USA's health improving; Hawaii ranks first, Miss. last

An annual measure of the nation's health status finds evidence that Americans made "a notable shift" toward better health in 2013.

Important gains were seen in more than two-thirds of the measures analyzed for the 2013 America's Health Rankings report, released today, including:

•A decline in the smoking rate, down from 21.2% of the adult population in 2012 to 19.6%. Seventeen states had significant drops in smoking, the largest being in Nevada, Maryland, Oklahoma, Kansas and Vermont.

•A drop in physical inactivity, defined as not doing any physical activity outside work for 30 days, down from 26.2% of the adult population in 2012 to 22.9% in 2013. The prevalence of physical inactivity varies from a high of 31.4% in Arkansas to a low of 16.2% in Oregon.

•A leveling off of the obesity epidemic as the percentage of adults who are obese — defined as roughly 30 or more pounds over a healthy weight — holds steady.

This marks the first year since 1998 that obesity rates did not increase, making it "a victory of sorts," says Reed Tuckson, senior medical adviser to the not-for-profit United Health Foundation, which sponsors the report with the American Public Health Association and the Partnership for Prevention.

"We are encouraged," Tuckson says. "Put all together, the big conclusion is that these trends give us reason to be empowered to do more. We're seeing it all across America — individuals and families are making the decision to be active, to eat a more appropriate diet, to stop smoking. We are seeing that people can do it. And we are encouraged by the work in communities to address these issues that compromise America's health and vitality. Now we have to do more of it.

"We are in no way declaring the war is over but are declaring that there is reason for optimism," he says.

Among the challenges noted in the report is the increasing percentage of adults who have been diagnosed with diabetes (excluding pre-diabetes and gestational diabetes), a chronic condition that affects 9.7% of adults, about double the rate in the mid-1990s. The prevalence of diabetes ranges from 7% of adults in Alaska to 13% in West Virginia.

The disease is the seventh leading cause of death in the USA and contributes to heart disease and stroke, the first and fourth leading causes of death, respectively.

Of the three major types of diabetes (type 1, type 2 and gestational) type 2 diabetes is the most common and accounts for 90% to 95% of all diabetes cases, according to the report.

Hawaii is this year's healthiest state, according to the analysis, which uses data from the Centers for Disease Control and Prevention, American Medical Association, Census Bureau, Department of Education and even the FBI. It looks at 27 measures of health, including tobacco and alcohol abuse, exercise, infectious diseases, crime rates, public health funding, access to immunizations, premature birth rates and cancer and heart disease rates. Last year, Vermont was No. 1.

Hawaii scored well on most measures, particularly for having low rates of uninsured individuals, high rates of childhood immunization and low rates of obesity, smoking and preventable hospitalizations. The report notes that Hawaii also has areas where it can improve: higher-than-average rates of binge drinking and occupational fatalities, and lower-than-average rates of high school graduation.

Mississippi is ranked last this year and ranked among the bottom three states since the inception of the rankings in 1990. It ranks in the bottom five states on 15 of the 27 measures including high prevalence of obesity, physical inactivity, diabetes and children in poverty. It scored well for a low prevalence of binge drinking, a high rate of child immunizations and small disparity in health status between adults 25 and older who graduated from high school and those who didn't.

States that had the greatest improvement in the rankings include Wyoming (up eight places on the list); Idaho (up seven); Montana (up five); New Mexico (up four) and New York (up three).

"People love rankings, and they do provide a real positive function," says Steven Wallace, the associate director of the UCLA Center for Health Policy Research, which was not involved in the report. "Being at the top is reason to crow, and being at bottom is a real motivator for policymakers, public health officials and communities to say we can do a lot better than we have been."

He calls this report "credible and carefully constructed" and notes that a number of other health rankings from government and private organizations do similar and complementary work.

Although much of the political and media discussion has focused on insurance and medical care issues, "we still need a much higher level of engaging on the prevention side," Tuckson says. "You cannot medicalize yourself out of the problems we have. We will never ever have enough money to do that."

State-by-state rankings (ranking, state, score)

1 Hawaii 0.919

2 Vermont 0.868

3 Minnesota 0.731

4 Massachusetts 0.725

5 New Hampshire 0.703

6 Utah 0.695

7 Connecticut 0.649

8 Colorado 0.565

9 North Dakota 0.557

10 New Jersey 0.531

11 Nebraska 0.460

12 Idaho 0.442

13 Oregon 0.426

14 Washington 0.403

15 New York 0.370

16 Maine 0.366

17 Wyoming 0.355

18 Iowa 0.317

19 Rhode Island 0.317

20 Wisconsin 0.313

21 California 0.310

22 South Dakota 0.284

23 Montana 0.277

24 Maryland 0.276

25 Alaska 0.275

26 Virginia 0.259

27 Kansas 0.122

28 Arizona 0.020

29 Pennsylvania -0.022

30 Illinois -0.096

31 Delaware -0.097

32 New Mexico -0.175

33 Florida -0.210

34 Michigan -0.218

35 North Carolina -0.247

36 Texas -0.250

37 Nevada -0.294

38 Georgia -0.315

39 Missouri -0.373

40 Ohio -0.407

41 Indiana -0.487

42 Tennessee -0.579

43 South Carolina -0.635

44 Oklahoma -0.666

45 Kentucky -0.716

46 West Virginia -0.727

47 Alabama -0.822

48 Louisiana -0.844

49 Arkansas -0.893

50 Mississippi -0.894

Source: United Health Foundation, 2013