In this issue of RHQ, we focused on devising rural health report cards for every state in the nation with at least one rural county. It was a daunting task, and we used a very systematic process to assess and score each state.

We did this after some forethought about the consequences of doing such a thing. We anticipated that some people who read this will not agree with the grades. Some will level criticism at the process, at the data and factors we considered. Some will be concerned over the age or characteristics of the data.

Nevertheless, we are a society that loves report cards, rankings and anything that has the potential for showing us where we stand. As long as we stand out positively from all the rest who are ranked, of course.

There is more to this than standings, however. There was a movement some years ago where it was proposed that we use something other than the A, B, C, D, F format in our schools. Instead, some proposed using O, G, S, U, and NI (Outstanding, Good, Satisfactory, Unsatisfactory and Needs Improvement). I like that idea because it places the focus on improvement; however, we stuck with A, B, C, D and F because everyone knows what that means. We think improvement is the basis for any benchmarking project. The idea is to do better, not just in the outcome but by improving the metrics we consider as we apply ranks based upon them.

Generally, the more objective these metrics are, the more precise our assessments might be. That increases validity, and if they are objective then it also increases reliability. We think the factors that we considered are not subject to unwarranted variability that is not due to actual reflections of rural health status. I know all of this sounds to your ear (and mine) to be pretty academic, so let me use a personal story to illustrate.

When I was a kid going to school, I got a report card every six weeks during the year. It was my teachers’ summation of how I had performed in critical subjects like reading, writing and arithmetic. Later they added things like deportment. Before, that was taken care of with a paddle and a note home; but I digress. The grades were based on things like homework assignments, tests and sometimes on the teacher’s sense of how well we were learning the key subjects.

Those report cards were my guideposts, and every six weeks there were consequences when I had not improved. Often those consequences were things like more help from my parents or restrictions on extracurricular activities so I could stay after school to work with willing teachers. They were also badges of honor when I had done better. These grades were personally meaningful, but they were also meaningful to all of my classmates who were in a sense my competitors.

So as you read these report cards, I hope they are a good benchmark that motivates improvements. If we all do well, then the competition will have been well worth the toil.

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Billy U. Philips Jr.
Dr. Billy U. Philips Jr. is Publisher of Rural Health Quarterly and Director of the F. Marie Hall Institute for Rural and Community Health at the Texas Tech University Health Sciences Center.