Indiana County Health Rankings
IntroductionThe County Health Rankings (www.countyhealthrankings.org) are created through collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. They are part of the County Health Rankings: Mobilizing Action Towards Community Health web site which includes extensive background on how the ranking method and action steps and resources for addressing risks and enhancing protective factors.
Health Outcomes county rankings are based on a calculation that weighs equally mortality and morbidity. Health Factors county rankings are determined through an equation that considers contributing factors as 30% health behaviors, 20% aspects of clinical care, 40% social and economic factors, and 10% environmental factors.
For fact sheets that describe the various health factor variables, why they are used and the measuring strategies, strengths and limitations, go to http://www.countyhealthrankings.org/health-factors.
The Health Outcomes ranking is calculated based 50% on Mortality (premature death - years of potential life lost before age 75 rate) and 50% on Morbidity.
Morbidity is calculated based on the sum four factors, including self-reports by adults of overall fair or poor health, mean physically unhealthy days per month, and mean mentally unhealthy days per month, plus percent of live births with low birth weight weighted double. The equation is self-reported health (10%) + mean physically unhealthy days per month for adults (10%) + mean mentally unhealthy days per month for adults (10%) + percent of live births with low birth weight (20%).
Health Factors are calculated based on an equation which includes health behaviors (30%), clinical care (20%), social and economic factors (40%), and environmental factors (10%).
Behavioral factors (worth 30% of overall Health Factors score) is calculated based on tobacco use (10%), diet and exercise (10%), alcohol use (5%) and sexual behavior (5%).
Clinical Care (valued as 20% of Overall Health Factors) consists of access to care (10%) plus quality of care (10%). Access to Care, in turn, is based on percent of population under 65 without health insurance (5%) and primary care providers (5%). Quality of care is based on hospitalization for ambulatory-care conditions per 1,000 Medicare enrollees (5%) and percent of diabetic Medicare enrollees that receive HbA1c screening (2.5%) and percent of female Medicare enrollees that receive mammography screening (2.5%)
Social and Economic factors constitute 40% of the overall health factors score. This score is based on valuations of education (10%), employment (10%), income (10%) family and social support (5%), and community safety (5%).
Education, in turn, is calculated based on two equally weighted factors: average freshman graduation rate, defined as the percent of ninth grade cohort that graduates in 4 years (5%), and percent of adults aged 25-44 years with some pot-secondary education (5%). Employment is the percent of population age 16+ unemployed but seeking work (10%). Income is defined as the percent of children in poverty (10%). Family and social support is calculated based equally on the percent of adults without social/emotional support (2.5%) and the percent of all households that are single-parent households (2.5%). Community safety is for Indiana is based on homicide death rate per 100K population (age-adjusted).
Environmental factors are calculated based equally on environmental quality (5%) and built environment (5%). The calculation of environmental quality is based equally on the annual number of unhealthy air quality days due to ozone (2.5%) and the annual number of unhealthy air quality days due to fine particulate matter (2.5%). The calculation of built environment is based equally on the percent of zip codes in the county with healthy food outlets (2.5%) and access to recreational facilities (2.5%).
Summary of data sources:
Data Sources for:
Mortality, National Center for Health Statistics (NCHS), 2005-2007
Morbidity, Behavioral Risk Factor Surveillance System (BRFSS), 2003-2009, for all but low birth weight which is from BRFSS, 2001-2007.
Health Factors- Health Behaviors data come from:
Tobacco Use and Alcohol Use, BRFSS, 2003-2009
Diet and Exercise, National Center for Chronic Disease Prevention and Health Promotion
Sexual behavior from National Center for Hepatitis, HIV, STD, and TB Prevention for sexually transmitted infections; and from NCHS for teen birth rate.
Health Factors – Clinical Care – Access to Care data comes from the U.S. Census CPS, Small Area Health Insurance Estimates, 2007. Primary Care Providers from Health Resources Services Administration Area Resource File (ARF). Quality of Care data comes from the Medicare claims/Dartmouth Atlas, 2006-2007.
Health Factors – Social and Economic Factors data for:
Education for average freshman graduation rate come from National Center for Education Statistics, 2006-2007; and for percent of adults aged 25-44 with some post-secondary education from American Community Survey (ACS), 2005-2009.
Employment from Local Area Unemployment Statistics, Bureau of Labor Statistics (BLS).
Income data from Census/CPS—Small Area Income and Poverty, 2008.
Family and Social Support data for social/emotional support from BRFSS, 2005-2009 and for single parent households, ACS, 2005-2009.
For Community Safety, NCHS, 2001-2007
Health Factors – Environment data for Environmental Quality come from CDC-EPA collaboration, 2006; and for Built Environment for healthy food outlets from Census Zip Code Business Patterns, 2008; and for access to recreational facilities from Census County Business Patterns, 2008.
The following web pages will allow you to search for your county’s ranking for many variables, including health outcomes, health factors, and the many variables that contribute to their derivation. The data sources used by the County Health Rankings system to determine the rankings are described for each variable on the subsequent web pages.
It is important to note that we do not suggest that the rankings themselves represent statistically significant differences from county to county. That is, the top ranked county in a state (#1) is not necessarily significantly healthier than the second ranked county (#2).
The County Health Rankings are not meant to be regarded as necessarily indicating statistically significant variations between counties. The Robert Woods Johnson and Wisconsin Population Health Institute recommend considering the ranking more so in terms of quartiles of relative healthier or less healthy rankings. Being in the top quartile versus the bottom or penultimate quartile would indicate a marked difference. Hence also changes of more than 20 in ranking score would indicate a significant decrease or increase in health ranking, whereas a difference, for example, of ranking 30th versus 31st would not.
To see an Indiana by county map for any of these and additional variables, go to the County Health Rankings web site mapping section, and select from the many options.