State-by-State Health Rankings

Over the past 25 years, the United Health Foundation has published its annual "America's Health Rankings" analysis, giving Americans an up-to-date examination of the factors that affect their health and a state-by-state comparison of their physical health.

The United Health Foundation ranks each state on 27 measures of health which are grouped into five core measures that contribute to health outcomes as follows:

1.) Behaviors: these include smoking, binge drinking, drug deaths, obesity, physical inactivity and rate of high school graduation.

2.) Community and Environment: these include violent crime rate, occupational fatalities, childhood poverty, air pollution and infectious diseases including Chlamydia, Pertussis and Salmonella.

3.) Policy: these include lack of health insurance, public health funding levels, childhood immunization rates, adolescent immunization rates and low birthweight.

4.) Clinical Care: these include primary care physicians, number of dentists and preventable hospitalizations.

5.) Outcomes: these include diabetes, poor mental health days, poor physical health days, disparity in health status, infant mortality, cardiovascular deaths, cancer deaths and premature deaths.

Additional behavioural measures examined include cholesterol levels, annual dental visits, consumption of fruits, consumption of vegetables, insufficient sleep, teen birth rate, youth smoking rate and youth obesity rate.

Here is a table showing the state health rankings based on the 27 measures of health:

For the third consecutive year, Hawaii is the healthiest state; it has been consistently in the top six places over the past 25 years.  As well, for the third year running, Vermont comes in at second place.  On the other side of the ledger, Mississippi ranks 50th for the third consecutive year; it gets this ranking because it ranks in the bottom five states in 16 out of the 27 health measures used in the study as well last 50th for all health determinants.

Here is a summary of Hawaii's strengths and weaknesses as the number one ranked state when it comes to overall health:

For comparison, here is a summary of Mississippi's strengths and weaknesses as the state ranked in last place when it comes to overall health:

Here is a graphic showing which states have seen the greatest change, both positive and negative in their health status between 1990 and 2014 with the darker colors showing the greatest decline and the lighter colors showing the greatest improvement:

The most improved state was New York which saw its ranking rise from 40th place in 1990 to 14th place in 2014.  The state with the greatest ranking decline over the 25 year prior was Iowa which saw its ranking fall from 6th place in 1990 to 24th place in 2014.

Now that we've seen how the states rank, let's look at a chart that compares infant mortality rates, life expectancy and health expenditures as a percentage of GDP for many developed and developing nations and the United States:

Note that, at 79 years, Americans have a life expectancy that is tied with Cuba and Columbia, which puts the U.S. in 34th place in the world, despite spending 17.9 percent of GDP on health care, the highest level of expenditure among the 52 nations by a very wide margin.

Here are some of the biggest challenges facing Americans and their overall health:

1.) Smoking:  While smoking has decreased 36 percent from 1990 levels, 19 percent of American adults still smoke regularly.

2.) Infant Mortality:  While infant mortality has decreased 41 percent since 1990 to 6.0 deaths per 1000 live births, America's rate is still double the rate of many developed nations including Canada, Australia, Japan and most nations in Western Europe.

3.) Obesity:  Since 1990, obesity has increased from 11.6 percent of adults to 29.4 percent of adults, an increase of 153 percent as shown on this graph:

Since obesity is such a growing core health problem in the United States, here is a map showing the percentage of adults with a body mass index of 30.0 or higher by state:

It is interesting to note that, according to the study, obesity rates increase with lower education and lower income levels.

4.) Physical Inactivity:  The level of physical inactivity has remained high and stable over the past 25 years at 23.5 percent of adults who get very little physical activity in a day.

5.) Children in Poverty:  At 19.9 percent of all children, the current childhood poverty rate is far above the 23-year-low of 15.8 percent in 2002 and very close to the 1990 level of 20.6 percent.

6.) Diabetes:  Nationwide, 9.6 percent of adults report that they are diabetic; data shows a steady climb in the prevalence of diabetes over the past 25 years as shown on this graph:

As we can see from this study, there is a great state-to-state disparity in health among Americans.  Some states, particularly those in the south-central part of the continental United States, have had the poorest health ratings for decades, an issue that has led to lower life expectancy and an overall and persistent poorer quality of life.