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The Key Findings Of America's Health Rankings

Armen Hareyan's picture

The health rankings show that nationally, air pollution has declined over the last seven years. Vermont leads the nation as the healthiest state for the second year in a row. It is followed by Hawaii (2), New Hampshire (3), Minnesota (4), and Utah (5).

America’s Health Rankings: A Call to Action for Individuals & Their Communities is the longest running report of its kind, providing an important, annual assessment of the nation’s health on a state-by-state basis. For nearly two decades, the America’s Health Rankings™ report has evaluated health, environment and social-economic data to determine national health benchmarks and an annual ranking of the healthiest and least healthy states. Rankings are determined by evaluating four components: personal behaviors; the environment in which people live and work; the decisions made by public and elected officials; and the quality of medical care delivered by health professionals. Health of the Nation Remains Stagnant For the fourth consecutive year, the health of Americans has failed to improve. During the 1990s, health improved at an average rate of 1.5 percent per year, but improvements against national health measurements have remained flat for the last four years.

Three critical national health challenges contributing to these results include growth in the prevalence of obesity to unprecedented levels, an increasing number of uninsured people, and the persistence of risky health behaviors, such as tobacco use.

While there has been an overall 33 percent decrease in the prevalence of smoking (from 29.5 percent of the population in 1990 to 19.8 percent of the population in 2008), significant improvements in reducing this behavior have not occurred since the early 1990s. Reductions in the rate of smoking have virtually stalled in the last four years.

The prevalence of obesity has more than doubled in the last 19 years, increasing from 11.6 percent of the population in 1990 to 26.3 percent of the population in 2008 (a 127 percent increase over 1990 rates). Now, more than one in four Americans are considered obese and this alarming rate of increase shows no evidence of slowing.

The lack of health insurance coverage increased by 16 percent from 13.9 percent in 1990 to 15.5 percent in 2008, leaving 45.7 million Americans without coverage.

America’s Health Rankings™ Key Findings/Page Two America Does Not Measure Up When Compared to Other Nations When compared with other developed countries, the United States lags behind in many of the common measures used to gauge healthiness, including average life expectancy, infant mortality, and The United States currently falls behind 27 other developed countries in terms of healthy life expectancy (HALE) with an average of 69 years, while Japan leads all countries with an average of 75 years. Some differences in healthy life expectancy can be attributed to the nation’s inability to effectively treat disease, especially those that are amenable to care or curable.

Among 18 other industrialized nations studied by the Organization for Economic Cooperation and Development (OECD), the United States ranked last in death from treatable conditions before age 75. In the last five years, the United States has fallen four spots as Finland, Portugal, the United Kingdom, and Ireland have all reduced their mortality rate from treatable conditions more rapidly.

A UNICEF study of child well-being, revealed the United States ranked second to last when compared to 21 other developed countries due to a high infant mortality rate, a high percentage of low-birth-weight infants, and only an average rate of immunization. One of the underlying causes for this difference is the gap in infant mortality rates between the United States and many other countries.

According to the Commonwealth Fund, the United States is last in health care system performance when compared to six other countries: Australia, Canada, Germany, New Zealand, and the United Kingdom. The United States spends twice as much as these countries on a per-capita basis, yet it is last on dimensions of access, patient safety, efficiency, and equity.
2008 State-by-State Information Regardless of an individual state’s ranking, each state has its share of successes and challenges. Vermont leads the nation as the healthiest state for the second year in a row. It is followed by Hawaii (2), New Hampshire (3), Minnesota (4), and Utah (5).

Louisiana is ranked as the least-healthy state, while Mississippi (49), South Carolina (48), Tennessee (47) and Texas (46) remain in the bottom five. Each of these states continues to struggle with difficult socioeconomic challenges that manifest themselves in these rankings.

Utah (5) currently leads the nation as the state with the lowest prevalence of smoking. Other states making progress against the nation’s biggest health challenges include Massachusetts (6), which leads the nation as the state with the lowest uninsured rate, and Colorado (19), which ranks as the state with the lowest national prevalence of obesity.
A comparison of state rankings from 2007 to 2008 indicates that 36 states had positive changes in their overall health scores and 14 experienced declines.

