester, New Hampshire - Trenton, New Jersey
- Miami-Dade County, Florida - Tulsa County, Oklahoma
- New Haven, Connecticut - White Mountain Apache Tribe, Arizona
The 2016 Winners will be announced in Fall 2016.

24. What Works for Health
Find effective programs and policies at
KEY POINTS
To help you look for policies and programs that could help move health forward in your community, visit What Works for Health, an easy-to-use, searchable menu of solutions for the specific problem you are targeting.
It includes evidence ratings, literature summaries, and implementation resources for over 325 strategies.
Simply select a health factor of interest (e.g., tobacco use, employment, access to health care, environmental quality) and browse through the listings for ideas of strategies that your community could use to addresses the health factor(s) of interest to you.
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NOTE TO PRESENTER
To get to What Works for Health from our home page, pull down the menu under Roadmaps to Health and select What Works for Health.
For each strategy included in What Works for Health, experts at the University of Wisconsin Population Health Institute search published and unpublished literature as well as the findings of credible organizations that assess evidence of effectiveness. Learn more about our methods here:

25. evidence matters Smart investments Inform decisions Inform innovation
Photo Credit: Sky Noir
KEY POINTS
When it comes to developing and implementing solutions to problems that affect our communities, evidence matters.
Using what has been shown to work can drive smart investments. None of us have a lot of time, money or resources, so choosing strategies that have been shown to work can help you stretch the impact of scarce dollars and resources.
Knowing whether there are strategies that effectively address your community’s priorities can help inform decisions about when to adopt existing strategies and when to take more innovative approaches.
It is important to understand what has been shown to work – and what hasn’t – when creating new solutions. Explicitly considering what works can help to ensure that your innovative solutions are effective.

26. Evidence ratings Scientifically supported Some evidence Expert opinion
Insufficient evidence
Mixed evidence
Evidence of ineffectiveness
KEY POINTS
In What Works for Health, each strategy is assigned an evidence rating based on the quality, quantity, and overall findings of relevant research.
There are six evidence ratings, ranging from Scientifically Supported, assigned to strategies with the strongest evidence, to Evidence of Ineffectiveness, assigned to strategies that have been shown consistently to be ineffective or cause harm.
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness:  Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.
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NOTE TO PRESENTER
Review ALL definitions or just give a few examples. Learn more about our ratings here:

27. Summary Where we live matters to our health.
There are great disparities in health based on where we live.
Health is more than health care. Many factors contribute to health.
We’re all in this together. It takes all of us working together to improve the health of a community.
You can find data and practical help at
KEY POINTS
The County Health Rankings help us see how where we live, learn, work and play influences how healthy we are and how long we live.
The Rankings are an annual check-up of the health of each county. They show us that some places are doing very well and other places have a lot of work to do. Everyone can improve.
Having health insurance is important – but much of what affects our health occurs outside of the doctor’s office. It’s hard to live a healthy life if you live in an unhealthy place.
Improving community health is not something solved by a local health department, hospital, or physician. We need everyone to improve health in community. All of us need to work together and take action together.
You can find practical guidance through on-line resources in the Action Center and using the “Get Help” button to reach a Community Coach for consultation on your community efforts to improve health.

28. University of Wisconsin Population Health Institute
Thank you!
University of Wisconsin Population Health Institute
Madison, WI
Mel Downey-Piper