12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 A call to action for individuals and their communities 2016 Findings Behaviors Community & Environment 20 1 6 Health Outcomes Clinical Care m Em ES ba T, rg De oe ce d U m nt be il r1 5, Policy America’s Health Rankings® was built upon the World Health Organization definition of health: 12 :0 1a “Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.” The model reflects that determinants of health directly influence health outcomes. A health outcomes category and four categories of health determinants are included in the model: behaviors, community & environment, policy, and clinical care. B ww w. a m e r i c a s h e a l t h ra n kin g s.o r g Contents Executive Summary 2 Introduction 4 Findings 5 Overview 5 5 State Rankings Determinants and Outcomes 8 6 Largest Changes in Rank Since 2015 20 1 National Findings m Em ES ba T, rg De oe ce d U m nt be il r1 5, National Successes 9 11 11 National Challenges 12 13 Smoking and Obesity: A Public Health Success and Challenge Trends in Smoking Prevalence, 2012 to 2016 14 Trends in Obesity Prevalence, 2012 to 2016 18 Annual Rate of Change in Smoking and Obesity 22 Comparison With Other Nations 23 Core Measures 27 Behaviors 28 40 Community & Environment 1a Policy Clinical Care 48 56 60 Supplemental Measures 75 State Summaries 89 12 :0 Outcomes US Summary 142 Appendix 145 Core Measures Table 146 Supplemental Measures Table 148 Methodology 150 Model Development 152 Scientific Advisory Committee 154 The Team 155 AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 1 America’s Health Rankings® Annual Report Executive Summary 20 1 6 Nation Continues to Experience Declines in Prevalence of Smoking, Rate of Preventable Hospitalizations, and Percentage of the Population Who Are Uninsured Highlighting key national successes, the report finds that the United States has made notable long-term improvements across key indicators of health, including smoking, preventable hospitalizations, and health insurance coverage. • Since 1990, the prevalence of smoking in the United States has decreased 41%, including a 17% decline over the past four years. 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, Overview For 27 years, America’s Health Rankings® Annual Report has served as the nation’s source for trends in nationwide public health and state-by-state rankings. The report analyzes a comprehensive set of behaviors, community and environment, policy, clinical care, and outcomes data to provide a holistic view of the health of the nation. It also offers a benchmark to compare each state’s progress and declines over the past 27 years against national performance, offering insights into the success of public health efforts. All information is available in a single, easy-to-use web platform that allows users to explore health measures and state data for custom comparisons. In the 2016 edition, the report looks at historical trends and finds that the health of the nation is at a critical crossroad between making encouraging progress against long-standing public health challenges, while treading into dangerous territory on other key health indicators. For instance, the nation has experienced successes in reducing the prevalence of smoking, the number of preventable hospitalizations, and the percentage of the population without health insurance. However, the nation faces health concerns with drug and cardiovascular deaths and a continued high prevalence of obesity. With these observations, the United Health Foundation continues its commitment to providing valuable information to policymakers, public health officials, and communities with the goal of stimulating a dialogue on strategies to improve the health of our communities. The longevity of the report and wealth of credible data from trusted sources provide a unique opportunity for America’s Health Rankings to track both short-term successes and challenges, and identify emerging areas of interest that indicate improvement or decline since 1990. 2 ww w. a m e r i c a s h e a l t h ra n kin g s.o r g • During the last decade, the rate of preventable hospitalizations among Medicare enrollees has declined 35% and declined 13% in the past year alone. • The percentage of the population that is uninsured declined 35% over the past five years and is now at the lowest point in the Annual Report’s 27-year history. Rising Rates of Cardiovascular and Drug Deaths and High Prevalence of Obesity Present National Health Challenges As the nation celebrates encouraging progress on key indicators of health, the report also highlights serious challenges for the country that are eroding hard-won health gains. This year, the rates of cardiovascular and drug deaths increased nationally and the prevalence of obesity remained high. • This year marks the end of a 26-year decline in the rate of cardiovascular deaths. In the past year, the national cardiovascular death rate increased from 250.8 to 251.7 deaths per 100,000. The United States has made notable long-term improvements across key indicators of health, including smoking, preventable hospitalizations, and health insurance coverage. This year, the rates of cardiovascular and drug deaths increased nationally and the prevalence of obesity remained high. m Em ES ba T, rg De oe ce d U m nt be il r1 5, • Premature death, the years of potential life lost before age 75, increased for the second consecutive year. 20 1 6 • The report also finds that in the past five years, the rate of drug deaths has increased 9%, rising 4% in the past year alone. • Since the start of America’s Health Rankings Annual Report in 1990, the prevalence of obesity among adults has increased 157%. 2016 Ranking of the Healthiest Overall States The report ranks each state across 34 measures of behaviors, community and environment, policy, clinical care, and outcomes. This year, northeastern states generally rank among the healthiest overall states, while southeastern states generally rank among those states with the greatest challenges. 12 :0 1a Hawaii ranks as the healthiest state for the fifth straight year. The state has held the top spot eight times in the 27-year history of the Annual Report. Massachusetts (second), Connecticut (third), Minnesota (fourth), and Vermont (fifth) round out the top five states for overall health. Informing Conversations About Improving the Health of Our Nation With this report, United Health Foundation contributes 27 years worth of data to ongoing conversations among policymakers, public health officials, and community leaders about how they can collaborate to promote and achieve better health for all. Our nation has experienced impressive public health achievements since the launch of the first America’s Health Rankings Annual Report in 1990, but this year’s findings highlight that the country still faces critical challenges that may undermine progress in other key areas of health. Those working to improve the health of our nation are encouraged to use the report as a call to action for positive change in their communities. Mississippi ranks as the state with the greatest opportunity for improvement, dropping from 49th to 50th this year. Louisiana improved to 49th, while Arkansas (48th), Alabama (47th), and Oklahoma (46th) round out the states with greatest opportunities for improvement. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 3 Introduction 6 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1. Providing a benchmark for states. As the longest-running annual assessment of America’s health on a state-by-state basis, this report is vital for gauging how each state’s health changes from year to year and decade to decade, and how each state compares with the health of other states and the nation overall. The data for many measures extend back to 1990 and are invaluable when forming a wide-angle, holistic view of state and US health. America’s Health Rankings Annual Report presents findings “from the front lines” of population health, revealing both encouraging and troubling trends over time. population without health insurance continue to fall. At the same time, problems are mixed in with progress. Our nation continues to struggle with certain stubborn health concerns—obesity and drug deaths. Premature deaths increased for the second consecutive year and the long-term trend of declining cardiovascular deaths has ended. Two of the most troubling health concerns, smoking and obesity, are examined in a special section of this year’s report. Smoking and Obesity: A Public Health Success and Challenge (pages 13–22), takes a deeper dive into five-year trends in smoking and obesity prevalence and illustrates how changes in these markers are not shared uniformly across states and education levels. When reading the 2016 America’s Health Rankings Annual Report, it is important to read beyond the “headlines” of the rankings. Every state has strengths and challenges. Additionally, each measure does not stand alone but is a strand in the web of health and everyday life of Americans. Example: A change for the good in physical inactivity could affect obesity, diabetes, cardiovascular deaths, and other measures. America’s Health Rankings new website, americashealthrankings.org, allows users to read and download the entire report and to study and analyze the data by state or by measure of interest. A detailed view of this report is available in the Learn section, and the Explore section provides a variety of tools to visualize trends and variations in rankings geographically and by demographic characteristics. America’s Health Rankings Annual Report provides a continually evolving snapshot of health, yields important insights on how each state’s health changes over time, and—perhaps most importantly—enables action for making communities and states healthier. 20 1 The United Health Foundation is pleased to release the 2016 America’s Health Rankings® Annual Report. For 27 years, this report has provided data-driven insights and measurements to improve health across the country on a state-by-state basis. America’s Health Rankings serves as an actionable resource for public health professionals, elected officials, employers, individuals, and communities to identify needs for improving our population’s health. America’s Health Rankings Annual Report serves the United States and, in particular, public health by: 12 :0 1a 2. Stimulating action. This is the overarching purpose of the report—to be a catalyst for datadriven discussions on indicators that have the potential to improve health and drive positive change. Numerous states incorporate the report into their annual review of programs, and many organizations use the report as a reference point when assigning goals for health-improvement programs. The 2016 edition of America’s Health Rankings Annual Report highlights promising progress in principal markers of our nation’s health. Examples: Smoking prevalence, the rate of preventable hospitalizations, and the percentage of the 4 ww w. a m e r i c a s h e a l t h ra n kin g s.o r g Findings Overview • Iowa makes the biggest improvement in rank in one year, rising five spots from 22nd to 17th. • Some states score much better in health determinants than health outcomes, which may have implications for future population health. m Em ES ba T, rg De oe ce d U m nt be il r1 5, • There are national improvements in preventable hospitalizations among Medicare enrollees, smoking prevalence, and public health funding. High school graduation continues a three-year upward trend, and human papillomavirus (HPV) immunizations are increasing among male and female adolescents. Long-term improvements in health insurance coverage continue. 