The United States spends far and away the most on health care per capita, yet the nation lags nearly two years behind the average life expectancy among developed nations. The Affordable Care Actwill mark its five-year anniversary this upcoming March. While the plan has helped reduce the share of Americans who lack insurance — a significant burden on public health — much more will need to happen to align the U.S. health care system with that of other developed nations.



To provide a more complete picture of where the country is succeeding and where it is failing when it comes to public health, the United Health Foundation's 2015America's Health Rankings report examined both determinants and health outcomes. The UHF included such factors as healthy behaviors, quality of health care, health policy, the presence of diseases, and preventable deaths across the nation. Each of these areas varies considerably between states. Based on this year's edition of America's Health Rankings, Hawaii is once again the healthiest, and for the first time since 2011, Louisiana is the least healthy state in the nation.

Based on data provided by United Health Foundation's America's Health Rankings, 24/7 Wall St. reviewed and ranked all 50 states based on their overall scores. These scores were based on a number of measures that fall into two separate categories: health determinants and health outcomes. Determinants were further divided into behaviors, such as smoking and drinking; community and environmental factors, such as children living in poverty; policy factors, such as public health funding and immunization rates; and clinical care factors, such as the availability of dentists and doctors. Outcomes included rates of death from cancer and cardiovascular diseases, as well as infant mortality rates. Additionally, we also reviewed supplementary data provided by America's Health Rankings, including economic factors such as median household income based on the U.S. Census Bureau's Current Population Survey.

THE HEALTHIEST STATES

1. Hawaii
> Pct. obese 22.1% (2nd lowest)
> Cardiovascular deaths per 100,000 people: 203 (3rd lowest)
> Primary care physicians per 100,000 people: 141 (9th highest)
> Pct. with health insurance: 94.0% (2nd highest)

Hawaii ranks for the fourth consecutive year as the healthiest state in the country, according to the UHF. It has never ranked worse than sixth overall since the organization introduced the ranking in 1990. The state rates among the top 10 in the majority of health measures as they relate to policy, behavior, and outcomes. It is second best in the country for health insurance coverage, public health funding, and cancer deaths. No state has a lower incidence of preventable hospitalizations than Hawaii.

While it is the healthiest — ranking high in most measures — Hawaii also ranks low in some of the indicators. Specifically, the state has one of the highest rates of chronic drinking, and 44% of Hawaii's adults fail to get sufficient sleep, a worse rate than in any other state.

2. Vermont
> Pct. obese 24.8% (5th lowest)
> Cardiovascular deaths per 100,000 people: 220 (14th lowest)
> Primary care physicians per 100,000 people: 181 (3rd highest)
> Pct. with health insurance: 93.9% (3rd highest)

Vermont is the second healthiest state in the nation, trailing only Hawaii. The state has some of the nation's safest communities and strongest health services. With just 121 violent crimes per 100,000 people, Vermont has the lowest violent crime rate in the country — a figure that, when high, can discourage physical activity and cause mental stress. For residents of the state, medical care is very accessible. For every 100,000 Vermonters, there are 181.3 primary care physicians, the third most doctors per capita nationwide. A high prevalence of physicians often coincides with a high health insurance coverage rate. Almost 94% of Vermonters have health insurance, the third largest share in the country.

Vermonters also eat well. The average adult in the state eats 1.5 servings of fruit and 2.0 servings of vegetables every day, a higher consumption and a healthier diet than in all but a few other states.

3. Massachusetts
> Pct. obese 23.3% (3rd lowest)
> Cardiovascular deaths per 100,000 people: 206 (4th lowest)
> Primary care physicians per 100,000 people: 207 (the highest)
> Pct. with health insurance: 96.5% (the highest)

Massachusetts ranks as the third healthiest state for the second consecutive year. One of the strongest indicators of a population's health is the prevalence of obesity. Obesity can raise the risk of such diseases as heart disease and diabetes, which are some of the most common causes of death. While it is on the rise nationwide, obesity remains a relatively minor problem in Massachusetts compared to most states. Only 23.3% of the state's adult population is obese, third lowest in the country and well below the 29.6% obesity rate nationwide.

The state also excels in another important health indicator, access to health care. Massachusetts launched health care reform in 2006 that provided near-universal coverage, one of the first states to do so. It now leads the nation in health insurance coverage. Just 3.5% of state residents are not insured, compared to the 13.1% of U.S. residents who are not.

