Click Here for the full 2023 CHR Report


County Health Rankings & Roadmaps (CHR&R) brings actionable data, evidence, guidance and stories to support community-led efforts to grow community power and improve health equity. The University of Wisconsin Population Health Institute (UWPHI) created CHR&R for communities across the nation, with funding from the Robert Wood Johnson Foundation.

This year, we focus on the connection between civic health and thriving people and places. Civic health reflects the opportunities people have to participate in their communities. It starts in our local communities and is the cornerstone of our democracy, representing promise, opportunity, belonging and shared responsibility.

We look at two elements of civic health:
  • CIVIC INFRASTRUCTURE, which includes the spaces such as schools, parks and libraries that help us stay connected and policies and practices that foster belonging, making civic participation possible.
  • CIVIC PARTICIPATION, which includes the ways people engage in community life to improve conditions and shape the community’s future, whether through political activities such as voting and advocacy, or community activities such as volunteering and mentoring.

Our civic health must be nurtured. Intentional investments in civic spaces that foster inclusive participation can have a positive impact on health equity. On the other hand, neglect or deliberate exclusion is detrimental to civic health and our opportunity to thrive. Our civic health depends on the decisions we make—whether we are an elected official or a local volunteer—to cultivate community conditions where everyone is welcome, lives with dignity, and thrives.

History shows that when previously disenfranchised groups built power and expressed their will through voting and advocacy, the policies that followed benefited the health and well-being of all. For example, after women won the right to vote in 1920, infant mortality rates dropped dramatically when lawmakers passed a law that set up maternal and child health units in every state health department, expanded birth and death data collection and supported home-visiting initiatives. The Civil Rights Act, which included hospital desegregation, is associated with health improvement. From 1965 through 1971, infant mortality rates dropped significantly and the gap between Black and white infant mortality narrowed. This followed the passage of the Voting Rights Act in 1965, which fundamentally shifted electoral power in the U.S. and ushered in a new era of government responsiveness to Black voter participation and marginalized populations.

We will make progress toward health equity when all people can be heard and have meaningful involvement in decision-making processes. To do this, we must repair harmful policies and practices aimed at exclusion. There are multiple examples of laws and policies—some that started with the birth of the nation and whose effects are still felt today—that underlie current barriers to health. The U.S. census, started in 1790, excluded American Indians until 1890. Literacy tests and poll taxes during the Jim Crow era intentionally prevented Black Americans from voting. Current policy proposals that levy fines, impose prison sentences or force protestors to pay for policing costs all deter people from the right to peaceably assemble. Discriminatory policies and practices do not reflect the aspirational values of our democracy. We can claim our democracy for the common good.