6 • Hawaii—for the fifth consecutive year—is the healthiest state. states (Figure 1). Hawaii’s strengths include a low prevalence of obesity, a low percentage of people without health insurance, and a low rate of preventable hospitalizations. In addition, HPV immunization among females aged 13 to 17 years increased 38% from 38.0% to 52.4% in the past year. The prevalence of diabetes decreased 13% from 9.8% to 8.5% of the adult population. All states have challenges and areas for improvement. Hawaii scores above the national average in the prevalence of excessive drinking and incidence of Salmonella, and below the national average for tetanus-diphtheria-acellular pertussis (Tdap) immunization among adolescents aged 13 to 17 years. These same challenges were identified in the 2015 America’s Health Rankings Annual Report. 20 1 The 2016 America’s Health Rankings Annual Report finds: • A lack of decline in obesity prevalence and an increase in drug deaths remain ongoing challenges for the nation. 12 :0 1a • Troubling increases in cardiovascular deaths and premature death are occurring. Cardiovascular deaths increased for the first time in the 27-year history of America’s Health Rankings. State Rankings Healthiest States Hawaii takes the title of the healthiest state in 2016, followed by Massachusetts (second). Connecticut (third) rises three spots this year to re-enter the top five. Minnesota (fourth) and Vermont (fifth) complete the top five (Tables 1 and 2, Figures 1 and 2). Hawaii has ranked first for five straight years and has been in the top spot eight times since 1990, the most for any state in the history of America’s Health Rankings. It has been in the top six states since the first edition of America’s Health Rankings in 1990. Hawaii also scores far better than other top-five Most Challenged States Mississippi ranks 50th in 2016. Other states in the bottom five are Louisiana (49th), Arkansas (48th), Alabama (47th), and Oklahoma (46th) (Tables 1 and 2, Figures 1 and 2). West Virginia improves four spots this year to rise out of the bottom five. Mississippi has ranked in the bottom three states since the first edition of America’s Health Rankings in 1990. Mississippi and Louisiana score far worse than the other states in the bottom five (Figure 1). Mississippi’s challenges include a high prevalence of smoking and low birthweight, and a high percentage of children in poverty. Mississippi ranks in the bottom 10 for 25 measures, including ranking in the bottom three for all measures of clinical care. All states, no matter their overall ranking, have areas of strength. Mississippi ranks well for a low prevalence of excessive drinking and a low rate of drug deaths, as well as a small disparity in health status by education. Mississippi does better than the national average for low incidence of pertussis and low rate of violent crime. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 5 Findings TABLE 1 TABLE 2 2016 Ranking Overall Score* State Overall Score* 47 Alabama -0.793 30 Alaska -0.031 29 Arizona -0.020 48 Arkansas -0.834 16 California 0.346 10 Colorado 0.559 3 Connecticut 0.747 31 Delaware -0.077 36 Florida -0.307 41 Georgia -0.464 1 Hawaii 0.905 15 Idaho 0.356 26 Illinois 0.084 39 Indiana -0.372 17 Iowa 0.343 27 Kansas -0.012 45 Kentucky -0.651 49 Louisiana -1.043 22 Maine 0.192 18 Maryland 0.322 2 Massachusetts 0.760 34 Michigan -0.251 4 Minnesota 0.727 50 Mississippi -1.123 37 Missouri -0.338 23 Montana 0.178 12 Nebraska 0.432 35 Nevada -0.304 6 New Hampshire 0.696 9 New Jersey 0.571 38 New Mexico -0.363 13 New York 0.430 32 North Carolina -0.194 11 North Dakota 0.473 40 Ohio -0.391 46 Oklahoma -0.691 21 Oregon 0.211 28 Pennsylvania -0.016 14 Rhode Island 0.422 42 South Carolina -0.532 24 South Dakota 0.169 44 Tennessee -0.626 33 Texas -0.208 8 Utah 0.578 5 Vermont 0.709 19 Virginia 0.264 7 Washington 0.582 43 West Virginia -0.595 20 Wisconsin 0.220 25 Wyoming 0.116 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, 2016 RANKINGS 1 Hawaii 0.905 2 Massachusetts 0.760 3 Connecticut 0.747 4 Minnesota 0.727 5 Vermont 0.709 6 New Hampshire 0.696 7 Washington 0.582 8 Utah 0.578 9 New Jersey 0.571 10 Colorado 0.559 11 North Dakota 0.473 12 Nebraska 0.432 13 New York 0.430 14 Rhode Island 0.422 15 Idaho 0.356 16 California 0.346 17 Iowa 0.343 18 Maryland 0.322 19 Virginia 0.264 20 Wisconsin 0.220 21 Oregon 0.211 22 Maine 0.192 23 Montana 0.178 24 South Dakota 0.169 25 Wyoming 0.116 26 Illinois 0.084 27 Kansas -0.012 28 Pennsylvania -0.016 29 Arizona -0.020 30 Alaska -0.031 31 Delaware -0.077 32 North Carolina -0.194 33 Texas -0.208 34 Michigan -0.251 35 Nevada -0.304 36 Florida -0.307 37 Missouri -0.338 38 New Mexico -0.363 39 Indiana -0.372 40 Ohio -0.391 41 Georgia -0.464 42 South Carolina -0.532 43 West Virginia -0.595 44 Tennessee -0.626 45 Kentucky -0.651 46 Oklahoma -0.691 47 Alabama -0.793 48 Arkansas -0.834 49 Louisiana -1.043 50 Mississippi -1.123 Rank 6 State 20 1 Rank 2016 Alphabetical Ranking 6 ww w. a m e r i c a s h e a l t h ra n kin g s.o r g * Weighted standard deviation relative to US value FIGURE 1 2016 Overall Score* 0.500 1.000 6 0.000 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, -0.500 20 1 -1.000 Hawaii Massachusetts Connecticut Minnesota Vermont New Hampshire Washington Utah New Jersey Colorado North Dakota Nebraska New York Rhode Island Idaho California Iowa Maryland Virginia Wisconsin Oregon Maine Montana South Dakota Wyoming Illinois United States Kansas Pennsylvania Arizona Alaska Delaware North Carolina Texas Michigan Nevada Florida Missouri New Mexico Indiana Ohio Georgia South Carolina West Virginia Tennessee Kentucky Oklahoma Alabama Arkansas Louisiana Mississippi * Weighted standard deviation relative to US value AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 7 Findings FIGURE 2 2016 Ranking 1–10 11–20 21–30 31–40 41–50 not ranked DC RI m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 DE Largest Changes in Rank Since 2015 12 :0 1a Iowa is the most improved state, rising five spots from 22nd in 2015 to 17th in 2016 (Table 3). The state’s rise is due to improvements in the percentage of children aged 19 to 35 months and adolescents aged 13 to 17 years receiving recommended immunizations, including a 32% increase in HPV immunization among adolescent females. There are also improvements in pertussis incidence and public health funding. Other states showing notable improvement this past year include West Virginia, Wisconsin, Connecticut, and Nevada. Wisconsin and West Virginia each rise four spots, and Connecticut and Nevada each rise three. Maine has the largest decline in rank over the past year, moving from 15th in 2015 to 22nd in 2016. South Dakota’s rank falls five spots, and Alaska, Florida, and Vermont all fall three spots. 8 ww w. a m e r i c a s h e a l t h ra n kin g s.o r g TABLE 3 Largest Changes in Rank Since 2015 Edition (One-Year Change) Rank Improved 2015 Rank 2016 Rank Iowa 22 West Virginia 47 Wisconsin 24 Connecticut 6 Nevada 38 Rank Declined 2015 Rank Maine South Dakota Alaska Florida Vermont 2016 Rank 15 19 27 33 2 Change 17 5 43 4 20 4 3 3 35 3 Change 22 -7 24 -5 30 -3 36 -3 5 -3 TABLE 4 Determinants and Outcomes Scores,* 2016 State 1a 12 :0 Outcomes Score Difference in Scores Potential Future Effect on Health -0.366 -0.061 Neutral 0.108 -0.247 Negative 0.042 -0.104 Neutral -0.328 -0.178 Negative 0.069 0.208 Positive 0.186 0.187 Neutral 0.13 0.488 Positive -0.074 0.071 Neutral -0.081 -0.146 Negative -0.109 -0.246 Negative 0.289 0.327 Positive 0.125 0.106 Neutral 0.021 0.042 Neutral -0.144 -0.084 Neutral 0.114 0.115 Neutral 0.047 -0.105 Neutral -0.291 -0.069 Neutral -0.335 -0.372 Negative -0.032 0.256 Positive 0.007 0.308 Positive 0.112 0.536 Positive -0.115 -0.021 Neutral 0.271 0.185 Neutral -0.378 -0.367 Negative -0.136 -0.066 Neutral 0.088 0.002 Neutral 0.146 0.140 Neutral -0.008 -0.287 Negative 0.139 0.417 Positive 0.128 0.315 Positive -0.029 -0.305 Negative 0.089 0.252 Positive -0.099 0.003 Neutral 0.158 0.157 Neutral -0.14 -0.111 Negative -0.264 -0.164 Negative -0.028 0.267 Positive -0.052 0.087 Neutral -0.017 0.455 Positive -0.187 -0.158 Negative 0.157 -0.145 Negative -0.262 -0.103 Neutral 0.016 -0.240 Negative 0.208 0.162 Neutral 0.082 0.545 Positive 0.055 0.154 Neutral 0.156 0.271 Positive -0.352 0.109 Neutral 0.106 0.008 Neutral 0.108 -0.100 Neutral 20 1 Alabama -0.427 Alaska -0.139 Arizona -0.062 Arkansas -0.506 California 0.277 Colorado 0.373 Connecticut 0.618 Delaware -0.003 Florida -0.227 Georgia -0.355 Hawaii 0.616 Idaho 0.231 Illinois 0.063 Indiana -0.228 Iowa 0.229 Kansas -0.058 Kentucky -0.360 Louisiana -0.707 Maine 0.224 Maryland 0.315 Massachusetts 0.648 Michigan -0.136 Minnesota 0.456 Mississippi -0.745 Missouri -0.202 Montana 0.090 Nebraska 0.286 Nevada -0.295 New Hampshire 0.556 New Jersey 0.443 New Mexico -0.334 New York 0.341 North Carolina -0.096 North Dakota 0.315 Ohio -0.251 Oklahoma -0.428 Oregon 0.239 Pennsylvania 0.035 Rhode Island 0.438 South Carolina -0.345 South Dakota 0.012 Tennessee -0.365 Texas -0.224 Utah 0.370 Vermont 0.627 Virginia 0.209 Washington 0.427 West Virginia -0.243 Wisconsin 0.114 Wyoming 0.008 m Em ES ba T, rg De oe ce d U m nt be il r1 5, For states to improve the health of their population, their efforts must focus on improving determinants of health. If a state scores better on health determinants than it does on health outcomes, it may improve its health in the future. Conversely, if a state scores better on health outcomes than it does on health determinants, its health may decline. Table 4 presents each state’s score for determinants, outcomes, and the implications for future health. If the difference between the determinants and outcomes scores (determinants greater than outcomes) is in the top 25% of all differences (75th percentile or above), the potential future effect on health is deemed positive and the state’s future health may improve. If there is little difference between the determinants and outcomes scores (difference in the second and third quartiles), the state’s future health is unlikely to change much and is labeled as a neutral effect. If the difference between the scores (outcomes greater than determinants) is in the bottom 25% of all differences, the effect is negative and the state’s future health may decline. Louisiana, Mississippi, New Mexico, Nevada, and Alaska all have determinants scores that are much lower than their outcomes scores (Table 4, Figures 3 and 4). In contrast, Vermont, Massachusetts, Connecticut, Rhode Island, and New Hampshire all have determinants scores that are much higher than their outcomes scores. Determinants Score 6 Determinants and Outcomes * Weighted standard deviation relative to US value AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 9 Findings FIGURE 3 2016 Determinants Ranking 1–10 11–20 21–30 31–40 41–50 not ranked DC RI FIGURE 4 2016 Outcomes Ranking 11–20 21–30 31–40 41–50 not ranked 12 :0 1a 1–10 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 DE DC RI DE 10 w w w. a m e r i c a s h e a l th ra n kin g s.o r g NATIONAL SUCCESSES National Findings National Successes SMOKING • Smoking decreased 3% from 18.1% to 17.5% of US adults in the past year. Virginia and Arizona had a statistically significant decrease in smoking prevalence. PREVENTABLE HOSPITALIZATIONS: In the past 10 years, preventable hospitalizations decreased 35% from 77.0 to 49.9 discharges per 1,000 Medicare enrollees. IMMUNIZATIONS m Em ES ba T, rg De oe ce d U m nt be il r1 5, • Immunization coverage among children aged 19 to 35 months increased 6% in the past three years from 68.4% to 72.2%. There is still room for improvement before reaching the Department of Health and Human Services Healthy People 2020 target of 80% coverage. 