It may be that most states rankings are skewed for the same reasons, and a valid comparison would take an analysis of each state as was done in this article for vermont.
I pulled the national data after reading your comment. America's Health Rankings' own analysis confirms that the 10 most rural states average significantly worse health outcomes than the 10 least rural states — and the gap is widest specifically in health outcomes, which is exactly the dimension my Vermont piece was examining. Peer-reviewed research using County Health Rankings data shows the rural-urban disparity has been widening since at least 2015. Your instinct that most states' rankings are skewed by the same compositional problem is backed up.
I've updated the story with a paragraph on the national context and added an editor's note at the top crediting reader feedback for prompting the addition.
There is one Vermont-specific wrinkle worth knowing: on primary care physician access specifically, Vermont's rural residents actually have *better* access than urban ones — one of only a handful of states where that's true. So Vermont isn't a perfect stand-in for the national pattern. What the ranking misses here isn't access gaps so much as the economic and social cost reality for rural families. That distinction is in the update.
My wife is a physician at UVM. When we moved here in 2011, there were similar headlines about VT being one of the healthiest states. But her initial reaction was that VT had the unhealthiest patient population she'd ever seen. There was a massive health divide between the top and bottom of the economic ladder.
It may be that most states rankings are skewed for the same reasons, and a valid comparison would take an analysis of each state as was done in this article for vermont.
Peter —
That's a valid point.
I pulled the national data after reading your comment. America's Health Rankings' own analysis confirms that the 10 most rural states average significantly worse health outcomes than the 10 least rural states — and the gap is widest specifically in health outcomes, which is exactly the dimension my Vermont piece was examining. Peer-reviewed research using County Health Rankings data shows the rural-urban disparity has been widening since at least 2015. Your instinct that most states' rankings are skewed by the same compositional problem is backed up.
I've updated the story with a paragraph on the national context and added an editor's note at the top crediting reader feedback for prompting the addition.
There is one Vermont-specific wrinkle worth knowing: on primary care physician access specifically, Vermont's rural residents actually have *better* access than urban ones — one of only a handful of states where that's true. So Vermont isn't a perfect stand-in for the national pattern. What the ranking misses here isn't access gaps so much as the economic and social cost reality for rural families. That distinction is in the update.
Thank you,
Tom Davis, Publisher
My wife is a physician at UVM. When we moved here in 2011, there were similar headlines about VT being one of the healthiest states. But her initial reaction was that VT had the unhealthiest patient population she'd ever seen. There was a massive health divide between the top and bottom of the economic ladder.