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. 2013 Apr;103(4):727-32.
doi: 10.2105/AJPH.2012.301016. Epub 2013 Feb 14.

Improving the environmental quality component of the County Health Rankings model

Michael Hendryx  1 , Melissa M Ahern, Keith J Zullig
Affiliations

Improving the environmental quality component of the County Health Rankings model

Michael Hendryx et al. Am J Public Health. 2013 Apr.

Abstract

Objectives: We examined the association between environmental quality measures and health outcomes by using the County Health Rankings data, and tested whether a revised environmental quality measure for 1 state could improve the models.

Methods: We conducted state-by-state, county-level linear regression analyses to determine how often the model's 4 health determinants (social and economic factors, health behaviors, clinical care, and physical environment) were associated with mortality and morbidity outcomes. We then developed a revised measure of environmental quality for West Virginia, and tested whether the revised measure was superior to the original measure.

Results: Measures of social and economic conditions, and health behaviors, were related to health outcomes in 58% to 88% of state models; measures of environmental quality were related to outcomes in 0% to 8% of models. In West Virginia, the original measure of environmental quality was unrelated to any of the 8 health outcome measures, but the revised measure was significantly related to all 8.

Conclusions: The County Health Rankings model underestimates the impact of the physical environment on public health outcomes. Suggestions for other data sources that may contribute to improved measurement of the physical environment are provided.

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References

    1. University of Wisconsin Population Health Institute County Health Rankings, 2010. Available at: http://www.countyhealthrankings.org. Accessed March 10, 2012
    1. United Health Foundation America’s Health Rankings, 2011 ed Available at: http://www.americashealthrankings.org. Accessed March 10, 2012
    1. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood). 2002;21(2):78–93 - PubMed
    1. Booske B, Athens J, Kindig D, Park H, Remington P. County Health Rankings working paper: different perspectives for assigning weights to determinants of health. University of Wisconsin, Population Health Institute, February 2010. Available at: http://www.countyhealthrankings.org. Accessed March 10, 2012.
    1. US Department of Health and Human Services Fourth National Report on Human Exposure to Environmental Chemicals. Atlanta, GA: Centers for Disease Control and Prevention; 2009

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