20 1 6 • In the past four years, smoking decreased 17% from 21.2% to 17.5% of the adult population. HEALTH INSURANCE COVERAGE: The percentage of people without health insurance decreased 19% from 13.1% to 10.6% of the population in the past year. This is the lowest level in the history of America’s Health Rankings. 1a • Among adolescents aged 13 to 17 years, 81.3% and 86.4% received meningococcal and Tdap immunizations in the past year, respectively. However, HPV immunization coverage is much lower than the other recommended adolescent immunizations; only 28.1% and 41.9% of females and males, respectively, received HPV vaccinations. 12 :0 • HPV immunization coverage is improving. HPV immunization among males aged 13 to 17 years increased 30% in the past year, from 21.6% to 28.1%, though coverage among males still lags far behind HPV immunization among females. In the past two years, HPV immunization coverage among females aged 13 to 17 years increased 11% from 37.6% to 41.9%. HEALTH INSURANCE COVERAGE • The percentage of people without health insurance decreased 19% from 13.1% to 10.6% in the past year. This is the lowest level in the history of America’s Health Rankings. • Compared with 2011, the percentage of people without health insurance decreased 35% from 16.2% to 10.6% of the population. PREVENTABLE HOSPITALIZATIONS • Preventable hospitalizations decreased 13% from 57.6 to 49.9 discharges per 1,000 Medicare enrollees in the past year. • In the past 10 years, preventable hospitalizations decreased 35% from 77.0 to 49.9 discharges per 1,000 Medicare enrollees. Smoking and Obesity: A Public Health Success and Challenge (pages 13–22) provides an analysis of five-year trends in smoking and obesity, including variations by state and education level. ADDITIONAL SUCCESSES • The percentage of students graduating from high school increased 2% from 81.4% to 83.2% of students in the past year, continuing a three-year upward trend. A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 11 Findings • Public health funding increased 9% from $86 to $94 per person over the past year. National Challenges the communities they serve. The rate of drug deaths increased 4% from 13.5 to 14.0 deaths per 100,000 population in the past year. This continues a troubling trend. • In the past five years, drug deaths increased 9% from 12.9 to 14.0 deaths per 100,000 population. The 27-year history of America’s Health Rankings can be used to examine the progress the nation has made to improve population health. The rankings also highlight when the nation’s health may be moving in the wrong direction. There are alarming changes in two measures that have been historically trending in a positive direction. It is important to call attention to these changes so that progress previously made is not further eroded. Premature death has been largely declining since 1990. Between the 2005 and 2015 editions, the rate of premature death decreased from 7,564 to 6,997 years lost before age 75 per 100,000 population. However, in the past year, premature death increased for the second consecutive year, from 6,997 to 7,054 years lost before age 75 per 100,000 population. While the premature death rate has increased a few times during the history of America’s Health Rankings, this recent increase is important to monitor. Reducing deaths from heart disease has been a major objective of the clinical and public health communities over the past few decades. Between 1990 and 2015, cardiovascular deaths have decreased 38% from 405.1 deaths to 250.8 deaths per 100,000 population. However, this year cardiovascular deaths increased for the first time in America’s Health Rankings history, from 250.8 to 251.7 deaths per 100,000 population. While this may be a relatively small increase, it is statistically significant and is the first time since 1990 that an increase of any magnitude has occurred. It is important to watch for developing trends in key health outcomes so that individuals, communities, and officials can act to stem any erosion of our progress in improving population health. m Em ES ba T, rg De oe ce d U m nt be il r1 5, • The prevalence of obesity decreased in 25 states in the past year—although none of the decreases were statistically significant. It’s too early to determine if these are meaningful changes. Additional trend data are needed to determine if obesity has peaked in these states. SOUNDING THE ALARM: A REVERSAL OF LONG-TERM TRENDS? 6 • The prevalence of obesity remains high at 29.8% of the adult population and has not declined in the past year. 20 1 OBESITY • The prevalence of obesity increased significantly in one state—Kansas-—in the past year. • In the past four years, obesity prevalence increased 7% from 27.8% to 29.8% of adults. • Compared with 1990, obesity is 157% more prevalent among US adults. In 1990, 11.6% of adults were obese, compared with 29.8% now. DRUG DEATHS 12 :0 1a • One contributing factor to the rise in obesity prevalence is a long-term stagnation in physical inactivity. For the past 15 years, the prevalence of physical inactivity among adults has hovered around 25%. Increasing physical activity may be necessary to curb current trends in obesity. • Drug deaths are becoming a greater concern for state, local, and national officials, as well as 251.7 This year cardiovascular deaths increased for the first time in America’s Health Rankings history, from 250.8 to 251.7 deaths per 100,000 population 12 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 12 :0 1a 6 m Em ES ba T, rg De oe ce d U m nt be il r1 5, America’s Health Rankings has tracked the prevalence of smoking among US adults since the report was first published in 1990. Obesity was also included in 1990, but was a part of a combined measure called “risk for heart disease.” Obesity was explicitly added to the model in the 2004 edition. To better gauge where the United States is in its recent efforts to reduce the prevalence of smoking and obesity, a five-year trend analysis was conducted using data from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS). The analysis highlights the variation in prevalence and the annual rate of change1 for both of these significant public health challenges by state and education level2 using data from editions 2012 through 2016. Obesity is the second-leading cause of preventable death, close behind smoking. Obesity contributes to conditions such as heart disease, stroke, diabetes, and certain cancers.3 Smoking also contributes to cancer, heart disease, stroke, and respiratory diseases. In addition, smoking has adverse effects on reproductive health, and it impacts treatment of other chronic diseases such as diabetes. The CDC estimates that smoking and secondhand smoke cause more than 480,000 deaths annually, or one in five deaths.4 Since the publication of the first Surgeon General’s report on smoking and health in 1964, more than 20 million Americans have died from smoking.5 Smoking has been steadily declining in the United States since the mid-1960s.6 Since then, states have adopted numerous policies to prevent people—especially youth—from starting to smoke, help people quit smoking, and help reduce death and disability from the effects of smoking. A few examples of state smoking cessation efforts include enacting laws restricting or prohibiting smoking in public places and workplaces, raising the prices of tobacco products through taxation, and implementing telephone quitlines staffed with counselors trained to help smokers quit. In the first edition of America’s Health Rankings, published in 1990, the prevalence of smoking among US adults was 29.5%. Today, 17.5% of adults smoke. Contrary to smoking, obesity among US adults has been rising. Despite calls to action by the Surgeon General as early as 2001, the prevalence of obesity has nearly tripled from 11.6% in 1990 to 29.8% today.7 Factors associated with obesity include where people live, environment, culture, attitudes, emotions, stress, dietary habits, sedentary behavior, genes, income, and education.8, 9 Obesity risk and likelihood of being a smoker have been linked to education level. Education has been shown to have a direct and indirect association with the risk of obesity.10 Higher educational attainment is associated with a decreased likelihood of obesity, especially among women.9 Lower education level is associated with an increased risk of smoking.11 Since the negative health effects of smoking became wellknown, the prevalence of smoking among college graduates has been significantly lower compared with adults who are less educated.6 20 1 Smoking and Obesity: A Public Health Success and Challenge 1. Average rate of change per year was calculated as the slope of a leastsquares fitted line in prevalence over the five-year period. 2. Education levels analyzed were less than high school graduate, high school graduate or equivalent, some college, and college graduate. 3. Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html. Accessed October 26, 2016. 4. Centers for Disease Control and Prevention Fact Sheet. Current cigarette smoking among adults in the US. https://www.cdc.gov/tobacco/data_ statistics/fact_sheets/adult_data/cig_smoking/index.htm. Accessed October 26, 2016. 5. US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. 6. Trends in higher education: Smoking rates by education level, 1940-2008. The College Board website. https://trends.collegeboard.org/education-pays/ figures-tables/smoking-rates-education-level-1940-2008. Accessed October 26, 2016. 7. Office of the Surgeon General (US). The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville (MD). Office of the Surgeon General (US); 2010. Background on Obesity. https://www.ncbi.nlm.nih.gov/books/ NBK44656/. Accessed October 26, 2016. 8. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-pro/guidelines/archive/ clinical-guidelines-obesity-adults-evidence-report. Accessed October 26, 2016. 9. Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: A systematic review. Obesity Reviews : An Official Journal of the International Association for the Study of Obesity. 2013;14(12):989-1005. doi:10.1111/obr.12062. 10. Devaux, M, Sassi F, Church J, Cecchini M, et al. Exploring the relationship between education and obesity. OECD Journal: Economic Studies. 2011;1. http://dx.doi.org/10.1787/eco_studies-2011-5kg5825v1k23. Accessed October 26, 2016. 11. Gilman SE, Martin LT, Abrams DB, Kawachi I, et al. Education attainment and cigarette smoking: a causal association? Int J Epidemiol. 