4. Minnesota
> Pct. obese 27.6% (15th lowest)
> Cardiovascular deaths per 100,000 people: 187 (the lowest)
> Primary care physicians per 100,000 people: 146 (7th highest)
> Pct. with health insurance: 93.0% (4th highest)

Minnesota moves back up into the top five after falling to sixth place in the UHF 2014 ranking. While healthy behaviors and healthy outcomes tend to correlate, Minnesota's residents appear to be in better health than their actions might suggest. The state ranks below the healthiest 10 in smoking, physical inactivity, and obesity, and it has one of the highest excessive drinking rates in the country.

Still, Minnesota has some of the best health outcomes in the country. Residents report the fewest days of poor physical health per month of any state, and they are the least likely to die from cardiovascular diseases. Each year, the state loses a nation-lowest 5,414 years per 100,000 residents on average due to premature death, versus a national rate of 6,997 years lost per 100,000 Americans.

5. New Hampshire
> Pct. obese 27.4% (14th lowest)
> Cardiovascular deaths per 100,000 people: 213 (7th lowest)
> Primary care physicians per 100,000 people: 138 (11th highest)
> Pct. with health insurance: 90.1% (16th highest)

After ranking seventh healthiest last year, New Hampshire improves by two places to rank as the fifth healthiest state in the country today. The improvement is partially due to a decline in sedentary behavior. The share of New Hampshire adults claiming to be physically active increased from 77.6% last year to 81.7% this year.

New Hampshire also has fairly high immunization coverage. Of adolescents between the ages of 13 and 17, 94.4% receive the Tdap vaccine, which protects against tetanus, diphtheria, and pertussis. This is significantly higher than the 87.6% of adolescents who get the vaccine nationwide. The spread of infectious disease is very low in New Hampshire, not just due to high immunization but also responsible and healthy habits. The incidence of chlamydia, for example, is the lowest in the nation. Strong economic conditions are closely tied to positive health outcomes. Just 11.1% of New Hampshire children live below the poverty line, the second lowest child poverty rate in the nation.

THE LEAST HEALTHIEST STATES

50. Louisiana
> Pct. obese 34.9% (4th highest)
> Cardiovascular deaths per 100,000 people: 306 (5th highest)
> Primary care physicians per 100,000 people: 125 (20th highest)
> Pct. with health insurance: 84.3% (9th lowest)

Louisiana is the least healthy state in the country. Roughly 35% of adults in the state are obese, a higher obesity rate than in all but three other states. Additionally, 10.9% of babies born in the state have a low birthweight, the largest share of any state in country after Mississippi. Low birthweight has likely contributed to a high infant mortality rate in the state. With slightly more than eight out of every 1,000 infants dying before their first birthday, infant mortality is more common in Louisiana than in every state but nearby Mississippi and Alabama.

Negative health outcomes in Louisiana are likely the result of pervasive bad habits. Nearly one in four adults in the state identifies as a smoker, a larger share than in all but a handful of other states. Furthermore, roughly 30% of adults in the state do not exercise, the third highest rate of physical inactivity in the country.

49. Mississippi
> Pct. obese 35.5% (3rd highest)
> Cardiovascular deaths per 100,000 people: 345 (the highest)
> Primary care physicians per 100,000 people: 85 (2nd lowest)
> Pct. with health insurance: 84.2% (8th lowest)

Mississippi's annual median household income of $35,521 is the lowest in the country — one of a range of weak social and economic measures contributing to the especially poor health among state residents. Ultimately, poor economic conditions and poor health lead to untimely deaths. For example, the incidence of infant mortality often reflects the health of the mother, the quality of prenatal care, and the ease of access to quality health care. Infant mortality is far more common in the South than it is elsewhere. In Mississippi, the infant mortality rate of 9.3 deaths per 1,000 live births is the highest in the nation. The state also reports the nation's highest incidence of premature death, at an estimated 10,744 years lost per 100,000 people annually due to preventable deaths. Unhealthy choices drive the prevalence of premature death in Mississippi. Residents are among the most likely to smoke and some of the least likely to consume recommended servings of fruits and vegetables.

48. Arkansas
> Pct. obese 35.9% (the highest)
> Cardiovascular deaths per 100,000 people: 313 (4th highest)
> Primary care physicians per 100,000 people: 105 (12th lowest)
> Pct. with health insurance: 86.1% (16th lowest)

Nearly 30% of children in Arkansas live in poverty, the third highest percentage nationwide and up considerably from 1990, when the state's child poverty rate was 25.2%. Financial stress in families is closely tied with poor health outcomes. A high teen birth rate also often reflects weak social and economic conditions, which in turn can lead to poor health outcomes.There are specific economic costs associated with teen births, including increased health care and foster care costs. Children of teen parents also tend to have lower educational attainment and a higher likelihood of incarceration. Arkansas leads the nation in teen births, with roughly 44 births for every 1,000 female teens each year.