America’s Health Rankings™ Key Findings/Page Three  Arkansas, New Mexico, and Kentucky showed the greatest overall health score improvement during the past year. Texas and Montana showed the least improvement in health during the past year.

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South Dakota and Virginia both show a strong indication they will improve over time compared to other states. New York, Iowa and Texas show a strong indication that they will decline over time, compared to other states.

New 2008 Measurements Two new measures were added to the America’s Health Rankings™ 2008 Edition: Air Pollution and Geographic Disparity.

Air Pollution measures microscopic solids and liquid droplets, such as dust and smoke chemicals in the air we breathe. Too small to see, these particles appear as a haze in higher concentrations and enter the deepest portions of the lungs. Air pollution exposure has been linked to decreased lung function, aggravated asthma, development of chronic bronchitis, irregular heartbeat, nonfatal heart attacks, and premature death in people with heart or lung disease.

- Nationally, air pollution has declined over the last seven years from 15.0 to 13.1 micrograms per cubic meter.

- California has experienced the greatest improvement in this measure during the last seven years, declining from 20.0 to 14.8 micrograms per cubic meter. Only five states have experienced no improvement during this interval: Utah, Texas, Wisconsin, Alaska, and Iowa.

Geographic disparity is an explicit metric for disparities that reflects the wide range of mortality rates that exist within a state at the county level. The causes for the variation in mortality occur for many reasons, including differences in personal behaviors, genetics, community and environmental situations, health care policies, and clinical interventions. Some of the greatest disparities exist in states where one population group has been especially successful in one determinant.

Persistence of Disparities in Health Status Across Socioeconomic and Ethnic Groups The statewide measures used in America’s Health Rankings™ reflect the condition of the “average” resident. However, when those measures are examined more closely, startling differences can exist within a state when race, sex, geographic location and/or economic status are considered. Themes emerging from the 2008 America’s Health Rankings™ include: Disparities in access to quality health care are not decreasing and still exist across many groups, including women, children, the elderly, rural residents, and among racial and socioeconomic groups, according to the National Healthcare Disparities Report.

The problem of persistent lack of insurance is a major barrier to reducing these health disparities, which affect all aspects of health and health care delivery, including preventive care, acute care, and chronic disease management.

America’s Health Rankings™ Key Findings/Page Four Hispanics 18 to 64 years are almost three times as likely to be uninsured than non-Hispanic whites, and non-Hispanic blacks are 1.5 times more likely to be uninsured than non-Hispanic whites. The percentage of uninsured Hispanics is 34.2 percent compared to 17.7 percent of non-Hispanic blacks and 12.2 percent of non-Hispanic whites.

- At the state level, the uninsured rate for Hispanics is more than four times higher than non-Hispanic whites in five states: Connecticut, Illinois, Iowa, New Jersey, and North Carolina.

- In Ohio, Wyoming, Montana, and Mississippi, the uninsured rate of Hispanics compared to non-Hispanic whites is only 1.5 times higher.

- In Minnesota, the uninsured rate for non-Hispanic blacks is almost three times the uninsured rate for non-Hispanic whites.

Nationally, low birth weight infants are 1.9 times as common among non-Hispanic blacks as among non-Hispanic whites and twice as common among non-Hispanic blacks and Hispanics. Of non-Hispanic blacks, 13.8 percent babies are born at a low birth rate, compared to 7.2 percent for non-Hispanic whites and 6.8 percent of Hispanics.

Cardiovascular death rates vary considerably by race. There is a considerable gap between blacks with a cardiovascular death rate of 395.7 deaths per 100,000 population and all other races at 181.8 deaths per 100,000 population. While these disparities exist in all states, the gaps are largest in California, Michigan, and Wyoming, with West Virginia and Massachusetts demonstrating the smallest disparity.