2008; 37(3): 615-624. A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 13 Findings Annual Rate of Change in Smoking Prevalence by State Between 2012 and 2016 all states experienced an average decrease in smoking prevalence per year (Figure 7). 6 Trends in Smoking Prevalence, 2012 to 2016 Nationally, the prevalence of smoking among US adults aged 18 years and older has decreased over the past four years from 21.2% in 2012 to 17.5% in 2016 (Figure 5), an average annual decrease of -0.89%. Among adults aged 25 years and older, the prevalence of smoking is significantly lower among those who have a college degree compared with those with less than high school, high school or equivalent, and some college (Figure 6). Smoking prevalence decreased at a faster average rate in 16 states compared with the average rate of change in the United States (-0.89%). • Smoking prevalence decreased at the fastest rate in Illinois, with an average decrease in smoking of -1.37% per year. Smoking prevalence decreased at the slowest rate in Tennessee, at -0.29% per year on average. PERCENTAGE OF ADULTS 20% 15% 10% 5% 0 m Em ES ba T, rg De oe ce d U m nt be il r1 5, Smoking Prevalence Among Adults Aged 18 Years and Older, United States, 2012 to 2016 • Smoking prevalence decreased at a faster average rate in 16 states compared with the average rate of change in the United States (-0.89%). 20 1 FIGURE 5 2012 2013 2014 2016 12 :0 1a EDITION YEAR 2015 • Indiana (23.0%), Oklahoma (23.3%), and Wyoming (20.8%) had a higher five-year average prevalence of smoking relative to other states, and the prevalence has decreased at a fasterthan-average rate of -1.11% per year, -1.00% per year, and -1.01% per year, respectively. • On the other hand, California (12.7%), Hawaii (14.6%), and Utah (10.3%) had a lower five-year average prevalence of smoking relative to other states and the prevalence decreased at a slowerthan-average rate of -0.38% per year, -0.59% per year, and -0.63% per year, respectively. Annual Rate of Change in Smoking Prevalence by Education Level Interesting differences emerged when smoking was stratified by education level among adults aged 25 years and older between 2012 and 2016 (Figure 8). • Nationally, smoking decreased across all education groups over the past four years. The average rate of decrease ranged from -0.39% per year among college graduates to -0.74% per year among adults who did not graduate from high school. 14 w w w. a m e r i c a s h e a l th ra n kin g s.o r g FIGURE 6 Smoking Prevalence by Education Level Among Adults Aged 25 Years and Older, United States, 2012 to 2016 EDITION YEAR 30% 2012 2013 2014 2015 2016 20% 20 1 6 15% 10% 5% 0 Less Than High School m Em ES ba T, rg De oe ce d U m nt be il r1 5, PERCENTAGE OF ADULTS 25% High School EDUCATION LEVEL • In a handful of states, the average annual rate of smoking prevalence increased among adults with a high school degree, some college, or among college graduates. For example, Tennessee increased 1.05% for adults with some college. 12 :0 1a • Despite the average national rate of decline being largest among adults who did not graduate from high school, smoking prevalence increased among this population in 15 states over the same time period, led by South Dakota and Connecticut. • Compared with other education levels, there was more variation in smoking prevalence by state among adults who did not graduate from high school. Among adults who did not graduate from high school: • Nevada experienced an average decrease of -3.44% per year in smoking prevalence Some College College Graduate from 2012 to 2016, while South Dakota saw an average increase of 1.76% per year in smoking prevalence over the same five-year period. • Relative to other states, Connecticut (24.5%) and Hawaii (23.5%) had a lower five-year average prevalence of smoking, but a faster average rate of increase per year at 1.07% per year and 0.54% per year, respectively. • Even though Ohio (41.8%) had a higher average prevalence of smoking relative to other states from 2012 to 2016, the prevalence increased at a rate of 0.04% per year, which is a slower rate than other states over the same time period. • Indiana (39.0%), New Hampshire (38.4%), and Vermont (37.9%) had a higher five-year average smoking prevalence relative to other states, but the prevalence in these states decreased at a much faster rate of -1.90% per year, -2.15% per year, and -3.15% per year, respectively. A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 15 Findings FIGURE 7 Average Annual Rate of Change in Smoking Prevalence Among Adults Aged 18 Years and Older, 50 States and the Nation, 2012 to 2016 -1.2 -1 ANNUAL RATE OF CHANGE (%) -0.8 -0.6 -0.4 -0.2 0 Illinois Nevada Texas Arizona Indiana Wisconsin Wyoming Rhode Island Massachusetts Pennsylvania Oklahoma Georgia Kansas Maryland Ohio South Dakota United States New Jersey Missouri Alabama Louisiana Delaware Minnesota Kentucky Virginia New Mexico Nebraska Alaska Mississippi South Carolina Connecticut North Dakota New York Maine Colorado North Carolina West Virginia Michigan Idaho Florida Washington New Hampshire Vermont Utah Montana Oregon Hawaii Arkansas Iowa California Tennessee 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 -1.4 16 w w w. a m e r i c a s h e a l th ra n kin g s.o r g FIGURE 8 Average Annual Rate of Change in Smoking Prevalence by Education Level Among Adults Aged 25 Years and Older, 50 States and the Nation, 2012 to 2016 AVERAGE ANNUAL RATE OF CHANGE (%) -1 0 1 Less Than High School High School Graduate Some College College Graduate 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 -2 12 :0 South Dakota Connecticut Louisiana Arkansas Tennessee Maine North Dakota Hawaii Kentucky Virginia Michigan Missouri Idaho Ohio Minnesota California Alaska West Virginia Mississippi South Carolina Florida New York United States Massachusetts Iowa Washington Alabama Rhode Island New Mexico North Carolina Texas Pennsylvania Colorado Oregon Maryland Montana New Jersey Oklahoma Nebraska Utah Arizona Georgia Indiana Wyoming Kansas Illinois New Hampshire Delaware Wisconsin Vermont Nevada -3 A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 17 Findings 6 Annual Rate of Change in Obesity Prevalence by State At the state level, all states except Michigan and Colorado experienced an average annual increase in obesity from 2012 to 2016 (Figure 11). 20 1 Trends in Obesity Prevalence, 2012 to 2016 The prevalence of obesity among US adults has increased 0.60% per year between 2012 and 2016, reaching its highest level in 2016 at nearly 30% of adults aged 18 years and older (Figure 9). Since 2007, the prevalence of obesity among US adults has been above 25%. When stratified by education level, the prevalence of obesity among adults aged 25 years and older was significantly lower among those with a college degree compared with other education levels; however, it was still increasing yearly for each education level (Figure 10). Obesity prevalence increased at a faster average rate in 21 states compared with the average rate of change in the United States (0.60%). m Em ES ba T, rg De oe ce d U m nt be il r1 5, • Obesity prevalence increased at a faster average rate in 21 states compared with the average rate of change in the United States (0.60%). FIGURE 9 Obesity Prevalence Among Adults Aged 18 Years and Older, United States, 2012 to 2016 20% 15% 10% 5% 0 2012 2013 EDITION YEAR 2014 1a • On the opposite end of the spectrum, Michigan and Colorado experienced average annual decreases in obesity prevalence of -0.06% and -0.02%, respectively. 25% 2015 12 :0 PERCENTAGE OF ADULTS 30% • Obesity prevalence increased at the fastest rate in Wyoming, with an average annual increase of 1.29%. 2016 • Both states decreased even though Michigan (31.2%) had a relatively high average prevalence of obesity and Colorado (20.8%) had the lowest five-year average prevalence. This shows that improvements can occur regardless of a state’s obesity prevalence. • While Arizona (27.0%), Oregon (27.7%), and Wyoming (27.2%) had a lower five-year average prevalence of obesity relative to other states, the prevalence increased at a faster average rate at 0.95% per year, 0.74% per year, and 1.29% per year, respectively. • Mississippi (35.1%) had the highest five-year average prevalence of obesity relative to other states, but the prevalence was increasing at a slower average rate (0.23% per year) compared with other states. 18 w w w. a m e r i c a s h e a l th ra n kin g s.o r g FIGURE 10 Obesity Prevalence by Education Level Among Adults Aged 25 Years and Older, United States, 2012 to 2016 EDITION YEAR 2012 2013 2014 2015 2016 35% 25% 20% 6 15% 10% 20 1 PERCENTAGE OF ADULTS 30% 0 Less Than High School m Em ES ba T, rg De oe ce d U m nt be il r1 5, 5% High School Graduate EDUCATION LEVEL Some College College Graduate • Vermont (2.52% per year), Pennsylvania (1.91% per year), and New York (1.78% per year) experienced a dramatic increase in the average rate of obesity prevalence compared with the other education levels. • Nationally, obesity increased across all education groups over the past four years. However, the average rate of change per year was 2.5 times higher among high school graduates than college graduates. • Relative to other states, Nevada (32.7%) and Nebraska (33.3%) had a lower fiveyear average prevalence of obesity, but the prevalence increased at a much faster rate on average than other states (1.43% per year and 1.32% per year, respectively). 12 :0 1a Annual Rate of Change in Obesity Prevalence by Education Level Interesting differences emerged when obesity was stratified by education level among adults 25 years and older between 2012 and 2016 (Figure 12): • There was more variation in obesity prevalence by state among those who did not graduate from high school compared with other education levels. Among adults who did not graduate from high school: • Even though Mississippi (38.1%) and California (35.4%) had a higher five-year average prevalence of obesity relative to other states, the prevalence has been decreasing on average (-0.09% per year and -0.08% per year, respectively) unlike most other states. • Seventeen states experienced a negative average annual rate of change in obesity prevalence over the past four years, led by Wisconsin (-2.76% per year) and Indiana (-2.65% per year). A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 19 Findings FIGURE 11 Average Annual Rate of Change in Obesity Prevalence Among Adults Aged 18 Years and Older, 50 States and the Nation, 2012 to 2016 20 0.3 AVERAGE ANNUAL RATE OF CHANGE (%) 0.5 0.7 0.9 1.1 20 1 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1a 12 :0 Michigan Colorado Montana Washington Hawaii New Hampshire California Vermont Virginia Florida Utah North Carolina South Carolina Connecticut Mississippi Indiana Rhode Island Minnesota Ohio Maryland Massachusetts Pennsylvania Maine New York Missouri Idaho Delaware Louisiana Nevada United States New Jersey South Dakota New Mexico Oklahoma Texas Iowa Georgia Oregon Wisconsin Nebraska Alabama West Virginia Illinois Arkansas Kentucky Alaska North Dakota Tennessee Arizona Kansas Wyoming 0.1 6 -0.1 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 1.3 FIGURE 12 Average Annual Rate of Change in Obesity Prevalence By Education Level Among Adults Aged 25 Years and Older, 50 States and the