Prevention, access, and quality

Community conditions influence health behaviors. Healthy communities have comprehensive smoke-free air laws, offer easy access to exercise opportunities, and have high-quality health care available. Because health is so deeply related to quality of life, many other categories of livability in this Index include metrics related to health. For example, access to healthy foods, jobs and education, number of walk trips, lower speed limits, social engagement measures, and air and water pollution are all related to health. Where you live matters.

How does my community compare to neighborhoods across the country?

  • Top Third
  • Middle Third
  • Bottom Third

Healthy behaviors Smoking prevalence

of people smoke regularly Median US neighborhood: 20.3%

Estimated smoking rate: measured at the county scale, lower values are better

As the leading cause of preventable death in the United States, tobacco not only harms smokers—causing cancer, lung disease, heart disease, and numerous other ailments—but also puts others at risk through secondhand exposure. Here, the Index examines livability by measuring the percentage of people in a county who regularly smoke.

Source: Institute for Health Metrics and Evaluation, 2012 data from Cigarette Smoking Prevalence in US Counties: 1996-2012

Healthy behaviors Obesity prevalence

of people are obese Median US neighborhood: 27.8%

Estimated obesity rate: measured at the county scale, lower values are better

Second only to tobacco use as the leading cause of preventable death in the United States, obesity directly causes heart disease, diabetes, and high blood pressure. High obesity rates can indicate that a community lacks access to healthy food or exercise opportunities. The Livability Index measures the percentage of people in a county who are obese, adjusted for age.

Source: Centers for Disease Control and Prevention, 2011 Interactive Diabetes Atlas

Healthy behaviors Access to exercise opportunities

of people have access Median US neighborhood: 83.2%

Percentage of people who live within a half-mile of parks and within 1 mile of recreational facilities (3 miles for rural areas): measured at the county scale, higher values are better

Physical activity doesn’t just help people get in shape, it also reduces the risk of medical conditions such as obesity, diabetes, cancer, and dementia. Easy access to parks and recreational facilities such as gyms and community centers not only makes residents more likely to exercise, but also creates a sense of community, since these locations often double as meeting places. Here, the Index measures the percentage of people in a county who live reasonably close to both parks and recreational facilities, accounting for the fact that people in rural areas may be willing to travel farther to exercise.

Source: The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, 2014 County Health Rankings & Roadmaps

Access to health care Health care professional shortage areas

index from 0 to 25 Median US neighborhood: 0

Severity of clinician shortage: measured at the health professional shortage area scale from 0 to 25, lower values are better

People who live far away from medical facilities may avoid the preventive care that could reduce their risk of developing more serious health conditions. The impact may be most extreme for low-income people who cannot afford the cost it would take to travel for health care. Here, we rate community health care shortages, based on poverty levels, infant health, distance to nearest provider, and the ratio of primary care physicians to residents. The U.S. Department of Health and Human Services assigns communities a score from 0 to 25 to show how serious a shortage they face, with higher scores indicating more severe shortages.

Source: Health Resources and Services Administration, 2014 Health Professional Shortage Area Data Warehouse

Quality of health care Preventable hospitalization rate

preventable hospitalizations per 1,000 patients Median US neighborhood: 62.1

Number of hospital admissions for conditions that could be effectively treated through outpatient care per 1,000 patients: measured at the hospital service area scale, lower values are better

Some patients occasionally wind up hospitalized with serious conditions that could have been easily prevented with better primary care or patient education. To gauge the quality of a community’s health care system outside its hospitals, the Index measures how frequently people are hospitalized for conditions that could be treated at a doctor’s office or urgent care clinic. These conditions include asthma, high blood pressure, diabetes, and dehydration. Communities receive a value based on data from nearby hospitals.

Source: The Dartmouth Institute for Health Policy & Clinical Practice, 2011 Dartmouth Atlas of Health Care

Quality of health care Patient satisfaction

of patients are satisfied Median US neighborhood: 67.3%

Percentage of patients who give area hospitals a rating of 9 or 10, with 10 indicating the highest level of satisfaction: measured at the hospital service area scale, higher values are better

High-quality care produces not only satisfied patients, but also healthier ones. People are less likely to postpone medically necessary hospital care if they were satisfied with their last experience. Obtaining necessary care results in a lower likelihood of developing serious conditions down the road. Patient satisfaction can reflect the overall quality of care people receive in the hospital. Poor-quality care can result in readmission, new illness, and other serious adverse outcomes. Here, the Index measures the percentage of patients who rate their local hospitals a 9 or 10, with 10 indicating the highest level of satisfaction.

Source: Centers for Medicare & Medicaid Services 2013 Hospital Compare database

Healthy behaviors State and local smoke-free laws

State and local laws that prohibit smoking in workplaces, restaurants, and bars

Given the lingering damage secondhand smoke can inflict, many communities prohibit smoking in public to protect their residents from unwanted health risks. Here, the Livability Index gives credit to any state, city, or county that bans smoking in workplaces, restaurants, and bars.

Source: Americans for Nonsmokers’ Rights Foundation, April 2016 U.S. Tobacco Control Laws Database

Commitment to livability State and local plans to create age-friendly communities

Communities that have taken comprehensive steps to prepare for the aging of the U.S. population

By 2030, there will be twice as many Americans over the age of 65 as there were in 2000. To help residents live comfortably in all stages of life, communities must provide opportunities like convenient transportation, walkable neighborhoods, affordable and accessible housing, multi-generational social opportunities, and inclusive business practices—just to name a few. To guide communities toward making these forward-thinking changes, several organizations have also established peer-learning networks and identified processes to help make communities age-friendly. The Index gives credit to states, metropolitan areas, counties, and cities that are part of the AARP or World Health Organization (WHO) networks of Age-Friendly Communities or recipients of Grantmakers in Aging Community AGEnda grants. In the future, the Index may award communities that participate in other age-friendly initiatives.

Sources: AARP 2016 Age-Friendly Communities Member List, WHO Global Network for Age-friendly Cities and Communities, and Grantmakers in Aging 2016 Age-Friendly America database