Table of contents:
Our MissionOur ReportsOur Advisory CommitteesAdvisory CouncilAnnual Report Advisory CommitteeSenior Report Advisory CommitteeHealth of Women and Children Report Advisory CommitteeHealth of Those Who Have Served Report Advisory CommitteeHealth Disparities Report Advisory Committee
Our Model and Methodology
IntroductionRanking MethodologyMeasures, Weights and DirectionMeasures Selection and ChangesData SourcesDisparity Measurement MethodologyWhy Measure Health Disparities?
The America’s Health Rankings platform reports in multiple ways on the breadth, depth and persistence of health disparities at the national and state levels. This includes comparing the differences or ratios within demographic groups, such as age, educational attainment and race/ethnicity at a certain point in time, as well as examining trends to highlight where progress has been made in reducing disparities and where disparities have persisted or widened.
Health disparities largely stem from underlying inequalities in the conditions in which people are born, grow, live, work and age — referred to as the social determinants of health. Corresponding with the America’s Health Rankings model and the World Health Organization’s holistic definition of health, the platform reports on disparities across several measures, including health outcomes, behaviors, clinical care indicators, and economic and social drivers. America's Health Rankings provides health disparity data for the nation, all 50 states and the District of Columbia. The data span a wide breadth of demographic groups, including age, disability, educational attainment, gender/sex, geography (metropolitan status and differences across states), income, race/ethnicity, sexual orientation and veteran status.
Sharing disparity data aims to stimulate dialogue and collaborative action among policymakers, public health officials, community leaders, academia and the private sector to address health inequities and improve health outcomes. Health disparities contribute to the United States ranking poorly in measures of life expectancy, infant mortality and other measures compared with peer nations in the Organization for Economic Co-operation and Development (OECD), despite spending the most on health care globally. The impact of these disparities can limit economic opportunity and the health of future generations. In 2018, health disparities cost the U.S. an estimated $451 billion attributable to racial and ethnic inequities and $978 billion attributable to education inequities.
Disparity data can be found on AmericasHealthRankings.org in the Senior Report, the Health of Women and Children Report and the Annual Report. Additional insights are available in disparity-focused reports and briefs, including the 2021 Health Disparities Report, the 2023 Mental and Behavioral Health Data Brief and the 2024 Maternal and Infant Health Disparities Data Brief.
Supporting Healthy People 2030: Measuring Health Disparities and Health Equity
Healthy People 2030 is a program led by the U.S. Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP) that sets data-driven objectives for the nation’s health and well-being over the next decade, with a key focus on addressing the social determinants of health and working toward health equity. For nearly five decades, Healthy People’s national-level objectives have served as valuable benchmarks for advancing health and well-being at the state level. It also provides data to track the nation’s progress toward achieving those goals and tools to help guide individuals, organizations and communities to action.
As a longstanding champion of public health and the Healthy People goals, the United Health Foundation is honored to be recognized as a Healthy People 2030 Champion.
Disparities Methodology
For all measures, state- and nationally representative population estimates are produced for overall populations and at the demographic-group level using methods appropriate for each data source. In many cases, multiple years of data are combined to increase sample size and produce reliable demographic-group estimates at the state level. In some cases, more data years may be used in state-level estimates than national estimates. The number of data years included depends on the measure, source and size of the demographic group.
Individual estimates are suppressed if they do not meet the reliability criteria laid out by the data source or determined internally by the data analysts. When no recommended method exists, the relative standard error (RSE) is used to identify and suppress estimates with high unreliability (RSE >30%). Suppressed estimates are excluded from disparity calculations. Estimates with modest unreliability (CV ≥ 20) are included in disparity estimates but should be interpreted cautiously. These estimates are noted on the website for measures from the Annual Report, Health of Women and Children Report and Senior Report. For more information on suppression rules, see Data Sources.
For most estimates, 95% confidence intervals are calculated, indicating a range of probable values for an estimate. Non-overlapping 95% confidence intervals determine if the difference between two values is statistically significant.