Nation, 2012 to 2016 2 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 Less Than High School High School Graduate Some College College Graduate 12 :0 Vermont Pennsylvania New York Alaska Oklahoma Nevada Iowa Massachusetts Nebraska North Carolina Arkansas Kansas Montana Rhode Island West Virginia Connecticut Illinois Texas Maryland Alabama Arizona North Dakota Kentucky Georgia Missouri Delaware New Mexico Minnesota Colorado United States Tennessee Idaho New Jersey Wyoming Virginia California Mississippi Hawaii South Carolina Louisiana Utah South Dakota Michigan Oregon Florida Washington Ohio Maine New Hampshire Indiana Wisconsin AVERAGE ANNUAL RATE OF CHANGE (%) -1 0 1 -2 A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 21 Findings 20 1 6 Summary The prevalence of smoking has decreased in the past four years in all 50 states, but these improvements are not consistent across education levels. However, in the past four years obesity prevalence has increased in most states, and the prevalence varies across education levels. In terms of both smoking and obesity prevalence, where one lives matters most for those who did not graduate from high school. States that are reducing the prevalence of smoking and obesity faster than other states may be able to share lessons learned. Despite success in reducing smoking among adults, there is still work to be done to meet the Department of Health and Human Services Healthy People 2020 target of reducing the prevalence of smoking to 12.0%.12 At the same time, nearly one-third of US adults struggle with obesity. In the past four years, the nation has experienced a greater than 0.5% increase per year in obesity prevalence among adults, an indication of the uphill battle we face as a nation to prevent obesity and related health conditions. 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, Annual Rate of Change in Smoking and Obesity Some states are improving at a faster rate than the nation for prevalence of smoking and obesity, while others are improving at a slower rate than the nation or are stagnant. Ohio, Maryland, Rhode Island, and Indiana are experiencing faster decreases in smoking prevalence and slower increases in obesity prevalence compared with the United States, while Tennessee and Arkansas are experiencing slower decreases in smoking and faster increases in obesity, on average. Among adults aged 25 years and older who did not graduate from high school, some states are improving at a faster rate than the nation for prevalence of smoking and obesity. Others are improving at a slower rate than the nation or are stagnant. The prevalence of smoking and obesity among adults who did not graduate from high school decreased at a faster rate in Indiana and Wisconsin compared with the nation. Adults in the same population segment living in Nevada or Vermont are experiencing faster declines in smoking prevalence (>=-3.0% per year) compared with other states and the nation; however, they are also challenged with faster increases in obesity than the nation. In Arkansas and Connecticut, smoking and obesity are increasing at rates faster than the national average in this education level. California experienced the slowest rate of change in smoking and obesity prevalence from 2012 to 2016 among those who did not graduate from high school. 22 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 12. Healthy People 2020: Tobacco use goals and objectives. https://www. healthypeople.gov/2020/topics-objectives/topic/tobacco-use/objectives. Accessed October 26, 2016. Comparison With Other Nations Compared with other developed and many developing nations, the United States continues to rank at or near the bottom in indicators of mortality and life expectancy while continuing to exceed other countries in health spending.13 Thirty-five countries, including the United States, comprise the Organisation for Economic Co-operation and Development (OECD). Their mission is to promote economic development and social well-being of people worldwide. The United States ranks 29th in infant mortality among the 35 OECD countries—only six countries have higher rates. In 14 countries—including the Nordic countries of northern Europe, Japan, and Slovenia—the infant mortality rate is half the US rate (Figure 13). 13. OECD. Health spending (indicator). https://data.oecd.org/healthres/ health-spending.htm. Accessed October 25, 2016. Infant Mortality Rate Among OECD Countries, 2015 Number of infant deaths per 1,000 live births 10 15 20 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 5 1a Among the 35 OECD countries, US infant mortality ranks 29th. 12 :0 0 Luxembourg Iceland Finland Japan Norway Slovenia Estonia Sweden Czech Republic Austria Denmark Italy Australia Ireland Portugal Germany Israel Netherlands Belgium Switzerland France Spain United Kingdom Greece Canada Poland New Zealand Hungary United States Slovak Republic Latvia Chile Mexico Turkey Korea 20 1 6 FIGURE 13 Data Source: WHO. Infant mortality rate (probability of dying in the first year after birth per 1,000 live births) Mortality and global health estimates. 2015. http://apps.who.int/gho/data/ view.main.182 Updated: September 11, 2015. Accessed: October 25, 2016. A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 23 Findings Life expectancy at birth is another measure used to compare the health of nations. The United States also performs relatively poorly in this measure, which is highly influenced by infant mortality. Overall, the United States ranks 26th among OECD countries with an average life expectancy of 79 years (Figure 14). Japan leads the world in life expectancy at 84 years. Almost all western European countries, Australia, Canada, Chile, and Iceland also have a longer life expectancy than the United States. Twenty-five countries have an average life expectancy of at least 80 years, and 18 of those countries have a life expectancy at least three years longer than the US life expectancy. Years 24 65 70 75 80 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 60 1a The United States ranks 26th of 35 OECD countries for life expectancy, with an average life expectancy of 79 years. 12 :0 Japan Switzerland Australia Spain Iceland Italy Israel France Sweden Canada Luxembourg Netherlands Norway New Zealand Austria Ireland United Kingdom Belgium Finland Portugal Germany Greece Slovenia Denmark Chile United States Czech Republic Estoria Poland Mexico Slovakia Hungary Turkey Latvia Korea 20 1 Life Expectancy at Birth (Years) Among OECD Countries, 2015 6 FIGURE 14 w w w. a m e r i c a s h e a l th ra n kin g s.o r g Data Source: WHO. Life expectancy at birth (years) Mortality and global health estimates. 2015. http://apps.who.int/gho/data/node. main.688 Updated: September 11, 2015. Accessed: November 10, 2016. Rankings for infant mortality and life expectancy continue to be disappointingly low in the United States, especially considering how much money is spent on health. Compared with other OECD countries, expenditure on health (measured by percentage of gross domestic product [GDP] spent on health by private and public sectors), is highest in the United States at 16.9% of GDP (Figure 15). Switzerland is the next highest in expenditures at 11.5%. Including Switzerland, only 10 other OECD countries spend more than 10% of GDP on health. All other developed countries with health expenditures more than 10% of GDP have a lower infant mortality rate and a higher life expectancy than the United States. FIGURE 15 Health Expenditures Among OECD Countries, 2015 2 4 6 8 10 12 14 16 20 1 0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, All other OECD countries with health expenditures more than 10% of GDP have a lower infant mortality rate and a higher life expectancy than the United States. 12 :0 Turkey Latvia Mexico Estoria Poland Slovak Republic Hungary Luxembourg Korea Israel Czech Republic Chile Greece Slovenia Iceland Portugal Spain Italy Australia Ireland New Zealand Finland United Kingdom Norway Canada Austria Belgium Denmark Netherlands France Sweden Germany Japan Switzerland United States 6 Health spending as percentage of GDP (%) Data Source: Organisation for Economic Co-operation and Development, OECD.stat. 2015 estimates. http://stats.oecd.org/index. aspx?DataSetCode=HEALTH_STAT# Accessed: November 10, 2016. A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 25 6 20 1 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1a 12 :0 26 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 6 20 1 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, Core Measures A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 27 Behaviors C ORE M E AS URE S Drug Deaths 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: National Vital Statistics System For details: http://www.americashealthrankings.org/AR16/ Drugdeaths m Em ES ba T, rg De oe ce d U m nt be il r1 5, Drug Deaths by State DEATHS PER 100,000 POPULATION Drug overdoses are the leading cause of injury deaths in the United States with a record high of 47,055 deaths in 2014. More than six out of 10 drug deaths involve an opioid, primarily prescription pain relievers (morphine, oxycodone, hydrocodone) or heroin. Opioid-related overdose deaths increased 200% between 2000 and 2014, and since 1999 opioid pain reliever prescribing quadrupled. The effects of drug abuse and overdoses are costly to society, burdening individuals, their families, the health care system, and the economy. The total cost of illicit drug use on the US economy—including its impact on crime, health, and productivity—is an estimated $193 billion per year. Number of deaths due to drug injury of any intent (unintentional, suicide, homicide, or undetermined) per 100,000 population 1a <=11.2 RI DE Bottom 5 States North Dakota 4.0 West Virginia 32.2 South Dakota 6.6 New Mexico 24.7 Nebraska 7.1 Kentucky 24.1 Iowa 8.9 Utah 22.8 Minnesota 9.3 Rhode Island 21.4 United States 14.0 United States 14.0 28 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 13.2 to 15.6 DC 12 :0 Top 5 States 11.3 to 13.1 15.7 to 18.3 >=18.4 Ranking Disparities in Drug Deaths by Drug Deaths US Rate Maximum and Minimum Rate by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Rate by Gender Black* Female Hispanic Male White* 20 30 0 40 6 10 DEATHS PER 100,000 POPULATION * Includes Hispanic ethnicity 10 20 30 DEATHS PER 100,000 POPULATION 40 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 0 “More persons died from drug overdoses in the United States in 2014 than during any previous year on record.” p ler s • suppo rt t h os e • in re co ve ry • po bo s i t e a n d i ve y o r ly ing p a s u u r int • c r e n • p p k i d er v om t i n pe edu o r t s • ent mu g • • er cat t h e n ion nic fa o i a m p r se a r elati on s e f o r • t tio ily c o a n e e • m k n t a nsh se i n r e m lk • e d tre l ip lf e e to i c a t m m s • -co c ov n t • • d at e o n n nt e r i s i o n n t i t o alox rol y r ci • p l d i s • pr i n g one i n p op se e os e • cu al r y rl re place • ea r t ac ice s in prescrib ing kil ke ep pr es cr ipt r n ai te 12 :0 1a MORBIDITY AND MORTALITY WEEKLY REPORT n ion drugs i in im pl em e nt b es tp 4.0 6.6 7.1 8.9 9.3 9.6 10.1 11.0 11.1 11.2 11.2 11.4 11.7 12.1 12.3 12.6 12.8 13.1 13.1 13.1 13.2 13.3 13.4 13.6 13.8 14.0 14.0 15.1 15.3 15.6 15.7 15.7 15.9 16.0 16.7 17.0 17.7 17.9 18.1 