A State-by-State Look at the Health of Americans

Updated January 2020

With Congress and the President regularly discussing the delivery of health care in the United States, they rarely actually deal with the health of Americans, particularly how health outcomes vary across America.  Thanks to the United Health Foundation and its 2017 Annual Report, we have a regular appraisal of how health varies from state to state.

According to the World Health Organization, health is defined as:

"...a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity....the health of all people's is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and states....Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures."

Health outcomes can be broken down into four categories of health determinants:

1.) Behaviors - includes drug deaths, excessive drinking, obesity, physical inactivity, smoking.

2.) Community and Environment - includes air pollution, children living in poverty, infectious diseases, violent crime, occupational fatalities.

3.) Policy - includes immunizations for adolescents and children, public health funding, uninsured.

4.) Clinical Care - includes low birthweight, mental health provision, preventable hospitalizations, primary care physicians

Let's now look at some of the key statistics from the report.  Keeping the aforementioned health determinants in mind, here is a listing of the ten highest ranking states when it comes to overall health and their score with a score of 0.000 being the overall score for the entire United States:

1.) Massachusetts: 0.916

2.) Hawaii: 0.845

3.) Vermont: 0.789

4.) Utah: 0.734

5.) Connecticut: 0.699

6.) Minnesota: 0.676

7.) Colorado: 0.624

8.) New Hampshire: 0.622

9. Washington: 0.520

10.) New York: 0.507

Here is a listing of the ten lowest ranking states when it comes to overall health in order from lowest score:

1.) Mississippi: -1.036

2.) Louisiana: -0.908

3.) Arkansas: -0.772

4.) Alabama: -0.762

5.) West Virginia: -0.696

6.) Tennessee: -0.637

7.) South Carolina: -0.611

8.) Oklahoma: -0.594

9.) Kentucky: - 0.512

10.) Georgia: -0.432

Over the period from 1990 when the first analysis was completed, New York has risen from 40th place to 10th place, Vermont has risen from 20th place to 3rd place and Maryland has risen from 31st place to 18th place.  On the other hand, North Dakota has fallen from 1st place to 18th place and Missouri has fallen from 24th place to 40th place.

Overall, over the past five years, among others, improvements have been noted in the following four aspects of health:

1.) Smoking: over the past five years, the prevalence of smoking among adults has dropped from 21.2 percent to 17.1 percent and has decreased the most among adults between the ages of 18 and 44.  The prevalence of smoking declined in all 40 states with the greater percentage point decreases in Oklahoma, Nevada and Rhode Island.

2.) Air Pollution: over the past five years, the level of air pollution decreased from 10.5 to 8.6 micrograms of fine particles per cubic metre and over the past ten years, the level decreased from 12.2 micrograms, a total drop of 30 percent over the decade.  The biggest decreases occurred in California, Arkansas and West Virginia while Alaska saw its level increase from 6.0 to 8.7 micrograms per cubic metre.

3.) Children in Poverty: the percentage of children who live in households at or below the poverty threshold has decreased from 19.7 percent to 18.0 percent over the past year but is up 14 percent above its 25-year low of 15.8 percent seen in 2002.  Over the past five years, the percentage of children living in poverty decreased 9 percentage points or more in the District of Columbia, Indiana, New Mexico and Nevada.  Increases were noted in North Dakota, Alaska and Mississippi.

4.) Uninsured: the percentage of the population that does not have private health insurance decreased from 16.0 percent to 9.0 percent thanks to the implementation of the Affordable Care Act.  The largest declines occurred in California, New Mexico, Nevada and Arkansas.  The smallest improvements were noted in Maine and Massachusetts, largely because they both had high levels of insured individuals in 2012.

Over the past five years, here are four areas that have shown a decline:

1.) Drug Deaths: Over the past year along, the number of deaths due to drugs increased by 7 percent and, over the past five years, has increased by 23 percent.  Looking further back in time, deaths associated with drugs has risen a whopping 60 percent since 2007.  The death rate among males is 18.7 deaths per 100,000 population and 11.3 deaths per 100,000 for females.  Over the past five years, drug-related deaths have increased in 34 states and the District of Columbia with Massachusetts, Rhode Island, Ohio, New Hampshire and West Virginia seeing the largest increases.

2.) Obesity: In the past five years, the percentage of Americans with a body mass index of 30.0 or higher has increased from 27.8 percent to 29.9 percent of adults.  Obesity is significantly higher among African Americans when compared to whites, Hispanics and all other racial/ethnic groups other than the American native population.  Over the past five years, the smallest percentage point increases in obesity occurred in the District of Columbia (actually decreased), Virginia, Idaho, New Hampshire, Floria and Montana whereas the largest percentage point increases in obesity occurred in North Dakota, Illinois, Arkansas, West Virginia and Tennessee. In the case of West Virginia, 37.7 percent of the adult population is obese compared to 22.3 percent for adults living in Colorado.

