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Volume 12 Number 215 News: Quality The nation's health declined by a rate of 0.3 percent since 2006, following a decade of improvements that include mortality rates for cancer and heart disease, according to a national ranking report released Nov. 5. "While this is a small annual change, it is part of a three year stagnation in health, which is notable as compared to the 1.5 percent per year improvements during the 1990s," according to the report, America's Health Rankings(TM): A Call to Action for People & Their Communities. Overall, the United States still faces increasing rates of obesity, lack of health insurance coverage, and high levels of poverty--all problems identified as impediments to health improvements in the report. "Even though specific mortality rates have improved, this report shows there are still many people who, through unhealthy personal behaviors, adverse community environment and difficult access to care, are vulnerable to a future life of poor health," Reed Tuckson, a board member of the United Health Foundation, one of the organizations that produced the report, said in a statement. 'Stagnation' in Health Improvements Over the 18 years that the report has been published, the nation has experienced an 18.4 percent improvement in overall health, the study said, citing reductions in infectious diseases, infant mortality rates, prevalence of smoking, violent crimes, cardiovascular health, children in poverty, occupational fatalities, and increased immunizations and prenatal care. Nonetheless, in 2007 a quarter (25.1 percent) of the U.S. population is obese, up from 24.4 percent a year earlier. Also, the number of people without health insurance has increased to nearly 16 percent, up from 15.3 percent, the study said. Further, preventable hospitalizations occur in 78.4 discharges per 1,000 Medicare enrollees, up from 77 discharges in 2006, the study said, adding that the number of poor mental and physical health days per month have increased to more than three. State Rankings Low rate of preventable hospitalizations, ready access to prenatal care and primary care, low percentage of children living in poverty, and low levels of obesity catapulted Vermont to first place from eighth place in 2001. Minnesota previously held the first place ranking in the last four years, the study said. Vermont has high marks for overall health, but received low marks on per capita public health spending (41st in nation), and for having a high percentage of binge drinkers at 16.7 percent of the state population. Joining Vermont and Minnesota on the top five healthiest states list were Hawaii, New Hampshire, and Connecticut. Unlike Vermont, the study said, Mississippi has a low prevalence of binge drinking and a high level of per capita public health spending. Nonetheless, the state's ranking slipped from 49th place in 2006 to last place designation in 2007, the study said. The state has high prevalence of obesity, high infant mortality and childhood poverty, and high rates of cardiovascular deaths and premature deaths. Mississippi also ranks in the bottom 10 states for 15 out of the 20 measures, the study said. Joining Mississippi on the least healthy states were Louisiana, Arkansas, Oklahoma, and Tennessee. Most Improved States South Carolina, Montana, Maryland, and New Mexico, respectively, had the greatest overall health score improvements, the study said. The percentage of people without health insurance in South Carolina decreased from 17.3 percent in 2006 to 15.9 percent in 2007. Further, the percentage of children living in poverty decreased from 19.4 percent in 2006 to 15.6 percent, the study said. Despite increases in the number of uninsured from 15.6 percent to 17.1 percent, the study said Montana improved by reducing the number of children living in poverty and the level of violent crimes. Maryland experienced reductions in the prevalence of smoking, from 18.9 percent to 17.7 percent of the state population. The state also saw reductions in premature deaths, the percentage of children living in poverty, and level of violent crimes. New Mexico experienced health improvements by reducing smoking prevalence from 21.5 percent to 20.1 percent of the state population in 2007, the study said. But it increased the number of uninsured (22.9 percent of the total population) and rate of preventable hospitalizations. Least Improved States Kansas and New Jersey had the greatest overall health score declines, the study said. The prevalence of smoking in Kansas increased to 20 percent of the state population, the study said. Obesity and rate of uninsured also increased to 25.9 percent and 12.3 percent of total state population respectively. New Jersey saw increases in percentage of people without health insurance, up to 15.5 percent of the state's population, and saw a drop in its high school graduation rate. The study added, however, that the state increased the number of primary care physicians from 138.7 to 141.8 per 100,000 population, and reduced premature deaths and cardiovascular deaths. Study Methodology The report is produced by United Health Foundation, a nonprofit foundation funded by UnitedHealth Group, in collaboration with the American Public Health Association, and the Partnership for Prevention. The three health advocacy groups first published the annual health ranking in 1990. The state rankings are based on 20 measures of overall health categorized in four groups: (1) personal behaviors, such as smoking and binge drinking; (2) quality of available clinical care, such as access to medical care and prevalence of preventable diseases; (3) community environment factors such as graduation rates and poverty levels; and (4) public health policies, including those that impact health care resources in each state. The report uses data from the departments of Health and Human Services, Commerce, Education and Labor; the American Medical Association; Dartmouth Atlas Project; and the National Association of State Budget Officers. The study is available.
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