---
type: source
title: "University of Wisconsin Population Health Institute — 2025 Model of Health (County Health Rankings Update)"
author: "University of Wisconsin Population Health Institute"
url: https://www.countyhealthrankings.org/health-data/methodology-and-sources/methods/the-evolution-of-the-model
date: 2025-11-15
domain: health
secondary_domains: []
format: methodology-document
status: null-result
priority: medium
tags: [health-determinants, county-health-rankings, social-determinants, model-update, UWPHI, clinical-care-share, health-behaviors]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

The University of Wisconsin Population Health Institute (UWPHI) introduced a revised Model of Health in 2025, updating the widely-cited 2014 County Health Rankings model. This is the most widely used public framework for health outcome determinants in the US.

**2014 County Health Rankings Model (legacy — still widely cited):**
The original model assigned explicit weights to health factors contributing to health outcomes:
- Health behaviors: **30%**
- Clinical care: **20%**
- Social and economic factors: **40%**
- Physical environment: **10%**

This is the empirical basis for the "10-20% clinical care" claim that underlies Belief 2. The original model based these weights on a synthesis of McGinnis-Foege (1993), Schroeder (2007), and County Health Rankings analysis.

**2025 UWPHI Model of Health (updated):**
Four primary components:
1. **Population Health and Well-being** — the outcome layer
2. **Community Conditions** — sharpened from "Health Factors" to emphasize structural conditions (safe housing, jobs, schools)
3. **Societal Rules** — NEW: the policies, laws, norms, and power structures that shape community conditions
4. **Power** — NEW: who has the ability to shape Societal Rules and Community Conditions

**Key changes:**
- The new model does NOT display explicit numerical weights (unlike the 2014 model)
- "Community Conditions" replaces "Health Factors" — semantically emphasizing that conditions are structural, not individual
- The addition of "Societal Rules" and "Power" as explicit components represents a shift toward structural/political determinants — beyond individual behavior and clinical care
- Clinical care remains one component of Community Conditions but is not weighted

**Significance of removing weights:**
The UWPHI acknowledges that the nominal weights in the 2014 model have been cited widely, but their empirical basis was always contested. The new model moves away from implied precision in the determinant hierarchy, while preserving the directional insight: non-clinical factors dominate.

**What stays the same:**
The directional claim — that health behaviors, social/economic conditions, and environment collectively account for far more than clinical care — is preserved and strengthened. The addition of Power and Societal Rules expands the structural determinant framework upstream.

**Working paper:** A UWPHI 2025 working paper documents the transition, but the PDF is not directly accessible for full extraction.

## Agent Notes
**Why this matters:** The 2025 model update is important for two reasons: (1) it confirms the continued validity of the non-clinical primacy claim while making the framework more structurally sophisticated; (2) the removal of explicit weights is actually an intellectual honest move — the 20% clinical care figure was always an approximation. The Belief 2 grounding claim remains valid in its directional form, but the extractor should note that the 2025 model update moves away from precise percentage attribution.

**Assessment against Belief 2 disconfirmation:**
The UWPHI update does NOT challenge Belief 2 — it strengthens it. By adding "Societal Rules" and "Power" as explicit components, the model moves the structural determinant framing further AWAY from clinical care primacy. The update is best read as confirmation that the research community views social determinants as even more important than the 2014 model suggested.

**What surprised me:** The explicit addition of "Power" as a determinant category in an academic health determinants model. This is a significant conceptual shift — from listing what shapes health (behaviors, environment, care) to naming WHO shapes what shapes health. This is implicitly a political economy framing that would have been unusual in a 2014 model.

**What I expected but didn't find:** An updated version of the explicit percentage weights. The choice NOT to update the weights (rather than revise them upward for social factors) is itself informative — the UWPHI is acknowledging the empirical limitations of precise quantification while maintaining the directional claim.

**KB connections:**
- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]] — the 2025 update supports this claim's directional validity while flagging the need to note the explicit weights are contested
- [[the epidemiological transition marks the shift from material scarcity to social disadvantage as the primary driver of health outcomes in developed nations]] — the "Power" addition in the 2025 model aligns with this structural framing

**Extraction hints:**
- Could support an update to the existing KB claim on health determinants — noting that the 2025 UWPHI model retains the non-clinical primacy framing while adding structural power as an explicit determinant
- Not necessarily a standalone claim — more useful as an update/enrichment to [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]

## Curator Notes
PRIMARY CONNECTION: [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]
WHY ARCHIVED: Documents the 2025 update to the most-cited health determinants framework — confirming directional validity while noting the removal of explicit percentage weights
EXTRACTION HINT: Useful as an enrichment to the existing KB claim rather than a standalone claim. Key nuance: the 2025 model adds Power/Societal Rules as determinants, moving further from clinical care primacy, not toward it
