Frequently Asked Questions

The following citation should accompany any contents or graphics if used:   

University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2024. www.countyhealthrankings.org. 

CHR&R is committed to creating resources and tools that support community-led efforts to accurately diagnose core problems, understand and account for historical context and implement evidence-informed solutions.

Our team members can help navigate CHR&R resources and tools to support users on their journey to build power and create healthy, equitable communities. Our team support may include informal conversations, speaking engagements, presentations and media interviews that highlight these resources and tools. Click the Contact Us button at the bottom of any page on the website to get in touch with a CHR&R team member.

The measures in the Annual Data Release are based on a model of population health that emphasizes the many social, economic, physical, clinical and other factors that influence how long and how well we live. Our Model of health provides a graphical depiction of how we summarize the health of communities. It also provides one way to think about the influence of various factors on health outcomes based on the best available evidence, while further serving as an important conversation starter about how to improve community health. This model is not intended to provide a complete picture of everything that influences health and equity. Find a downloadable graphic of the County Health Rankings Model in English or Spanish in our Key Documents.  

The following citation should accompany these graphics if used:

University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2024. www.countyhealthrankings.org.  

Health Outcomes tell us how long people live on average within a community, and how much physical and mental health people experience in a community while they are alive. Health Factors represent those things we can improve to live longer and healthier lives. Health Factors are indicators of the future health of our communities.

Search for your state or county to visit the Health Snapshot and find maps illustrating Health Outcomes and Health Factors across the state. You will also find visuals to help you compare your county’s Health Outcomes and Health Factors to other counties across the nation. Our Compare Counties Tool allows you to select up to four locations and view measures side-by-side to help you understand key similarities and differences.

Visit the 2024 measures page to learn more about the measure definitions, data sources, and years of data used in the 2024 Annual Data Release. Details of our data methodologies can be found in our 2024 Technical Document.

Yes. In 2024, CHR&R expanded the definition of Child Mortality to include those aged 0-19 years (this measure previously included only those younger than age 18).

Also in 2024, CHR&R updated the measures of birth and death (Premature Death; Low Birthweight; Teen Births; Injury Deaths; Infant Mortality; Child Mortality; Premature Age-Adjusted Mortality; Life Expectancy; Suicides; Homicides; Firearm Fatalities; Motor; Vehicle Crash Deaths; Drug Overdose Deaths) to provide more detailed race categories including a separate category for ‘Native Hawaiian or Other Pacific Islander’ and a ‘Two or more races’ category where possible.  

Learn more about 2024 measure changes, comparability of measures across all years and how CHR&R shares available data to understand the health of racialized groups of people. 

We’ve sharpened our tools to help you understand your county’s health. We will no longer rank counties on Health Outcomes. Our new approach allows users to find counties experiencing similar conditions, whether in their state or across the country, to collaborate and create solutions to make sure that everyone lives long and well. No county needs to outperform another to get to the top spot. This approach aligns with our vision that ALL people and places have what they need to thrive.

Health doesn’t stop at state lines. Unlike rankings, which were confined to comparisons within a single state, we can more easily explore patterns across several states and find peer counties anywhere in the country. 

Our new view of county health allows you to see the range of Health Outcomes/Health Factors among counties in your state, as well as how your state is doing compared to the rest of the nation. Each dot represents a county in your state, placed on a continuum from least healthy (left) to healthiest (right) in the country. Counties are placed at their weighted z-score for Health Outcomes/Health Factors. Sensemaking statements accompany the graphic, describing how your county fares relative to your state and the nation, with state and national averages shown for reference with vertical dotted lines. 

Counties with similar health will be in the same shade of color. Colors are determined by using a data-informed grouping method to assign counties into Health Groups. These data-informed groupings draw on health information for all U.S. counties. There are 10 unequally-sized Health Groups based on meaningful similarities and differences in the health of counties nationwide. While the color range is consistent across all states, states may or may not have counties that fall within each of these Health Groups. Health Groups are defined annually and may contain different sets of counties from year to year. 

For more information on z-score methods and how Health Groups are determined, see our Working Paper on Updates to Methods and Tools for Practical Application to Improve Health and Equity. For more information on methods, see our Technical Document.

Some data sources have not released new data in time to be included in the 2024 Annual Data Release. In these cases, the measures feature the most recently available data. For 2024, these measures include: Limited Access to Healthy Foods, Air Pollution – Particulate Matter, Insufficient Sleep, Reading Scores, Math Scores, Childcare Centers, Voter Turnout and Census Participation.