18.3 18.6 19.8 20.9 20.9 21.1 21.4 22.8 24.1 24.7 32.2 14.0 15.3 on Value ti 1 North Dakota 2 South Dakota 3 Nebraska 4 Iowa 5 Minnesota 6 Texas 7 Virginia 8 Mississippi 9 New York 10 Georgia 10 Hawaii 12 California 13 Kansas 14 Arkansas 15 Oregon 16 Illinois 17 Montana 18 Alabama 18 Idaho 18 Vermont 21 Florida 22 North Carolina 23 South Carolina 24 Maine 25 Washington 26 New Jersey 26 Wisconsin 28 Connecticut 29 Maryland 30 Louisiana 31 Massachusetts 31 Michigan 33 Colorado 34 Alaska 35 Indiana 36 Missouri 37 Wyoming 38 New Hampshire 39 Delaware 40 Tennessee 41 Arizona 42 Pennsylvania 43 Nevada 43 Oklahoma 45 Ohio 46 Rhode Island 47 Utah 48 Kentucky 49 New Mexico 50 West Virginia United States District of Columbia ve n Rank State a A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 29 Behaviors C ORE M E AS URE S 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/ ExcessDrink m Em ES ba T, rg De oe ce d U m nt be il r1 5, Excessive alcohol use includes binge drinking and chronic drinking; it can lead to memory loss, poor decision making, fetal damage, liver diseases, hypertension, cardiovascular diseases, and other major health problems. An annual average of 87,798 alcohol-attributable deaths, 2.5 million years of potential life lost, and an average of 12,460 motor vehicle accidents were due to excessive drinking from 2006 to 2010. Excessive alcohol use cost the United States $249 billion in 2010, or $2.05 for each alcoholic beverage consumed, in terms of losses in workplace productivity, health care expenses, criminal justice expenses, motor vehicle accidents, and property damage. The median cost to states was $3.5 billion. PERCENTAGE OF ADULT POPULATION Excessive Drinking Excessive Drinking by State Percentage of adults who reported either binge drinking (having four or more [women] or five or more [men] drinks on one occasion in the past month) or chronic drinking (having eight or more [women] or 15 or more [men] drinks per week) 15.5% to 17.3% 1a <=15.4% DC 12 :0 Top 5 States RI DE Bottom 5 States Tennessee 11.2% North Dakota 24.7% West Virginia 11.4% Wisconsin 24.5% Utah 12.4% Alaska 22.1% Alabama 13.0% Montana 21.8% Mississippi 13.3% Illinois 21.2% United States 17.7% United States 17.7% 30 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 17.4% to 18.1% 18.2% to 19.6% >=19.7% Ranking Disparities in Excessive Drinking by Excessive Drinking US Rate Maximum and Minimum Prevalence by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Black* Prevalence by Gender Hawaiian/Pacific Islander* Female Hispanic Male 10 15 20 25 PERCENT OF ADULTS 30 White* 35 0 10 6 5 * Non-Hispanic 20 1 0 20 30 PERCENT OF ADULTS 40 Prevalence by Education Prevalence by Age m Em ES ba T, rg De oe ce d U m nt be il r1 5, 11.2 11.4 12.4 13.0 13.3 13.8 13.9 14.9 15.3 15.4 15.5 15.8 16.0 16.3 16.6 16.6 16.8 16.8 16.9 17.3 17.4 17.4 17.5 17.6 17.7 17.7 17.8 17.9 18.0 18.1 18.2 18.4 18.6 18.8 18.8 19.1 19.2 19.5 19.6 19.6 20.0 20.4 20.5 21.0 21.1 21.2 21.8 22.1 24.5 24.7 17.7 30.0 College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 5 10 15 20 25 30 PERCENT OF ADULTS 35 40 0 5 10 15 20 25 30 35 PERCENT OF ADULTS AGED 25+ Prevalence by Income Prevalence by Urbanicity Urban $75,000 or More $50,000 to $74,999 1a Value (%) 1 Tennessee 2 West Virginia 3 Utah 4 Alabama 5 Mississippi 6 New Mexico 7 Oklahoma 8 North Carolina 9 Arkansas 10 Idaho 11 Maryland 12 Nevada 13 Arizona 14 Kentucky 15 Delaware 15 South Carolina 17 Georgia 17 Indiana 19 Kansas 20 Texas 21 Florida 21 Virginia 23 Wyoming 24 New Jersey 25 Missouri 25 South Dakota 27 Washington 28 Rhode Island 29 California 30 Pennsylvania 31 New York 32 New Hampshire 33 Connecticut 34 Louisiana 34 Oregon 36 Colorado 37 Ohio 38 Massachusetts 39 Maine 39 Vermont 41 Michigan 42 Nebraska 43 Hawaii 44 Iowa 45 Minnesota 46 Illinois 47 Montana 48 Alaska 49 Wisconsin 50 North Dakota United States District of Columbia Suburban 12 :0 Rank State $25,000 to $49,999 Rural Less Than $25,000 0 5 10 15 20 25 PERCENT OF ADULTS 0 5 10 15 20 25 30 35 PERCENT OF ADULTS AGED 25+ moderation • set goals • accountability • name a driver • ask for help • admit you have a problem • talk with loved ones • find a support network • make a plan • don’t keep alcohol at home • recognize triggers • slow the pace • exercise • find productive ways to handle stress • fill your time with healthy activities • drink water between alcoholic beverages • set limits • drive sober A • establish drinking rules • never drink alone • reward suppyo u r s e l f f o r s o b r i e t y • a vo i d h e a v y d r i n k e r s ort group meeting A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 31 Behaviors C ORE M E AS URE S 100 90 80 70 60 50 40 30 20 10 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: National Center for Education Statistics, 2014-2015 For details: http://www.americashealthrankings.org/AR16/ Graduation m Em ES ba T, rg De oe ce d U m nt be il r1 5, Disparities in health outcomes by educational attainment have widened in recent decades, producing larger gaps in health status between Americans with high and low education. Among adults aged 25 years and older without a high school diploma, life expectancy is four to five years shorter than high school graduates and nine years shorter than college graduates. The prevalence of diabetes, high blood pressure, heart disease, and heart attack are significantly higher among those with less than a high school degree. If the health of less educated Americans were on par with the health of collegeeducated Americans, health improvements would result in savings of more than $1 trillion annually. PERCENTAGE OF STUDENTS High School Graduation High School Graduation by State Percentage of high school students who graduate with a regular high school diploma within four years of starting ninth grade 85.7% to 87.7% 1a >=87.8% DC 12 :0 Top 5 States RI DE Bottom 5 States Iowa 90.8% New Mexico 68.6% New Jersey 89.7% Nevada 71.3% Alabama 89.3% Oregon 73.8% Texas 89.0% Mississippi 75.4% Nebraska 88.9% Alaska 75.6% United States 83.2% United States 83.2% 32 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 82.5% to 85.6% 78.8% to 82.4% <=78.7% Ranking Disparities in High School Graduation Alaska Native/ American Indian* Asian* Black* Hispanic White* 25 50 75 PERCENTAGE OF STUDENTS 100 6 0 * Non-Hispanic 20 1 90.8 89.7 89.3 89.0 88.9 88.4 88.1 88.0 87.9 87.8 87.7 87.5 87.3 87.2 87.1 87.0 86.6 86.5 86.0 85.7 85.7 85.6 85.6 85.6 84.9 84.8 84.8 83.9 83.2 82.5 82.0 81.9 81.6 80.7 80.3 79.8 79.3 79.2 78.9 78.8 78.2 77.9 77.5 77.4 77.3 75.6 75.4 73.8 71.3 68.6 83.2 68.5 Percentage by Race and Hispanic Origin “The pathways to and consequences of dropping out [of school] perpetuate an insidious cycle of poverty, disparities, and entrenched inequities that underscore why graduation has become a public health priority.” AMERICAN PUBLIC HEALTH ASSOCIATION eat breakfast take notes • use a tutor • online study resources • homework • get enough sleep • ask questions • attend classes • parent-teacher conferences guidance counselors • parental involvement • complete assignments • test preparation • form a study group • meet with teachers • review notes • participate • ask for homework help • read • make homework a high priority • ask questions • rest • TUTOR • ASK QUESTIONS • ATTEND CLASSES 1 Iowa 2 New Jersey 3 Alabama 4 Texas 5 Nebraska 6 Wisconsin 7 New Hampshire 8 Kentucky 9 Tennessee 10 Missouri 11 Vermont 12 Maine 13 Massachusetts 14 Connecticut 15 Indiana 16 Maryland 17 North Dakota 18 West Virginia 19 Montana 20 Kansas 20 Virginia 22 Delaware 22 Illinois 22 North Carolina 25 Arkansas 26 Pennsylvania 26 Utah 28 South Dakota 29 Rhode Island 30 Oklahoma 31 California 32 Minnesota 33 Hawaii 34 Ohio 35 South Carolina 36 Michigan 37 Wyoming 38 New York 39 Idaho 40 Georgia 41 Washington 42 Florida 43 Louisiana 44 Arizona 45 Colorado 46 Alaska 47 Mississippi 48 Oregon 49 Nevada 50 New Mexico United States District of Columbia US Rate Maximum and Minimum m Em ES ba T, rg De oe ce d U m nt be il r1 5, Value (%) 1a Rank State 12 :0 by High School Graduation A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 33 Behaviors C ORE M E AS URE S 50 40 30 20 10 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/ Obesity m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 Obesity is generally caused by the regular consumption of more calories than the body is able to burn. Additional contributing factors include genetics, prenatal and early life influences, unhealthy diets, insufficient sleep, too much television, lack of physical activity, and the social and physical environment. Obesity contributes to an estimated 200,000 deaths yearly and is a leading factor in such preventable conditions as heart disease, type 2 diabetes, stroke, cancer, and hypertension. An estimated $190.2 billion is spent on obesity-related health issues each year, representing 21% of annual medical spending. PERCENTAGE OF ADULT POPULATION Obesity Obesity by State Percentage of adults with a body mass index of 30.0 or higher based on reported height and weight 25.7% to 28.9% 1a <=25.6% DE Bottom 5 States Louisiana 36.2% Hawaii 22.7% Alabama Montana 23.6% Mississippi California 24.2% West Virginia Massachusetts 24.3% Kentucky 34.6% United States 29.8% United States 29.8% w w w. a m e r i c a s h e a l th ra n kin g s.o r g >=32.5% RI Colorado 20.2% 34 30.5% to 32.4% DC 12 :0 Top 5 States 29.0% to 30.4% (tie) 35.6% Ranking Disparities in Obesity by Obesity US Rate Maximum and Minimum Prevalence by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Black* Prevalence by Gender Hawaiian/Pacific Islander* Female Hispanic Male 20 White* 30 0 10 6 10 PERCENT OF ADULTS * Non-Hispanic 20 1 0 20 30 PERCENT OF ADULTS 40 50 Prevalence by Education m Em ES ba T, rg De oe ce d U m nt be il r1 5, Prevalence by Age College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 10 20 30 40 PERCENT OF ADULTS 0 10 20 30 40 20 30 40 PERCENT OF ADULTS AGED 25+ Prevalence by Income Prevalence by Urbanicity $75,000 or More Urban $50,000 to $74,999 Suburban $25,000 to $49,999 Rural Less Than $25,000 30 PERCENT OF ADULTS 40 10 PERCENT OF ADULTS AGED 25+ down on carbohydrates • increase phys • avoid food triggers • exercise • eat vegetables ntain nutrition • restrict calorie intake activity • stick to your healthy weight m ai • limit fast food • l ica ut 0 limit alcohol 20 limit sweets 10 take the stairs instead of the elevator • c 0 • 20.2 22.7 23.6 24.2 24.3 24.5 25.0 25.1 25.3 25.6 26.0 26.1 26.3 26.4 26.7 26.8 28.4 28.6 28.8 28.9 29.0 29.2 29.7 29.8 29.8 30.0 30.0 30.1 30.1 30.4 30.7 30.7 30.8 31.0 31.2 31.3 31.4 31.7 32.1 32.4 32.4 33.8 33.9 34.2 34.5 34.6 35.6 35.6 35.6 36.2 29.8 22.1 1a Value (%) 1 Colorado 2 Hawaii 3 Montana 4 California 5 Massachusetts 6 Utah 7 New York 8 Vermont 9 Connecticut 10 New Jersey 11 Rhode Island 12 Minnesota 13 New Hampshire 14 Washington 15 Nevada 16 Florida 17 Arizona 18 Idaho 19 New Mexico 20 Maryland 21 Wyoming 22 Virginia 23 Delaware 24 Alaska 24 Ohio 26 Maine 26 Pennsylvania 28 North Carolina 28 Oregon 30 South Dakota 31 Georgia 31 Wisconsin 33 Illinois 34 North Dakota 35 Michigan 36 Indiana 37 Nebraska 38 South Carolina 39 Iowa 40 Missouri 40 Texas 42 Tennessee 43 Oklahoma 44 Kansas 45 Arkansas 46 Kentucky 47 Alabama 47 Mississippi 47 West Virginia 50 Louisiana United States District