America’s Health Rankings uses two commonly applied ways of analyzing and tracking disparities in health:
- The relative difference (ratio) describes the proportional difference between two groups. This is found by dividing the value of one group by the value of another group (e.g., the value of the race/ethnicity group with the highest value divided by the race/ethnicity group with the lowest value). Ratios account for the overall prevalence within each group, providing a better understanding of the relative disparity. For example, a smoking racial disparity of 2.0 means that the prevalence of smoking is two times higher among the racial/ethnic group with the highest smoking prevalence compared with the racial/ethnic group with the lowest smoking prevalence. Ratios are only presented for population groups whose prevalence estimates have non-overlapping 95% confidence intervals.
- The absolute difference (gap) conveys the magnitude of the difference experienced by different groups. This is found by taking the difference between two groups (e.g., the race/ethnicity group with the highest value minus the group with the lowest value). For example, a homeownership racial disparity of 33.4 means there is a 33.4 percentage point difference in homeownership between the population with the highest and lowest percentages.
These methods can be combined to provide a more comprehensive picture of the disparity and its importance and impact relative to disparities that exist for other measures. Users can navigate the Explore Measure pages to view disparities within a measure and state, and view all populations within a demographic group (e.g., all education levels). Demographic trend graphs are also available for users who want to evaluate changes in disparities over time.
Report-Specific Racial Disparity Measure Methodology
The Annual Report, Health of Women and Children Report and Senior Report each contain racial disparity-focused measures. These measures are Children in Poverty Racial Disparity, Early Death Racial Disparity - Ages 65-74, Homeownership Racial Disparity, Low Birth Weight Racial Disparity, Poverty Racial Disparity - Age 65+ and Premature Death Racial Disparity. To allow for a consistent reference group across states, these measures compare the racial/ethnic group with the least healthy value with the white population value because it is the largest racial demographic group in nearly all states and allows for higher reliability and lower sampling error. These measures are not limited to population groups whose prevalence estimates have non-overlapping 95% confidence intervals.
Interpreting Disparities Data
The America’s Health Rankings platform includes a wealth of data highlighting the breadth, depth and persistence of health disparities across the U.S. These data are captured in multiple ways across the platform.
- Breadth: Documents health disparities across health-related measures that include social and economic factors, clinical care indicators, physical environment, health behaviors and health outcome measures critical to addressing health disparities and advancing health equity.
- Depth: Measures the magnitude of health disparities among demographic groups, such as educational attainment, gender, geography and race and ethnicity for the nation, all 50 states and the District of Columbia.
- Persistence: Identifies where health disparities have remained and where they have grown over time.
Language
Throughout the platform, America’s Health Rankings uses language and demographic group definitions consistent with the underlying data sources to ensure accuracy.
America’s Health Rankings recognizes that inclusive language in public health is vital for ensuring that all individuals feel seen, heard and understood. Inclusivity in data collection is essential to documenting, analyzing and addressing the disparities that people experience. However, this must be supported by equitable systems that accurately represent diverse populations in data collection, analysis and interpretation. Inadequate representation of populations by data collection sources may hinder the identification of trends and patterns within different demographic groups and limit the ability to tailor public health interventions to specific populations.
Limitations
Not all demographic groups are available for all data sources and measures. Individual estimates are suppressed if they did not meet the reliability criteria laid out by the data source or internally established criteria.
Estimates for small populations should be interpreted with the understanding that the true prevalence may differ from the estimate presented due to wide confidence intervals.
Caution should be taken when interpreting data on specific health and behavior measures. Many are self-reported and rely on an individual’s perception of health and behaviors. Additionally, some health outcome measures indicate whether a respondent has been told by a health care professional that they have a disease, excluding those who may not have received a diagnosis or sought or obtained treatment. Social, cultural, geographical and other factors may affect mental health services and treatment access, awareness and use.