Making sense of state health data: The case of Kentucky

OBJECTIVE: State health rankings present oversimplified and potentially damaging accounts of health status. Using the example of Kentucky, this article illustrates the realities masked by rankings that use averages and fail to account for social determinants of health. METHODS: Findings from a range of publicly available data are combined to shed light on factors that influence or are associated with health status indicators, including demographic data, health services utilization, health system elements, poverty, and educational attainment. RESULTS: Despite its low overall performance, Kentucky includes counties with health status that is equal to the highest-ranking states. Poverty and loss of healthy, working-age populations are closely associated with low health status, as are low rates of high school graduation. CONCLUSIONS: Rankings that average health status indicators across widely diverse areas may yield findings that are only marginally relevant for health policy development. A high burden of morbidity pulls resources from population health to high-cost health services, challenging the viability of long-range initiatives; however, a comprehensive approach to health status improvement will be necessary to bring more southern US states like Kentucky into higher-ranking positions.