Increase the proportion of state and territorial jurisdictions that have a health improvement plan — PHI‑04 Data Methodology and Measurement

About the National Data


Baseline: 82.4 percent of state and territorial public health jurisdictions had developed or participated in developing a health improvement plan in 2016

Target: 86.0 percent

Number of states and territories that have developed a health improvement plan within the last 5 years.
50 States, the District of Columbia, and 8 US territories and freely associated states.
Target-setting method
Percentage point improvement
Target-setting method details
Percentage point improvement from the baseline using Cohen's h effect size of 0.10.
Target-setting method justification
Trend data were not available for this objective, although a similar objective that only focused on state jurisdictions was included in Healthy People 2020. A percentage point improvement was calculated using Cohen's h effect size of 0.1. This method was used because the Healthy People 2030 Workgroup Subject Matter Experts viewed this as an ambitious yet achievable target given knowledge of current and anticipated activity in state and territorial jurisdictions.


Methodology notes

A critical aspect of public health infrastructure assessment is monitoring the status of health improvement plans at the state and local level. A health improvement plan is a long-term, systematic effort to address health problems on the basis of the results of a community needs assessment. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources.

The ASTHO Profile Survey is the only comprehensive source of information about state and territorial public health agency activities, structure, and resources. ASTHO sends a link to the web-based survey to senior deputies at state health agencies in the 50 states and the District of Columbia. ASTHO develops a modified version of its survey for the territories. ASTHO sends a link of the web-based survey to senior deputies in territorial public health agencies. The eight U.S. territories and freely associated states are collectively referred to as the insular areas. The U.S. territories include three island jurisdictions in the Pacific—American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands—and the two Caribbean territories of Puerto Rico and the U.S. Virgin Islands. The remaining insular areas include three sovereign nation states holding compacts of free association with the United States, also known as compact nations: the Republic of Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands.

The approximately 120-question instrument covers the following topic areas: 1. Structure, governance, and priorities; 2. Workforce; 3. State health agency activities; 4. Planning and quality improvement; 5. Health information management; 6. Finance.

Along with general instructions, senior deputies received recommendations on the most appropriate staff/departments to fill out each section of the survey. Surveys could be filled out by multiple personnel in multiple sittings. If response errors were identified, ASTHO's Survey Research team worked with the state to correct these responses. In instances where the state did not respond to multiple follow-up attempts, the Survey Research team used their expertise to determine whether to retain the data.

Responding health agencies that responded "Yes, within the last three years" or "Yes, more than three but less than five years ago" to the survey question "Has your state/territorial public health agency developed or participated in developing a health improvement plan for your state/territory?" were counted in the numerator.


Comparable HP2020 objective
Modified, which includes core objectives that are continuing from Healthy People 2020 but underwent a change in measurement.
Changes between HP2020 and HP2030
This objective differs from the related Healthy People 2020 objective PHI-15.2 in that PHI-15.2 tracked states that have developed a health improvement plan, while this objective tracks state and territorial jurisdictions that have developed a health improvement plan.

1. Effect size h=0.1 was chosen to correspond with 10% improvement from a baseline of 50%.