Exploring Community Health in the 2020s: Updates to the County Health Rankings Model, Methods, and Tools

CONTEXT: For nearly two decades, the County Health Rankings have rated the health of counties within states according to a model of population health last updated in 2014. The purpose of this paper is to describe methods changes and outcomes associated with the evolution of the model and approach to comparing county-level health. PROGRAM IMPLEMENTATION: A new Model of Health, informed by review of updated evidence and theory, design thinking, and user experience principles, highlights the importance of Power and Societal Rules as upstream determinants of Community Conditions and, ultimately, Population Health and Well-being. Within-state ranks from healthiest to least healthy were replaced by Health Groups based on a national distribution of data. Health Groups were determined by cluster analysis of summary health measures calculated according to a new set of evidence informed, nominal weights created for the model. EVALUATION: Analyses of the newly-updated model, with its evolved measures and reallocated weights, showed similar geographic patterns and correlations >95% with the previous model, indicating strong consistency in underlying latent constructs. Examination of within-state z-scores used for ranks compared to national z-scores used for Health Groups showed the value of the new method in revealing more nuance to health distribution in states, and improved understanding of meaningful differences. DISCUSSION: The 2025 Model of Health represents a major evolution from the previous model by naming structural determinants as core drivers of health and well-being. This shift clarifies that community conditions, which enable behaviors and shape outcomes, are created by societal rules and how people who wield power set and maintain them. New methods mean counties can now find and work with peers across borders to improve health in their communities. While limitations remain, the inclusion of structural determinants opens new opportunities for more expansive, relevant, and transformative population health metrics.