Tuesday, December 19, 2017

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.

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