What is Healthiest Communities?

Location plays a critical role in determining the health, well-being and life expectancy of some 330 million Americans. Healthiest Communities, U.S. News' rankings and analysis platform, in collaboration with the Aetna Foundation, explores how communities across the United States are working to improve the health of their residents. The platform, featuring rankings drawn from an examination of nearly 3,000 counties and county equivalents in 84 metrics across 10 categories, informs citizens, health care leaders and elected officials about the local policies and practices in place that drive better health outcomes for all.

Why did U.S. News and the Aetna Foundation collaborate on this project?

U.S. News, the publisher of Best Hospitals and Best Children's Hospitals, brings decades of experience to measuring health care quality in the U.S. in order to improve it. Based on the same principles of in-depth data analysis and credible journalism, Healthiest Communities evaluates and explores how counties and county equivalents can minimize chronic disease, keep people out of the hospital, provide access to health care and lower costs. Ultimately, the platform allows communities to learn from each other, improve their efforts and create better health systems for their residents.

Who is on the U.S. News rankings team?

The Aetna Foundation, an independent charitable and philanthropic affiliate of CVS Health, has invested in this project as part of a $100 million commitment by CVS Health and its affiliates to making community health and wellness central to the company's charge for a better world. The new Building Healthier Communities initiative, which will be funded over five years by CVS Health and the CVS Health and Aetna foundations, builds upon a tradition of community investment by CVS Health and Aetna and advances CVS Health's purpose of helping people on their path to better health.

U.S. News collaborated with the University of Missouri Extension 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. In addition, U.S. News assembled a panel of independent experts to help assign weightings for each category, including members of the National Committee on Vital and Health Statistics.

How did you rank the Healthiest Communities?

The overall Healthiest Communities rankings were drawn from an evaluation of nearly 3,000 counties and county equivalents in 84 metrics across 10 categories: Community Vitality, Equity, Economy, Education, Environment, Food & Nutrition, Population Health, Housing, Infrastructure and Public Safety. All of the categories but one, Equity, were identified as key considerations in evaluating community health by the National Committee on Vital and Health Statistics as part of its Measurement Framework for Community Health and Well-Being. The U.S. News framework was developed by consensus following a thorough examination of research literature and extensive consultations with leading population health experts.

The categories and subcategories considered were:

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

What role did COVID-19 have in this year's project?

Due to the unknown longevity of the coronavirus pandemic, specific COVID-19 data is not included in the Healthiest Communities analysis and rankings. However, the rankings include data relevant to the pandemic, such as the county-level prevalence of obesity and diabetes – two comorbidities that can place patients at a higher risk of severe COVID-19.

In conjunction with the rankings release, the Healthiest Communities team also is releasing new COVID-19 tracking tools. These tools feature county-level information on coronavirus cases and deaths, as well as data on the pandemic's economic impact and demographic factors that could place a community at higher risk from the virus. Each searchable dataset is accessible via a single landing page and individual Healthiest Communities county profiles, and is accompanied by visualizations that show trends over time and allow for comparisons between communities.

What COVID-19 metrics are included in the new tracking tools?

The COVID-19 metric pages show:

• Total COVID-19 Cases
• New COVID-19 Cases per Day
• COVID-19 Cases per 100k
• Total COVID-19 Deaths
• New COVID-19 Deaths per Day
• COVID-19 Deaths per 100k
• Unemployment Rate
• Population 65 and Older
• ICU Beds
• Adults in Poor or Fair Physical Health
• Diabetes Prevalence
• Obesity Prevalence
• Cost-Burdened Households

What were the respective weights of the categories and why were they chosen?

The weights were assigned based on feedback from more than a dozen independent experts in community health assessment who agreed to review our framework and assess the relative importance of each data category to a community's overall health.

The weights of the categories are as follows:

• Population Health: 14.2%
• Equity: 12.23%
• Education: 12.15%
• Economy: 11.1%
• Housing: 9.5%
• Food & Nutrition: 8.8%
• Environment: 8.6%
• Public Safety: 8.5%
• Community Vitality: 7.6%
• Infrastructure: 7.5%

For more on weighting and inputs, see the Healthiest Communities methodology.

Are the rankings objective?

