Identifying Priorities to Reverse a Statewide Relative Health Decline: Results From a Delphi Study in Kansas

ABSTRACT Objective: To identify and prioritize system-level factors contributing to Kansas' long-term population health decline compared with the United States and demonstrate the application and value of the modified Delphi technique for complex, state-level health assessment. Methods: A modified Delphi study was conducted in Kansas to engage experts and leaders in Kansas' health across sectors. Participants (n = 50 Round 1; n = 67 Round 2; n = 60 Round 3) provided qualitative input and completed quantitative prioritization across 3 Delphi rounds. Issue statements were developed from open-ended responses (Round 1), rated for importance (Round 2), and prioritized through a constant sum resource allocation exercise (Round 3). Results: Participants identified 52 factors contributing to Kansas' health decline. Of these, 4 emerged as the highest priorities: closure of rural hospitals and health care services, failure to expand Medicaid, limited mental health service availability, and low public health funding. Seven additional factors were identified as high priorities. The highest-ranked issues reflected system-level drivers rather than individual behaviors. Conclusions: Kansas' declining health trajectory is primarily driven by structural system vulnerabilities, including policies and infrastructure gaps misaligned with what produces health. Policy Implications: Addressing Kansas' health decline will require targeted policy reforms that strengthen system capacity and align with evidence-based approaches used by higher-performing states.