3.) Low Birthweight: The percentage of newborns weighing less than 5 pounds 8 ounces has remained at levels that are higher than they were in the 1990s.  Since 2007, between 8.0 and 8.2 percent of newborns are classified as low birthweight infants compared to 7 percent in 1993.  The states of Mississippi, Oklahoma and New York have experienced statistically significant decreases in the percentage of low birthweight infants over the past five years.

4.) Diabetes: The percentage of adults that have been told that they were diabetic by a health care professional has increased from 9.5 percent in 2012 to 10.5 percent in 2017.  Over the same timeframe, the prevalence of diabetes has increasing significantly in Kentucky, Alabama and West Virginia and has declined in the District of Columbia, Idaho, South Dakota, Alaska, Colorado and Kansas.  

It is quite obvious that there is significant inequity in health status when comparing outcomes from state to state.  While Washington fiddles with getting rid of the Affordable Care Act, the study by the United Health Foundation suggests that Americans in some states have access to health care that is less than adequate, an issue that is likely having a negative impact on longevity and the ability to live a life that is free from the stresses associated with poor health.

Big America - The Growing Health Care Crisis

Updated February 2019

With healthcare regularly commanding the headlines in the American mainstream and non-mainstream media, there is one related topic that gets almost no attention - health, particularly health as it relates to body weight.  An analysis by the OECD looks at one key measure of health, that of obesity.  Here is a summary of their findings.

The study looked at the obesity rate in the 35 nations that make up the Organization for Economic Co-operation and Development and then compared the most recent obesity rates to those of the past.  The study found that, across the OECD, more than one in two adults and one in six children are either obese or overweight and that the "obesity epidemic" has spread further in the past five years with projections showing that all nations will experience a continuing increase in obesity.  That said, obesity rates for all 35 nations vary widely with a tenfold variation in obesity across the nations.

With that introduction, let us now look at obesity rates.  In 2015, on average across the OECD, 19.5 percent of adults were obese with the obesity rate varying from less than 6 percent in Korea and Japan to more than 30 percent in Hungary, New Zealand, Mexico and the United States.  Here is a graphic showing the obesity rates for all 35 OECD nations as well as the rates for some of the world's less-developed economies (i.e. the BRIC nations):

By a relatively wide margin, at 38.2 percent of the total adult population in the United States is considered obese followed by 32.4 percent in Mexico and 30.7 percent in New Zealand.  The least obese nations include Japan with 3.7 percent of its population considered obese followed by Korea at 5.3 percent and Italy at 9.8 percent.  In general, among OECD member nations, the obesity rate for women is slightly higher than the rate for men; this is particularly the case in Latvia, Turkey, Chile, Mexico and the United States.  If we look outside the OECD, in the case of South Africa, 37 percent of women are obese compared to only 16 percent of men.  That said, in general, male obesity has been growing more rapidly as the years have passed.

As was noted at the beginning of this posting, for many nations, the rate of obesity and the percentage of overweight persons has increased over the past few decades as shown on this graphic:

As you can see, the rate of overweight persons in the United States has risen from 43 percent in the late 1970s to 68 percent in 2013, a 58 percent increase.  Obviously, this should be of concern to policymakers since it is this trend that is has led to higher and higher health care cost burdens for American households. 

The future trend is not encouraging either.  Here is a graphic showing the percentage of self-reported overweight children aged 15, comparing the rate in 2001 - 2002 to that of 2013 - 2014 for each OECD nation:

As you can see, for every nation that has data for both years, the percentage of overweight children has increased over the decade with one exception; Denmark.

With all of this data in mind, let's look at the OECD's projections for the future rates of obesity going out to 2030:

Given the growing percentage of overweight children, it certainly appears that the global trend is not favouring a decrease in obesity rates.

Another interesting factor in the obesity equation is the relationship between educational level and obesity.  Less educated women are two to three times more likely to be overweight than those with a higher level of education in half of the eight nations for which that data is available.  In most nations, the rate of obesity has also been rising more rapidly in less-educated men and average-educated women with one exception; in the United States, obesity rates have been increasing most rapidly among highly educated people.

While Washington focuses on the partisan options for health care delivery, they are ignoring one of the most important factors in personal health; the maintenance of a healthy body weight.  Until politicians address this growing crisis, the health care situation in the United States is likely to reach the critical stage where the system simply cannot handle the growing numbers of people with weight-related illnesses. 

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.