The rankings are based on 84 metrics drawn in large part from publicly available data sets from reputable sources such as the U.S. Centers for Disease Control and Prevention, the Institute for Health Metrics and Evaluation, the U.S. Census Bureau and the U.S. Environmental Protection Agency. These metrics were selected for their value in assessing community performance in each of the categories and subcategories in our framework, as identified in consultation with industry experts. More than a dozen independent experts have advised U.S. News on the appropriate weights to be assigned to each major category. The University of Missouri Extension CARES team identified data sources, acquired the data and carried out the analysis.

What role did each partner play in producing Healthiest Communities?

U.S. News & World Report, the global authority on rankings, news analysis and consumer advice, provides the journalistic, data and rankings expertise for the Healthiest Communities project. U.S. News assembled a team of leading experts to help develop the rankings. U.S. News also hosts the website and maintains editorial control of the content.

The Aetna Foundation has invested in the Healthiest Communities project as part of a five-year, $100 million Building Healthier Communities initiative by CVS Health and its affiliates. The initiative builds upon the outstanding tradition of community investment by CVS Health and Aetna, and helps to advance CVS Health's purpose of aiding people on their path to better health.

How did you assure that the comparisons did not favor bigger communities with more resources over smaller communities with fewer resources?

The wealth of a community often plays a critical role in determining health outcomes, but it doesn't always have to be limiting. In addition to an overall ranking of the top 500 communities nationally, U.S. News developed four peer groupings based on counties' urban-rural status as tied to population density and the robustness of area economies. The peer groups are categorized as: urban high-performing, urban up-and-coming, rural high-performing and rural up-and-coming. The peer groups were created to better evaluate similar communities against more fairly competitive benchmarks.

The term "up-and-coming" highlights 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.

Beyond rankings, what does Healthiest Communities provide for consumers?

Healthiest Communities provides continuous reporting and analysis on community and public health issues, as well as comprehensive data covering the full spectrum of aspects that influence population health at the national, state and county levels.

How often will the rankings be updated?

The Healthiest Communities rankings will be updated annually, and the editorial and data teams at U.S. News will continually use the rankings and data to foster insights and analysis that will educate and inform consumers and policymakers on what's occurring in their communities.

What measures were taken to ensure the accuracy of the Healthiest Communities rankings and data?

Teams at both U.S. News and CARES performed quality assurance testing of Healthiest Communities data. Methods included mapping values to explore regional trends, examining year-over-year changes within metrics and checking that values fell within appropriate ranges.

In addition, an independent partner confirmed the raw data matched source values for a sampling of metrics, and confirmed score and ranking calculations for the full set of communities.

Have there been any changes to the rankings since last year?

The Healthiest Communities project is constantly evolving. Research and advice from experts led to incremental changes that were made to ensure the rankings are as accurate and comprehensive as possible.

The 2020 rankings measure county performance in 84 metrics. Three metrics were added: "Medical Debt in Collections" in the Economy category, "Eviction Rate" in the Housing category and "Census Self-Response Rate" in the Community Vitality category.

In the Public Safety category, "Accidental Death Rate" replaced "Homicide Rate," and the source for "Vehicle Crash Fatality Rate" was updated to better capture the impact of this measure.

Most metrics also were updated with more recently available data.

On Nov. 2, 2020, U.S. News substituted data sources for the property crime and violent crime metrics, resulting in some shifts within the initial rankings. See the Healthiest Communities methodology for more information.

Is this a long-term initiative?

Yes, this is a long-term project for U.S. News and the Aetna Foundation.

How does this rankings project differ from other health-related rankings?

Healthiest Communities is the first to adopt the Measurement Framework for Community Health and Well-Being developed by the National Committee on Vital and Health Statistics for a nationwide ranking and analysis of health at the county level. As part of this framework, U.S. News also has incorporated equity as a key measure of community health and well-being, which is a new component to a ranking of this kind. To assure fair comparisons, U.S. News has developed peer groupings based on economic factors and population density.

Will you be highlighting communities that do not do well?

Our goal is to highlight best practices from communities that promote healthier living for their residents. The trove of data underlying the rankings also will serve as a rich resource for analysis and reporting.

Why are only some cities included in the rankings?

County-type divisions called boroughs, municipalities and census areas 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.

Who can I contact with questions?

For questions about Healthiest Communities, please email healthiestcommunities@usnews.com