An alarming proportion of Americans are living with chronic illnesses such as heart disease and diabetes, and many are also struggling with unhealthy factors—ranging from poverty to air pollution—in their communities. The likelihood of experiencing these and other problems varies widely depending on where you live, however.
The latest state-by-state health rankings, published today by a group of nonprofit, business, and professional organizations, reveal some familiar trends: The healthiest states in the nation tend to be found in the Northeast, while the least healthy are clustered in the Deep South and Appalachia.
Vermont was again named the healthiest state—a spot it has occupied for six straight years, thanks in part to its low rates of infectious disease, high rates of insurance coverage, and ample supply of primary care physicians. Rounding out the top five were Hawaii, New Hampshire, Massachusetts, and Minnesota. (View the complete list.)
At the other end of the scale, Mississippi and Louisiana tied for last place. Both states have been among the bottom three since these rankings were first compiled, in 1990. Factors contributing to their perennial low ranking include high rates of obesity and diabetes and a large proportion of children living in poverty.
Overall, the annual report, known as America's Health Rankings, paints a mixed picture of the nation's public health. Americans today can expect to live about 78.5 years (up from 76.8 years in 2000), but that apparent progress masks many grim statistics. By conservative estimates, for instance, 31% of Americans have high blood pressure (hypertension) and 9.5% have diabetes.
"We are living longer, but we are clearly living sicker," says Reed Tuckson, MD, executive vice president and chief of medical affairs for UnitedHealth Group, a large Minneapolis-based health insurer. Tuckson is the medical adviser to the United Health Foundation, an affiliated nonprofit foundation that publishes the rankings in conjunction with the American Public Health Association and the Partnership for Prevention, a coalition of government, business and nonprofit organizations dedicated to health promotion.
Behind the escalating incidence of diabetes and other chronic diseases, such as heart disease and cancer, lies a single, dominating risk factor: obesity. Some 28% of Americans are now considered obese, and many more are overweight.
"Obesity is the biggest challenge facing the U.S. right now," says Nancy Bennett, MD, director of the Center for Community Health at the University of Rochester Medical Center, in Rochester, N.Y., who was not involved in the rankings. "Tobacco is still the number-one cause of death in the U.S., but with decreasing rates of smoking, the lack of physical activity and poor nutrition will quickly become the leading cause of death. We may even be at that point now."
The state rankings were based on 24 health and socioeconomic measures tracked by the Centers for Disease Control and Prevention, the Census Bureau, and other federal agencies. The measures included straightforward rates of disease, along with social and environmental factors that can impact health both directly and indirectly, such as health insurance coverage, crime, and poverty.
Many of the measures used in the report, such as smoking, obesity, binge drinking, and diabetes rates, are higher than last year, although it's difficult to draw conclusions about trends from just two years of data. (Adding to the difficulty, recent changes in how federal agencies collect data make year-over-year comparisons tricky.)
Still, many of the long-term trends seen in the report are troubling. The percentage of children and adolescents living in poverty—21.4% nationwide—remains high, and represents a dramatic increase since a low of 15.8% in 2002.
"That is one of the most startling statistics," Dr. Tuckson says. "These children are not going to have access to healthy foods, places to exercise; they're not going to have great educational systems. We're producing a whole cadre of kids whose health is going to be compromised."
The report contains other discouraging trends. Today, for instance, 16% of people are uninsured, versus 13.9% in 1992. And although infant mortality has dropped 36% since 1990, the rate of decline has leveled off in the last 12 years.
"Infant mortality continues to be pretty much flatlined and stable at 6.5 deaths per 1,000 live births," says Dr. Tuckson. "That is almost unfathomable. We are nowhere near our biological potential on one of the most fundamental of all measures."
For the first time, the rankings included a measure of sedentary behavior, finding that 26% of the population is doing "nothing at all" in terms of physical activity, Dr. Tuckson says. In some states, such as Mississippi and Tennessee, the number is as high as 35%.
The report did provide some glimmers of good news. Deaths from cardiovascular disease and from cancer have both declined since 1990, by 35% and 8% respectively. And the number of preventable hospitalizations dropped from 82.5 discharges per 1,000 Medicare enrollees in 2001 to 66.6 discharges in 2012. That ratio differed greatly by race and ethnicity, however.
The report highlights the need to focus on prevention of chronic diseases, says Dr. Tuckson. "We absolutely have to turn the spigot off," he says. "As important as insurance and access to medical care are, they key thing is to be controlling fundamental risk factors."