Healthiest Communities: How They Were Ranked

The Healthiest Communities rankings from U.S. News & World Report show how nearly 3,000 U.S. counties and county equivalents perform in 81 metrics across 10 health and health-related categories.

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 and 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 80 of the 81 individual metrics within each subcategory. One metric representing county residents' share of at-home food expenditures on fruit and vegetables was weighted double to correct for a cause-effect imbalance in the Nutrition subcategory.

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

Population Health: 14.2 percent

Equity: 12.23 percent

Education: 12.15 percent

Economy: 11.1 percent

Housing: 9.5 percent

Food & Nutrition: 8.8 percent

Environment: 8.6 percent

Public Safety: 8.5 percent

Community Vitality: 7.6 percent

Infrastructure: 7.5 percent

See below for a full list of the 81 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.

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 81 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. After removing outliers beyond that threshold, remaining raw values were rescaled and capped at three standard deviations again. This 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, with an exception in the Nutrition subcategory in which the metric measuring fruit and vegetable spending is weighted double. Taking the average of subcategory scores resulted in 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 2,891 counties or county equivalents assessed of the 3,142 across the U.S.

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 of 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 within their urban-rural classification. In the top 100 peer group rankings, "up-and-coming" applies to communities that did not score in the top 50 percent of economies, but did outperform other communities sharing their urban or rural 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.

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 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 for research and policy at the American Board of Family Medicine, 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, an independent charitable and philanthropic affiliate of CVS Health, 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 81 metrics used to determine America's Healthiest Communities, along with their applicable categories and subcategories follow below. Population values used for rates are from the 2010 decennial U.S. Census.

POPULATION HEALTH:
Access to Care

Health Behaviors

Health Conditions

Health Outcomes

Mental Health

EQUITY:
Educational Equity

Health Equity

Income Equity

Social Equity

EDUCATION:
Educational Achievement

Education Infrastructure

Education Participation

ECONOMY:
Employment

Income

Opportunity

HOUSING:
Housing Affordability

Housing Capacity

Housing Quality

FOOD & NUTRITION:
Food Availability

Nutrition

ENVIRONMENT:
Air & Water

Natural Environment

Natural Hazards

PUBLIC SAFETY:
Crime

Injuries

Public Safety Capacity

COMMUNITY VITALITY:
Community Stability

Social Capital

INFRASTRUCTURE:
Community Layout

Transportation