This measure is an aggregate of three measures of improvements in indicators related to 1) access to healthcare and preventive services; 2) maternal and child health; 3) mental and behavioral health. Access to healthcare and preventive services is defined by six indicators, including 1) health insurance; 2) primary care provider; 3) cost as a barrier to healthcare; 4) influenza immunization; 5) routine medical check-up; and 6) routine dental visit. Maternal and child health is defined by four indicators, including 1) first trimester prenatal care; 2) preterm birth; 3) births to adolescents; and 4) infant mortality. Mental and behavioral health is defined by four indicators, including 1) recent poor mental health; 2) adolescent suicide ideation; 3) suicide deaths; and 4) overdose and poisoning deaths. Percentages or rates for each indicator will be reported for each of the five Health Improvement Index (HII) groups (1) Very low HII; 2) Low HII; 3) Average HII; 4) High HII; and 5) Very high HII) in an appendix. Any improvement in percentages or rates from baseline to June 2024 will be counted as an improvement. The denominator will be 70 (14 indicators, each with percentages or rates for five HII groups.) The data sources for these indicators are BRFSS, ESSENCE, birth certificates, and death certificates.

Mental and behavioral health indicators

During the first period of data collection, 6.67% of mental and behavioral health indicators by geography showed statistically significant improvements. Very low HII areas showed improvement in recent poor mental health. There were no statistically significant improvements in suicide ideation and suicide death rates.

During the second period of data collection, 20% of mental and behavioral health indicators by geography showed statistically significant improvements. Average HII areas showed improvements in both recent poor mental health and suicide death rates. High HII areas showed an improvement in suicide death rates. While having a significantly better health status in recent poor mental health and suicide death rates in the first period of data collection, very low HII areas experienced a decline in both of these measures during the second period of data collection. Very high HII areas experienced a decline in both recent poor mental health and suicide ideation during the first period of data collection and maintained that status during the second period of data collection.

Health care and preventive service indicators

During the first period of data collection, 6.67% of health care and preventive service indicators by geography showed statistically significant improvements. Low HII areas showed improvement in influenza immunization and high HII areas showed improvement in access to a health care provider. There were no statistically significant improvements in routine checkups, routine dental care, access to health insurance, and cost as a barrier to healthcare.

During the second period of data collection, 10% of health care and preventive indicators by geography showed statistically significant improvements. Average HII areas showed an improvement in cost as a barrier to healthcare. Low HII areas maintained the improvement in influenza immunization achieved in the first period of data collection. Similarly, high HII areas maintained their improvement in accessing a health care provider.

Maternal and child health

During the first period of data collection, 20% of maternal and child health indicators by geography showed statistically significant improvements. Very low HII areas showed improvement in both preterm births and infant mortality, while average and high HII areas also showed improvement in preterm births. There were no statistically significant improvements in first trimester prenatal care and birth to adolescents.

During the second period of data collection, 15% of maternal and child health indicators by geography showed statistically significant improvements. While very low HII areas maintained their improvement in infant mortality, both very low and average HII areas maintained their improvement in preterm births. High HII areas showed higher infant mortality rates during this period. Additionally, both low and high HII areas showed higher preterm birth rates.