of Columbia 12 :0 Rank State • A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 35 Behaviors C ORE M E AS URE S 50 40 30 20 10 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/ Sedentary m Em ES ba T, rg De oe ce d U m nt be il r1 5, In the United States 6.7% of coronary heart disease, 8.3% of type 2 diabetes, 12.4% of breast cancer, 12.0% of colon cancer, and 10.8% of all-cause mortality are attributable to physical inactivity. Less than 21% of adults met US Department of Health and Human Services physical activity recommendations (minimum 150 minutes weekly) in 2014. Physical inactivity is associated with many social and environmental factors including low educational attainment, socioeconomic status, violent crime, and poverty. Elimination of physical inactivity would significantly decrease chronic disease prevalence and increase life expectancy. Physical inactivity costs $117 billion annually and accounts for more than 11% of total US health care expenditures. PERCENTAGE OF ADULT POPULATION Physical Inactivity Physical Inactivity by State Percentage of adults who reported doing no physical activity or exercise other than their regular job in the past 30 days 22.1% to 24.8% 24.9% to 26.5% 1a <=22.0% 12 :0 DC RI DE Top 5 States Bottom 5 States Colorado 17.9% Mississippi 36.8% Oregon 18.8% Arkansas 34.2% Washington 19.0% Oklahoma 33.2% California 20.0% Kentucky 32.5% Utah 20.3% Alabama & Louisiana 31.9% United States 26.2% United States 26.2% 36 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 26.6% to 29.4% >=29.5% Ranking Disparities in Physical Inactivity by Physical Inactivity US Rate Maximum and Minimum Prevalence by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Black* Prevalence by Gender Hawaiian/Pacific Islander* Female Hispanic Male White* 20 30 40 PERCENT OF ADULTS 0 6 10 * Non-Hispanic 10 20 1 0 20 30 PERCENT OF ADULTS 40 50 Prevalence by Education m Em ES ba T, rg De oe ce d U m nt be il r1 5, Prevalence by Age College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 10 20 30 40 PERCENT OF ADULTS 0 10 20 30 40 50 20 30 40 50 PERCENT OF ADULTS AGED 25+ Prevalence by Income Prevalence by Urbanicity $75,000 or More Urban 1a $50,000 to $74,999 $25,000 to $49,999 Rural Less Than $25,000 40 PERCENT OF ADULTS 0 ake the sta e•t irs ent watchin n p s g e • ride an ex e • red uce rcis ti m tor • leva ee n• th isio lev te o l o r wo dog • do pu • create more sidewalks n is • sh-ups • swim • • PERCENT OF ADULTS AGED 25+ bik rk ho 10 ot e lf 30 k s • go 20 ac 10 lk t o s c wa 0 • wa l k t h e 12 :0 Suburban jog • t e n 17.9 18.8 19.0 20.0 20.3 21.2 21.5 21.6 21.8 22.0 22.2 22.5 22.5 22.6 22.6 23.5 24.1 24.7 24.7 24.8 24.8 25.1 25.3 25.5 26.2 26.2 26.2 26.3 26.5 26.5 26.7 26.8 27.0 27.0 27.2 27.3 27.8 28.1 29.3 29.4 29.4 29.5 30.4 30.8 31.9 31.9 32.5 33.2 34.2 36.8 26.2 19.4 • Value (%) 1 Colorado 2 Oregon 3 Washington 4 California 5 Utah 6 Idaho 7 South Dakota 8 Wisconsin 9 Minnesota 10 Alaska 11 Vermont 12 Hawaii 12 Montana 14 New Hampshire 14 New Mexico 16 Connecticut 17 Maryland 18 Arizona 18 Nevada 20 Illinois 20 Maine 22 Virginia 23 Nebraska 24 Michigan 25 Florida 25 North Carolina 25 Wyoming 28 Iowa 29 Kansas 29 Massachusetts 31 South Carolina 32 North Dakota 33 Missouri 33 Ohio 35 New Jersey 36 Georgia 37 Pennsylvania 38 Rhode Island 39 New York 40 Delaware 40 Indiana 42 Texas 43 Tennessee 44 West Virginia 45 Alabama 45 Louisiana 47 Kentucky 48 Oklahoma 49 Arkansas 50 Mississippi United States District of Columbia • Rank State join a fitness club • do jumping j mall walk rake leaves A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 37 Behaviors C ORE M E AS URE S 50 40 30 20 10 0 1990 ’92 ’94 ’96 EDITION YEAR Smoking by State ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/ Smoking m Em ES ba T, rg De oe ce d U m nt be il r1 5, Smoking is the leading cause of preventable death. Annually, more than 480,000 people die from cigarette smoking, including nearly 42,000 deaths from secondhand smoke exposure. More than 16 million Americans are living with a smoking-related disease, which can damage nearly every organ and potentially cause respiratory disease, heart disease, stroke, cancer, preterm birth, low birthweight, and premature death. Smoking prevalence has decreased in all 50 states over the past four years, but in 15 states, it has increased among those with less than a high school education. Direct medical expenditures attributed to smoking exceed $170 billion annually. PERCENTAGE OF ADULT POPULATION Smoking Percentage of adults who are smokers (reported smoking at least 100 cigarettes in their lifetime and currently smoke every or some days) 15.2% to 16.5% 1a <=15.1% DC 12 :0 Top 5 States RI DE Bottom 5 States Utah 9.1% Kentucky 25.9% California 11.7% West Virginia 25.7% Connecticut New Jersey (tie) 13.5% Arkansas 24.9% Mississippi 22.5% Idaho 13.8% Missouri 22.3% United States 17.5% United States 17.5% 38 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 16.6% to 18.1% 18.2% to 20.7% >=20.8% Ranking Disparities in Smoking by Smoking US Rate Maximum and Minimum Prevalence by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Black* Prevalence by Gender Hawaiian/Pacific Islander* Female Hispanic Male White* 10 20 30 PERCENT OF ADULTS 0 10 6 0 20 30 PERCENT OF ADULTS 20 1 * Non-Hispanic 40 50 Prevalence by Education m Em ES ba T, rg De oe ce d U m nt be il r1 5, Prevalence by Age College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 10 20 PERCENT OF ADULTS 30 0 10 20 30 40 10 20 30 40 PERCENT OF ADULTS AGED 25+ Prevalence by Income Prevalence by Urbanicity Urban 1a $50,000 to $74,999 Suburban $25,000 to $49,999 Rural 10 20 PERCENT OF ADULTS Less Than $25,000 0 PERCENT OF ADULTS AGED 25+ lif e su p po rt network • m PLAN TO eling set a quit date • medication • nicotine patch • Nicotine AnonymousTM • remove ash trays • support network • counseling • avoid triggers • manage withdrawal symptoms • choose smoke-free settings • patience icatio ns ed c ou QUIT 0 $75,000 or More hange • ec yl st 9.1 11.7 13.5 13.5 13.8 14.0 14.0 14.1 15.0 15.1 15.1 15.2 15.2 15.5 15.6 15.8 15.9 16.0 16.2 16.5 17.1 17.1 17.3 17.4 17.5 17.5 17.7 17.7 18.1 18.1 18.7 18.9 19.0 19.1 19.1 19.5 19.7 20.1 20.6 20.7 21.4 21.6 21.9 21.9 22.2 22.3 22.5 24.9 25.7 25.9 17.5 16.0 12 :0 Value (%) 1 Utah 2 California 3 Connecticut 3 New Jersey 5 Idaho 6 Arizona 6 Massachusetts 8 Hawaii 9 Washington 10 Illinois 10 Maryland 12 New York 12 Texas 14 Rhode Island 15 Colorado 16 Florida 17 New Hampshire 18 Vermont 19 Minnesota 20 Virginia 21 Nebraska 21 Oregon 23 Wisconsin 24 Delaware 25 Nevada 25 New Mexico 27 Georgia 27 Kansas 29 Iowa 29 Pennsylvania 31 North Dakota 32 Montana 33 North Carolina 34 Alaska 34 Wyoming 36 Maine 37 South Carolina 38 South Dakota 39 Indiana 40 Michigan 41 Alabama 42 Ohio 43 Louisiana 43 Tennessee 45 Oklahoma 46 Missouri 47 Mississippi 48 Arkansas 49 West Virginia 50 Kentucky United States District of Columbia n Rank State A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 39 Community & Environment C ORE M E AS URE S Air Pollution by State 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: US Environmental Protection Agency, 2013-2015 For details: http://www.americashealthrankings.org/AR16/air m Em ES ba T, rg De oe ce d U m nt be il r1 5, Fine particulates in smoke or haze penetrate lung tissue and contribute to premature death. Air pollution is linked to increased respiratory symptoms, decreased lung function, asthma, chronic bronchitis, irregular heartbeats, and heart attacks. Asthma affects 6.3 million children; its direct medical costs total $50.1 billion annually, while lost productivity adds $6.1 billion. Combustion emissions cause an estimated 200,000 annual premature deaths. The EPA estimates the Clean Air Act prevented 130,000 heart attacks, 1.7 million asthma attacks, and 13 million lost workdays between 1990 and 2010. It is estimated that the Clean Air Act will prevent 230,000 annual cases of premature mortality in 2020. MICROGRAMS OF FINE PARTICLES PER CUBIC METER Air Pollution Average exposure of the general public to particulate matter of 2.5 microns or less in size (PM2.5) 1a <=6.8 DC 12 :0 Top 5 States RI DE Bottom 5 States Wyoming 4.4 California 11.4 North Dakota 4.9 Pennsylvania 11.0 Vermont 5.6 Illinois 10.8 New Mexico 6.0 Indiana 10.5 Montana & South Dakota 6.3 Ohio 10.2 United States 8.9 United States 8.9 40 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 6.9 to 7.9 8.0 to 8.6 8.7 to 9.1 >=9.2 Community & Environment C OR E M EASURES 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 Data source: Current Population Survey, 2016 Annual Social and Economic Supplement, 2015 For details: http://www.americashealthrankings.org/AR16/ ChildPoverty m Em ES ba T, rg De oe ce d U m nt be il r1 5, Poverty influences a family’s ability to meet children’s basic needs and may limit access to health care, healthy foods, educational opportunities, and physical activity choices. Children living in poverty are three times more likely to have unmet health needs than other children. Children born into poverty are more likely than other children to have low birthweight. As impoverished children grow, they are more likely to engage in risky or unhealthy behaviors and are at a greater lifetime risk of many different health problems. Programs such as the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) offer nutritional and other support to low-income families. PERCENTAGE OF CHILDREN Children in Poverty Children in Poverty by State Percentage of children younger than 18 years who live in households at or below the poverty threshold 14.0% to 17.3% 1a <=13.9% 19.6% to 21.4% >=21.5% DC 12 :0 Top 5 States 17.4% to 19.5% RI DE Bottom 5 States Minnesota 8.0% New Mexico 29.5% New Hampshire 8.7% Georgia 28.7% Wyoming 12.2% Mississippi 28.4% Utah 12.3% Arizona 25.5% Missouri 12.4% Kentucky 25.0% United States 19.7% United States 19.7% A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 41 Community & Environment C ORE M E AS URE S Infectious Disease through food, and chlamydia is sexually transmitted. Infectious diseases can lead to hospitalizations and even death, particularly in young children and the elderly. A high incidence of infectious disease may indicate a need for greater investment in public health prevention measures such as immunizations and educational campaigns. 6 Many largely preventable infectious diseases continue to burden our nation’s health. The CDC tracks many infectious diseases; the three included in this measure were chosen because they are common diseases representing different transmission mechanisms and therefore different prevention and treatment options. Pertussis (whooping cough) is spread through respiratory droplets, Salmonella is generally spread 20 1 Infectious Disease by State m Em ES ba T, rg De oe ce d U m nt be il r1 5, Mean z score of the incidence of chlamydia, pertussis, and Salmonella per 100,000 population <=-0.527 -0.526 to -0.273 -0.272 to -0.017 DC RI 12 :0 1a DE Chlamydia is an asymptomatic sexually transmitted infection caused by the bacterium Chlamydia trachomatis that infects both men and women. While easily treated, if left untreated chlamydia can cause permanent damage to a woman’s reproductive system. More than 1.4 million chlamydia cases were reported in 2014—making it the most common notifiable disease. 