Uses of Population Health Rankings in Local Policy Contexts: A Multisite Case Study

Abstract

Population health rankings are a common strategy to spur evidence-informed health policy making, but little is known about their uses or impacts. The study aims were to (1) understand how and why the County Health Rankings (CH-Rankings) are used in local policy contexts, (2) identify factors that influence CH-Rankings utilization, and (3) explore potentially negative impacts of the CH-Rankings. Forty-four interviews were conducted with health organization officials and public policy makers in 15 purposively selected counties. The CH-Rankings were used instrumentally to inform internal planning decisions, conceptually to educate the public and policy makers about determinants of population health, and politically to advance organizational agendas. Factors related to organizational capacity, county political ideology, and county rank influenced if, how, and why the CH-Rankings were used. The CH-Rankings sometimes had the negative impacts of promoting potentially ineffective interventions in politically conservative counties and prompting negative media coverage in some counties with poor rank.

Strategies for effective dissemination of research to United States policymakers: a systematic review

“…Roughly half of studies were atheoretical (n = 13). Four studies used the Weiss Typology [29,36,54,55], two studies used the operationalization framework [45,53], and two studies used the advocacy coalition framework [53,56].…”

“…The majority of studies focused on health topics (n = 12) [29,30,33,34,38,41,42,45,47,55,56,58] and child and family well-being (n = 6) [27,36,46,49,52,57]. The remaining studies covered the topics of education (n = 4) [39,43,53,54], guns [56], veterans [44], and general social research (n = 3) [31,32,48].…”

“…Included studies examined a variety of channels with many including multiple channels. Print materials was the most commonly used channel, including reports (n = 10) [27,30,33,41,46,50,53,55,57,58] and policy briefs (n = 3) [31,34,38]. Researchers examined in-person meetings and communications as a channel to disseminate research (n = 9) [30,32,33,39,44,48,53,56,57].…”

“…• Research use 'champions' engage with community stakeholders and policymakers [45] • Intermediary organizations connect "research supply" to "research demand" [53] • External brokers play a role both in connecting policymakers to research and in conceptualizing and developing policy [39,43] • Intermediary individuals or organizations may select or spin research to make their point [45,52,53] • Policymakers may have a list of preferred evidence brokers [53] • Basing policy on evidence requires identified 'best evidence', which may reflect bias and favoritism [29] Context matters • Integrate research evidence into broader sociopolitical context [45] • Research must be locally, contextually relevant [54,55,57] • Specify which government office(s) are responsible [47] • Federally imposed policies (e.g., education) often override local expertise around context and population [29] • Ideology, whether personal or regional, may create a barrier between researchers and policymakers [27,41,44,50,[54][55][56] Make research products timely, relevant, and accessible…”

“…For state-and local-level policymakers, policies may be most effective when based on the evidencebased understanding of local stakeholders, rather than imposed from the federal level without local contextual details [29]. Ideology of external advisors and brokers (as discussed above) and policymakers' own personal beliefs and experiences [54] and the prevailing political ideology of a particular geographic region [55] are critical components of context. Ideological beliefs, often deeply held and personal, may create a barrier between researchers and policymakers [41], though differentiating ideology from other factors that affect individual position-taking is difficult in most situations [44].…”