HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Wednesday, April 9, 2014

Guest Blogger Professor Mary Crossley: The Rankings are Here!

MaryCrossleyNo, not those rankings that law professors love to hate, the rankings published by the (former) magazine that shall not be named.  I’m talking about the County Health Rankings, released on March 26th.  For the fifth year, the Robert Wood Johnson Foundation has partnered with the University of Wisconsin Population Health Institute to crunch data from across 29 health-linked factors to give counties a snapshot of their residents’ health, relative to other counties in their state. They’ve included several new factors this year, including housing, transportation, and access to mental health providers.

The County Health Rankings differ markedly from the most well-known law school rankings.  The methodology and underlying data are transparent. Counties are not surveyed on their opinions of how healthy other counties are.  And counties are not ranked higher if they spend more per resident on health.

The Rankings reinforce several messages that seem just now to be sinking in with the American public. Social, economic and environmental factors are as important in determining health as insurance status and medical care received.  Where you live can matter as much to your health as how you live. While many of us are used to bemoaning the racial and ethnic health disparities that doggedly persist in the U.S., we may be less aware of striking geographic disparities that these rankings illuminate. According to the County-by-County Blog, “The Rankings show us that people living in the least healthy counties have twice the premature death rates than those living in the healthiest counties. There are also twice as many children living in poverty and teen births in the least healthy counties as in the healthiest counties.”  And while some counties have one mental health provider for every 72 residents, some have only one mental health provider per 55,989 residents. My jaw dropped when I read that.

The Rankings’ recent release received some media attention. Some of the bigger outlets (like the Washington Post and USA Today) covered them.  But so have many smaller outlets that seem primarily interested in examining their local performance.  An editorial in the Muncie Star Press, after noting that counties in the region had slipped in the rankings this year, opined:  “Most of us are not going to pack up and move to a county with better health metrics. But there are things we can do to take change of our own well-being, and they are not dependent on where we live or cost much money.”


That seems to be what the Rankings’ creators are hoping for.  They’re not trying to sell magazines.  They are trying give counties data about factors that contribute to and detract from residents’ health.. The Rankings website includes a “Roadmaps” section that “provides communities with information to help select and implement evidence-informed policies, programs, and system changes that will improve the variety of factors we know affect health.”  And it gives examples of how communities have actually improved on specific factors.

I have lots of ideas about the various ways health law professors might use these rankings in their teaching. Certainly, assigning students to look at the rankings for the county where your law school is located could prompt some lively discussions fueled by data. For example, I was fascinated when I drilled down some in the ranking for Allegheny County, where Pittsburgh is located.  In the “Clinical Care” set of factors, I learned that my county is doing well when it comes to the prevalence of primary care providers, dentists, and mental health providers (not a big surprise since Pittsburgh is home to the colossus UPMC Health System).  But pulling us down in this category are a high rate of preventable hospital stays and low rates for mammography screening and diabetic screening.

Some of the data will also provide important reality checks regarding the policy levers deployed or proposed to improve health. For example, if you’re covering mental health issues, the Mental Health Parity and Addiction Equity Act of 2008 and the ACA’s inclusion of mental health and substance use disorder services as “essential health benefits” represent real, if incomplete, successes in improving coverage for mental health care.  This good news regarding coverage, however, may ring quite hollow to persons who have to share a therapist with more than 55,000 neighbors.

This example just scratches the surface of how data from the Rankings might enrich health law teaching.  Take a look at your county’s ranking and you might be surprised.

-Guest Blogger Professor Mary Crossley

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