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Preventing Chronic Disease: Public Health Research, Practice and Policy

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Emerging Infectious Diseases Journal


Volume 2: No. 2, April 2005

Measuring Population Health Disparities: The Wisconsin County Health Rankings


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Angela M. Kempf, Patrick L. Remington, Paul E. Peppard, Elizabeth A. Dranger, David A. Kindig

Suggested citation for this article: Kempf AM, Remington PL, Peppard PE, Dranger EA, Kindig DA. Measuring population health disparities: the Wisconsin County Health Rankings [abstract]. Prev Chronic Dis [serial online] 2005 Apr [date cited]. Available from: URL:


Track: Methods and Surveillance

The purpose of this project was to rank the population health of counties in Wisconsin to promote use of local population health information, identify disparities between counties, encourage population health improvement, and broaden the understanding of the determinants of health.

The Wisconsin Public Health and Health Policy Institute, with assistance from state government, community, and university groups, annually compiles county data and produces the Wisconsin County Health Rankings report.

This project is modeled after the United Health Foundation’s annual America’s Health: State Health Rankings and is based on a population health model in which a variety of determinants impact health outcomes. Mortality years of potential life lost (YPLL) and self-reported health status are used to develop a summary measure of county health outcomes. A summary measure of health determinants is developed using 18 measures in four (weighted) categories: health care (10%), health behaviors (40%), socioeconomic factors (40%), and physical environment (10%). Data sources include the Centers for Disease Control and Prevention, the U.S. Census, state vital statistics, and the Wisconsin Department of Health and Family Services. A draft report was developed and shared with local public health officials in late 2003. The report was revised on the basis of feedback, and Wisconsin County Health Rankings, 2003 was released to the public in January 2004. A survey assessing the usefulness of the rankings was sent to all county health officers following its release.

Significant disparities exist in the health outcomes and determinants of Wisconsin counties. We used Pearson product moment correlation and found that, overall, the summary determinant and summary outcome ranks were well correlated (r = 0.75). Compared with the healthiest counties (e.g., Ozaukee), the least healthy counties (e.g., Menominee) showed greater improvement in health over time. Of the county health officers participating in the survey of the rankings (N = 68, 94% response rate), 82% reported that the rankings were useful to their work, and 69% planned to use the rankings in their communities. Suggestions received through this survey and other more informal feedback will be incorporated into the 2004 rankings, such as the expansion and improvement of the environmental health components and the inclusion of additional local survey data.

The Wisconsin County Health Rankings provides a valuable vehicle for delivering and discussing county-level health information and for engaging stakeholders in the discussion of approaches for reducing observed disparities. This report will continue to be produced annually with special attention given to improving population health measures and its use in community health improvement efforts.

Corresponding Author: Angela M. Kempf, MA, Project Assistant and Doctoral Student, University of Wisconsin Medical School, Department of Population Health Sciences, Wisconsin Public Health and Health Policy Institute, 610 Walnut St, Suite 760, Madison, WI 53726. Telephone: 608-263-7497. E-mail:

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


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