2007 America’s Health Rankings Show a Decline in the Overall Health of the Nation

The following is a press release from American Public Health Association.

Analysis shows Vermont, Minnesota and Hawaii are nation’s healthiest states; Mississippi and Louisiana rank as least-healthy states

WASHINGTON, D.C. – November 5, 2007 – The overall health of the nation declined over the past year, despite progress made in several key health indicators, according to a report launched today by United Health Foundation, the American Public Health Association (APHA) and Partnership for Prevention. The 18th annual edition of America's Health Rankings: A Call to Action for People & Their Communities measures the overall healthiness of states and the nation using a comprehensive and longitudinal set of related health determinants and health outcomes. The report indicates that the overall health of the nation declined by a rate of 0.3 percent since last year.

While this report, and others, show there have been modest gains in reducing the rates of cancer and cardiovascular mortality, these improvements continue to be dwarfed by increasing obesity, increasing numbers of uninsured people, children in poverty and the persistence of risky health behaviors, such as tobacco use and violent crime -- all of which have a significant impact on the overall healthiness of the nation.

"Even though specific mortality rates have improved, this report shows there are still many people who, through unhealthy personal behaviors, adverse community environments and difficult access to care, are vulnerable to a future life of poor health -- which is essentially preventable," said Reed Tuckson, M.D., member of the board of United Health Foundation. "The consequence of this reality manifests itself in a poor quality of life, people living with chronic disease, compromised productivity and significant escalation in the costs associated with managing chronic illness."

This lack of progress is in sharp contrast to the nation's average annual improvement of 1.5 percent between 1990 and 2000. In fact, since 2000, there has been a virtual stagnation in health improvement. The failure to demonstrate progress is particularly worrisome given that the U.S. continues to trail other nations in important health indicators such as infant mortality and healthy life expectancy.

Once again, this year's report provides a ranking of the healthiness of each state. Vermont surpassed Minnesota as the healthiest state in the nation this year, with Minnesota (2), Hawaii (3), New Hampshire (4) and Connecticut (5) rounding out the top five.

The data also notes that Mississippi ranks as the least healthy state, with Louisiana (49), Arkansas (48), Oklahoma (47) and Tennessee (46) completing the bottom five. The publishers of the report note that every state – no matter its ranking – has its own set of unique challenges to confront and successes on which to build and from which other states can learn.

A National Health Analysis

This year the report analyzes a comprehensive set of 20 related health measures, such as smoking, binge drinking, violent crime, infectious disease, high school graduation, health status and several measures of mortality. The analysis of this comprehensive set of factors allows for a more complete and holistic view of the health of the nation than only death-related statistics. The following is a snapshot of the national findings:

• Since the first report in 1990, America’s Health Rankings, using a consistent set of measures, has shown an 18.4 percent improvement in the nation's overall health. This national success can be attributed mostly to:

1. The reduction of several health determinants, such as infectious diseases, smoking, infant mortality, cardiovascular deaths and violent crime.
2. Fewer children living in poverty.
3. More ninth graders graduating high school within four years now than in 1990.

• Over the last six years, however, the nation’s health has virtually stagnated. Several reasons for the stagnation are obesity, a growing number of uninsured and persistent lack of progress in key health measures such as tobacco use, violent crime and children in poverty. Within the national environment, some states have addressed key health issues and improved, however others have not and are declining.
  
  
• Obesity has increased from 11.6 percent of the population in 1990 to more than 25 percent today. More than 55 million Americans are obese and as a result are at significant risk for other diseases, such as heart disease, diabetes, stroke, and cancer.
  
  
• According to the U.S. Census Bureau, the number of Americans who are uninsured has increased from 13.4 percent in 1990 to 15.8 percent of the population today. Up .5 percent from last year, an alarming 47 million Americans are living without health insurance. Tragically, more than nine million of the uninsured are children. According to the Institute of Medicine (IOM), people without health insurance are sicker and die sooner. IOM attributes 18,000 deaths per year to people under age 65 due to lack of insurance coverage.
  

The United States Compared to Other Nations

This year's report also looks at the U.S. compared to other nations. According to the 2007 Commonwealth Fund findings, the U.S. spends twice as much on health care than Australia, Canada, Germany, New Zealand and the United Kingdom. Despite this expenditure of health care assets, the U.S. continues to fall behind in several important indicators of health. For example:

• Although the U.S. can now celebrate its highest life expectancy in history (77.9 years), 43 other countries still have life expectancies that are higher than the U.S., including Japan, Sweden, France, Canada, Italy and Australia. In fact, a baby born today in Japan has a life expectancy of 82.0 years and a baby born in the U.S. has a life expectancy of 77.9 years. If we look at a broader measure and compare healthy life expectancy – that is number of years of active, healthy life expected at birth – a baby girl in Japan can expect 78 years whereas a girl born in the U.S. can expect only 71 years of healthy life at birth. Once again, U.S. citizens continue to demonstrate unacceptably high burdens of illness.

"The health of the American people is not just about length of life, but it is also about quality of life," said John Clymer, president of Partnership for Prevention. "We must look to each other, but also to these other nations as examples to aid us in our efforts to improve health."

State-by-State Analysis

Several states exhibited noteworthy gains in overall health improvement. For example:

• South Carolina had the highest overall health improvement with a 6.3 percent increase. Montana followed with a 4.6 percent increase, and Maryland and New Mexico both had a 4.5 percent increase in health status.
  
  
• Vermont moved to the top of the list of healthiest states after a steady climb in the rankings for the past seven years. This is notable because it demonstrates that progress can be made. Vermont has made significant progress in several key areas:

1. The prevalence of smoking declined from 21.5 percent in 2001 to 18.0 percent in 2007.
2. Children in poverty declined from 16.1 percent in 2001 to 8.9 percent of persons under age 18 in 2007.
3. In 2001, Vermont ranked only 29th in prenatal care – now it ranks 2nd.

• Nebraska’s return to the top ten (it last appeared in the top ten in 1992). Nebraska notes a continued improvement in high school graduation rates – now the highest in the U.S. Nebraska also has experienced reductions in the last few years in the occupational fatality rate and violent crime.
  
  
• After four years in the bottom ten, Georgia moved up to 40th place. Georgia has experienced a decline in the infectious disease rate, number of poor physical health days and prevalence of smoking.

Health Disparities among Populations

Given that America’s Health Rankings™ is specifically intended to provide opportunities for focused analysis and action to meet high priority local problems, documenting disparities in health status between populations has been, and continues to be, a major feature of the report. Once again, state-specific concerns are noted and national trends also are documented.

• Disparities continue to exist in measures such as premature death (premature death measures the loss of life before age 75 in a population). The premature death rate for Blacks is almost 1.5 times than the rate for Whites.
  
  
• Disparities also are growing between the Hispanic and non-Hispanic populations.
  
  
• According to the National Healthcare Disparities Report, Hispanics receive poorer quality care than non-Hispanics and data indicates that this trend is getting worse, not better.
  
  
• In terms of preventive care, the Hispanic population has the lowest percentage of people accessing regular dental care and colon cancer screenings – two key indicators of a population’s ability to stay healthy.

"Eliminating disparities in health requires a greater emphasis and focus on the root causes of poor access to care; differential access to quality medical care; and the social determinates that lead to unhealthy living conditions," said Georges C. Benjamin, M.D., FACP, FACEP (E), executive director of APHA. "Eliminating these disparities is a mechanism to improve the overall health status of the nation and advance our health rankings as compared to the rest of the world."

To view the entire report, please visit www.americashealthrankings.org or www.unitedhealthfoundation.org.