As in a number of other Southern states, Arkansas also has an obesity problem. The state's obesity rate of 35.9% is the highest in the country.

47. West Virginia
> Pct. obese 35.7% (2nd highest)
> Cardiovascular deaths per 100,000 people: 300 (6th highest)
> Primary care physicians per 100,000 people: 109 (18th lowest)
> Pct. with health insurance: 88.7% (22nd highest)

Nearly 20% of high school students and nearly 27% of adults in West Virginia smoke regularly, each the highest smoking rate of any state. West Virginia's obesity rate of 35.7% is also higher than the rate in every other state except for Arkansas. Both smoking and obesity are among the factors most closely tied to negative health outcomes. West Virginians are the most likely state residents to report heart disease, high blood pressure, heart attacks, and diabetes — all drivers of premature death. West Virginians are also more likely to die from drug abuse than Americans overall, with 32.4 drug deaths per 100,000 residents reported annually, the highest drug death rate in the nation. Many people in the state are aware of their poor health. Just 41.7% of adults in the state say their health is good or excellent, the lowest percentage in the nation.

46. Alabama
> Pct. obese 33.5% (5th highest)
> Cardiovascular deaths per 100,000 people: 330 (2nd highest)
> Primary care physicians per 100,000 people: 104 (11th lowest)
> Pct. with health insurance: 87.1% (20th lowest)

All factors combined, Alabama is the fifth least healthy state in the nation. The Southern state's biggest challenge is its poor health outcomes. In Alabama, 8.7 out of every 1,000 infants die before reaching the age of one, the second highest infant mortality rate in the country. This may be partially due to the state's high prevalence of low birthweight. One in every 10 children born in Alabama weigh less than 5 pounds, 8 ounces, the third highest prevalence of low birthweight nationwide.

Low incomes often coincide with poor health, and Alabama is no exception. The typical household in Alabama makes just $42,278, more than $11,000 less than the $53,657 the typical American household makes.

MORE ABOUT THE LIST
While this report includes measures of the quality and accessibility of health care, it also focuses on what leads to the poor health of Americans. Many would argue the poor health is as much a cause of high health costs as any other inefficiencies in the system.

In an interview with 24/7 Wall St., Dr. Reed Tuckson, senior medical adviser for United Health Foundation, echoed this sentiment. "Almost always, the conversation about health in America is a conversation about insurance and access to medical care as opposed to being about the prevention of disease and promotion of health. We are producing far too many unnecessarily sick people who are being delivered every day into the hands of a medical care system that we can no longer afford."

Two of the most significant factors driving up the rate of serious diseases and reducing life expectancy are obesity and tobacco use. According to Tuckson, while tobacco use has declined in the United States, 18.1% of Americans still smoke. As evidence of the impact smoking has on overall health, the 10 least healthy states are also among the 10 states with the highest smoking rates.

Obesity, meanwhile, has increased in the United States and now approaches 30% of the adult population. According to Tuckson, while tobacco remains the greatest cause of preventable illness and death, obesity is a close second. All ten of the least healthy states have above-average obesity rates.

Another factor that strongly correlates with health is income. Eight of the 10 least healthy states are among the bottom 10 in the country in median household income. Dr. Tuckson explained that this correlation is likely due to many considerations. People with lower incomes are less likely to obtain an education, are less likely to be able to afford better healthcare, and are more likely to live in areas where healthy options are not readily accessible. Tuckson added that there may be less tangible elements contributing to the relationship as well. "From my experience as a public health official, when you don't have as much of a sense of hope and optimism about your future, you tend not to take the steps necessary to protect that future." he added.

To consider any one of the critical factors that make up public health on its own is to ignore the complex, interrelated nature of these factors. For example, residents in areas with low violent crime rates tend to be healthier. This does not mean, however, that less exposure to violence is all that is needed to live a healthy lifestyle. Violent crime rates tend to be lower in communities with higher incomes, which can in turn afford their residents healthier options.

According to Tuckson, the fact that many of these determinants are both causes and effects of one another, particularly all of the factors that are tied to income, has resulted in a disturbing national trend. "Overall, we are concerned that we are becoming two nations, when it comes to our health. Those that are socioeconomically more privileged have significantly better health statistics than people that are not doing as well socioeconomically." Tuckson concluded.

Post a Comment Blogger

 
Top