The Behavioral Risk Factor Surveillance System (BRFSS) was unable to collect data over enough months for Florida to meet the minimum requirements for inclusion in the 2021 dataset. The 2024 County Health Snapshots include BRFSS data from 2020 for counties in Florida. Affected measures include: Poor or Fair Health, Adult Smoking, Adult Obesity, Poor Physical Health Days, Poor Mental Health Days, Excessive Drinking, Diabetes Prevalence, Physical Inactivity, Insufficient Sleep, Frequent Physical Distress and Frequent Mental Distress. The limited data collected by Florida in 2021 can be requested from the Florida Department of Health.  

To see the years of data used for all measures please visit the 2024 measures page. 

You may notice that some of the following measures do not appear in your Health Snapshot. This could mean that data are not available for your state. The following measures do not have data available in the 2024 Annual Data Release for the states listed:  

• Drinking Water Violations (HI)  
• Poor or Fair Health (FL)
• Poor Physical Health Days (FL)
• Poor Mental Health Days (FL)
• Adult Smoking (FL)
• Adult Obesity (FL)
• Physical Inactivity (FL)
• Excessive Drinking (FL)
• Frequent Physical Distress (FL)
• Frequent Mental Distress (FL)
• Diabetes Prevalence (FL)
• Insufficient Sleep (NJ)
• High School Graduation (IL, WA)  
• Reading Scores (AK, AZ, LA, MD, NM, NY, VT)  
• Math Scores (AK, AZ, LA, MD, NY, VA, VT)  
• School Funding Adequacy (HI, VT)  
• Children Eligible for Free or Reduced-Price Lunch (AK, DE, DC, GA, MA, MT, OH, OR, TN, WV)  
• Juvenile Arrests (CA, ID, KS, LA, NV, NH, NJ, ND, OK, TN)  
• Voter Turnout (AK)

Some COVID-19 deaths are included in the 2024 Annual Data Release. The 2024 data communicate deaths recorded through the end of 2021, including deaths attributed to COVID-19. These deaths are reflected in the Select measure of Premature Death (YPLL), and the Additional measures of Life Expectancy, Premature Age-Adjusted Mortality, Child Mortality and Infant Mortality. The 2024 Annual Data Release does not include deaths attributed to COVID-19 during 2022 or 2023. To see the years of data used for all measures please visit the 2024 measures page.

During the last decade, several counties have changed their name or boundary. These changes have occurred in Alaska, Connecticut, South Dakota and Virginia. Find more information about how these changes impact measures in the Annual Data Release in our 2024 Technical Document and review information from the U.S. Census Bureau about substantial changes to counties and county-equivalent entities.  

County changes mean that data for former counties are no longer represented in our Health Snapshots. However, data for these counties will continue to be available in the downloadable files for the years the counties existed.

The inclusion of people living in the United States without documentation status is specific to each data source used in the Annual Data Release. For example, data for births and deaths are provided by the National Center for Health Statistics registries and include all births and deaths in the U.S. By contrast, the American Community Survey (ACS), another major data source included in the Annual Data Release, uses self-reported survey responses. The ACS is meant to include all persons with a usual residence in the U.S., however, as with all surveys the ACS is vulnerable to non-response bias and studies have found that questions of citizenship are sensitive and can be a reason someone may choose not to complete the ACS.

College students are encouraged to report their residence in the U.S. census as the place they live most of the time during the past year (>6 months of the year). Generally, this is the city/county where their college or university is located. Find more information and guidance on the Census here.

People who are incarcerated are included in county-level counts for the following Select measures:

• Premature Death
• Low Birthweight
• Sexually Transmitted Infections
• Teen Births
• Dentists
• Mental Health Providers
• Injury Deaths
• Air Pollution - Particulate Matter

The congressional district maps generated during the redistricting process based on the 2020 decennial census are available for overlay on CHR&R state maps. Use our congressional districts mapping tool on the Health Outcome and Health Factor summary maps from any State Health Snapshot and on measure maps from our interactive Model where you can search for data by topic. For more information about redistricting and the availability of updated maps, please see the U.S. Census Bureau Redistricting Program page and this note about Congressional and State Legislative Districts in Geographic Products.

Data at multiple geographic levels provides additional context and information.  

• America’s Health Rankings report is a health assessment tool based on state-level health indicators.   
• City Health Dashboard features data for measures of health and well-being at the city level for over 750 cities in the U.S.  
• Congressional District Health Dashboard pulls together local data on the health and well-being for each congressional district.