42 w w w. a m e r i c a s h e a l th ra n kin g s.o r g CASES PER 100,0000 POPULATION Chlamydia 500 400 300 200 100 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 2016 edition data source: NCHHSTP Atlas, 2014 For details: http://www.americashealthrankings.org/AR16/ chlamydia -0.016 to 0.363 >=0.364 Community & Environment C OR E M EASURES Infectious Disease, continued Ranking Disparities in Chlamydia Rank State Value 1 West Virginia 2 Maine 3 New Hampshire 4 Utah 5 Massachusetts 6 New Jersey 7 Idaho 8 Wyoming 9 Vermont 10 Minnesota 11 Connecticut 12 Washington 13 Iowa 14 Kansas 15 Oregon 16 Pennsylvania 17 Nebraska 18 Kentucky 19 Wisconsin 20 Montana 21 Rhode Island 22 Colorado 23 Nevada 24 Florida 25 Indiana 26 Virginia 27 Michigan 28 Hawaii 29 California 30 Maryland 31 Missouri 32 Tennessee 33 Ohio 34 North Dakota 35 North Carolina 36 Delaware 37 Arizona 38 South Dakota 39 Texas 40 New York 41 Illinois 42 Georgia 43 Arkansas 44 Oklahoma 45 New Mexico 46 South Carolina 47 Alabama 48 Louisiana 49 Mississippi 50 Alaska United States District of Columbia 254.5 265.8 271.0 283.5 317.8 336.0 337.6 338.4 357.0 367.3 372.1 381.2 382.0 384.1 394.6 395.6 401.3 401.9 403.2 413.0 413.6 415.0 424.4 430.6 434.0 436.4 447.2 457.2 459.9 462.6 462.9 474.0 474.1 477.1 478.7 483.2 488.9 493.1 496.1 502.8 516.5 519.9 527.3 536.6 554.3 588.2 600.2 626.0 655.4 787.5 456.1 818.8 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 43 US Rate Maximum and Minimum by Chlamydia Incidence by Race and Hispanic Origin Alaska Native/ American Indian Asian Incidence by Gender Black* Hispanic Female 400 0 900 CASES PER 100,000 POPULATION Chlamydia by State 400 900 1,400 1,900 CASES PER 100,000 POPULATION 2,400 m Em ES ba T, rg De oe ce d U m nt be il r1 5, *Non-Hispanic 20 1 0 6 White* Male Number of new cases of chlamydia per 100,000 population <=367.3 12 :0 1a 367.4 to 413.0 Top 5 States Bottom 5 States West Virginia 254.5 Alaska 787.5 Maine 265.8 Mississippi 655.4 New Hampshire 271.0 Louisiana 626.0 Utah 283.5 Alabama 600.2 Massachusetts 317.8 South Carolina 588.2 United States 456.1 United States 456.1 DC RI DE 413.1 to 462.6 462.7 to 502.8 >=502.9 Community & Environment C ORE M E AS URE S Infectious Disease, continued Ranking by Pertussis 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 6 2016 edition data source: MMWR, Summary of Notifiable Infectious Diseases and Conditions, 2014 For details: http://www.americashealthrankings.org/AR16/ pertussis Pertussis by State Number of new cases of pertussis per 100,000 population m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 Pertussis (whooping cough) is a contagious respiratory disease that can last 10 weeks and be life-threatening, especially in infants. It is usually spread through coughing or sneezing. Vaccination can reduce transmission. In 2014, 32,971 cases were reported, but many go undiagnosed and unreported. CASES PER 100,000 POPULATION Pertussis <=4.1 4.2 to 6.4 12 :0 1a 6.5 to 9.7 Top 5 States Bottom 5 States West Virginia 1.0 Montana 48.7 Louisiana 1.9 Maine 41.9 Mississippi 2.3 Utah 32.4 Hawaii 2.7 Wisconsin 26.4 Connecticut 2.8United Colorado 24.3 United States 10.4 United States 10.4 44 w w w. a m e r i c a s h e a l th ra n kin g s.o r g DC 9.8 to 17.7 RI >=17.8 DE Rank State Value 1 West Virginia 2 Louisiana 3 Mississippi 4 Hawaii 5 Connecticut 6 Maryland 7 South Carolina 8 Florida 8 Oklahoma 10 Georgia 11 New Jersey 12 Massachusetts 13 Tennessee 14 Nevada 14 New York 16 Alabama 16 Illinois 18 Virginia 19 New Hampshire 20 Pennsylvania 21 Vermont 22 Kentucky 23 Iowa 23 North Dakota 25 Indiana 26 North Carolina 27 Arizona 28 Washington 29 Missouri 30 Arkansas 30 Texas 32 Rhode Island 33 Oregon 34 Wyoming 35 Ohio 36 South Dakota 37 Michigan 38 Kansas 39 Minnesota 40 New Mexico 41 Nebraska 42 Delaware 43 California 43 Idaho 45 Alaska 46 Colorado 47 Wisconsin 48 Utah 49 Maine 50 Montana United States District of Columbia 1.0 1.9 2.3 2.7 2.8 3.4 3.6 3.7 3.7 4.1 4.3 4.6 5.1 5.2 5.2 5.9 5.9 6.1 6.3 6.4 6.7 6.8 7.2 7.2 7.5 7.6 7.8 8.6 9.2 9.7 9.7 10.3 10.6 10.8 12.6 13.0 14.4 14.9 17.5 17.7 19.6 22.1 22.8 22.8 23.0 24.3 26.4 32.4 41.9 48.7 10.4 3.4 Community & Environment C OR E M EASURES Infectious Disease, continued Ranking Salmonella Rank State Value 1 Nevada 2 Alaska 3 Maine 4 West Virginia 5 Oregon 6 Ohio 7 Washington 8 Michigan 9 Idaho 10 Indiana 11 Pennsylvania 12 Colorado 13 New York 14 North Dakota 15 Connecticut 16 Utah 17 Wyoming 18 New Jersey 19 Kentucky 20 Rhode Island 21 Minnesota 22 Illinois 23 Nebraska 24 Missouri 25 Virginia 26 California 27 Montana 28 New Hampshire 29 Kansas 30 Vermont 31 Maryland 32 Tennessee 33 Arizona 34 Wisconsin 35 New Mexico 36 Delaware 37 Iowa 38 Massachusetts 39 Texas 40 South Dakota 41 Oklahoma 42 North Carolina 43 Georgia 44 Arkansas 45 Hawaii 46 Alabama 47 Louisiana 48 South Carolina 49 Florida 50 Mississippi United States District of Columbia 6.2 9.3 9.6 9.7 10.2 10.4 10.6 10.6 10.8 11.0 11.5 11.7 11.8 12.2 12.7 12.8 13.0 13.1 13.3 13.3 13.4 13.8 13.9 13.9 13.9 14.0 14.4 14.4 14.8 14.8 15.1 15.4 15.8 16.0 16.0 17.0 17.1 18.3 19.5 20.1 20.7 20.9 22.4 22.6 23.0 24.1 26.2 29.3 30.8 33.1 16.3 9.9 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 45 CASES PER 100,0000 POPULATION Salmonellosis, caused by the bacterium Salmonella, produces diarrhea, fever, and abdominal cramps. Symptoms appear 12 to 72 hours after infection. Approximately 1.2 million US Salmonella infections occur annually, with 1 million of them resulting from contaminated food. by Salmonella 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Salmonella by State m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 2016 edition data source: MMWR, Summary of Notifiable Infectious Diseases and Conditions, 2014 For details: http://www.americashealthrankings.org/AR16/ salmonella Number of new cases of Salmonella per 100,000 population <=11.0 11.1 to 13.3 12 :0 1a 13.4 to 14.8 Top 5 States DC 14.9 to 20.1 RI >=20.2 DE Bottom 5 States Nevada 6.2 Mississippi 33.1 Alaska 9.3 Florida 30.8 Maine 9.6 South Carolina 29.3 West Virginia 9.7 Louisiana 26.2 Oregon 10.2 Alabama 24.1 United States 16.3 United States 16.3 Community & Environment C ORE M E AS URE S 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Census of Fatal Occupational Injuries & US Bureau of Economic Analysis, 2012-2014 For details: http://www.americashealthrankings.org/AR16/ WorkFatalities m Em ES ba T, rg De oe ce d U m nt be il r1 5, In 2014, 4,821 deaths occurred on the job. The leading causes were transportation incidents, contact with equipment, falls, and violence that includes homicide and suicide. Occupational fatalities are indicative of how high-risk jobs and unsafe working conditions impact the population. Hispanic workers are at higher risk of dying from work-related injuries than non-Hispanic workers. Workplace fatalities are almost always preventable. Increased safety precautions and regulatory oversight have helped to decrease the estimated 8.6 million annual occupational injuries that lead to fatalities. The estimated annual direct and indirect cost of these fatalities is $6 billion. DEATHS PER 100,000 WORKERS Occupational Fatalities Occupational Fatalities by State Number of fatal occupational injuries in construction, manufacturing, trade, transportation, utilities, and professional and business services per 100,000 workers 1a <=3.5 DC 12 :0 Top 5 States RI DE Bottom 5 States Massachusetts 2.0 Wyoming 12.0 New York 2.2 North Dakota 10.4 Washington 2.6 Mississippi 8.0 Connecticut 2.9 Oklahoma 7.8 California 3.0 Louisiana 7.6 United States 3.7 United States 3.7 46 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 3.6 to 4.0 4.1 to 4.8 4.9 to 5.5 >=5.6 Community & Environment C OR E M EASURES Violent Crime More than 1.1 million violent crimes and 15,000 homicides occurred in the United States in 2015. Homicide is the thirdleading cause of death among 15 to 34 year olds. Violent crime can cause injuries, mental health issues, disability, death, and long-term stress in children, families, and neighborhoods. Violent crime interferes with healthy lifestyles by discouraging physical activity. Exposure to violence in childhood is associated with increased risk of chronic diseases in adulthood such as heart disease, diabetes, and stroke. Violent crime carries an annual economic burden estimated at $65 billion in lost productivity and $6 billion in direct medical costs. OFFENSES PER 100,0000 POPULATION 1,000 900 800 700 600 500 400 300 200 100 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 2016 edition data source: Federal Bureau of Investigation, 2015 For details: http://www.americashealthrankings.org/AR16/Crime Violent Crime by State Number of murders, rapes, robberies, and aggravated assaults per 100,000 population 1a <=239 294 to 384 385 to 462 >=463 DC 12 :0 Top 5 States 240 to 293 RI DE Bottom 5 States Vermont 118 Alaska 730 Maine 130 Nevada 696 Virginia 196 New Mexico 656 New Hampshire 199 Tennessee 612 Idaho 216 Louisiana 540 United States 383 United States 383 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 47 Policy C ORE M E AS URE S Immunizations—Adolescents m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 As children age, protection from some childhood vaccines begins to diminish, putting school-aged HPV Males children at risk for diseases like pertussis. A Tdap HPV Females booster at age 11 or 12 is recommended to maintain protection against tetanus, diphtheria, and pertussis. Meningococcal The booster also protects those who come in contact with school-aged children, most importantly infants and Tdap 0 10 20 30 40 50 60 70 80 90 100 the elderly. Additional recommended vaccines are the PERCENTAGE OF ADOLESCENTS AGED 13 TO 17 YEARS meningococcal conjugate vaccine (MenACWY) that protects against meningococcal disease in teens and 2016 edition data source: National Immunization Survey, 2015 young adults and the human papillomavirus (HPV) vaccine that protects against For details: http://www.americashealthrankings.org/AR16/immucervical, genital, and oropharyngeal cancers into adulthood. Yearly administration nize_teens_a of the flu vaccine is also recommended to protect against seasonal influenza. Immunizations—Adolescents by State Mean z score of the percentage of adolescents aged 13 to 17 years who received ≥1 dose of Tdap since age 10 years, ≥1 dose of meningococcal conjugate vaccine, and ≥3 doses of human papillomavirus (HPV) vaccine (females and males) 12 :0 1a >=0.597 Top 5 States 0.227 to 0.596 -0.123 to 0.226 -0.567 to -0.124 DC RI DE Bottom 5 States Rhode Island 1.783 Mississippi -1.788 Connecticut 1.300 South Dakota -1.625 Vermont 1.108 Alaska -1.597 New Hampshire 1.057 South Carolina -1.147 Pennsylvania 1.013 Wyoming -1.042 United States 0.000 United States 0.000 48 w w w. a m e r i c a s h e a l th ra n kin g s.o r g <=-0.568 Policy C OR E M EASURES Immunizations—Adolescents, continued Ranking HPV Female—Adolescents Rank State PERCENTAGE OF FEMALES AGED 13 TO 17 YEARS Human papillomavirus (HPV) is the most common sexually transmitted infection, affecting nearly all sexually active people. HPV vaccination can prevent HPV infections that cause cervical, vaginal, and vulvar cancers in women and anal cancer, throat cancer, and genital warts in both men and women. 68.0 55.2 54.4 52.8 52.8 52.4 51.4 49.8 48.9 48.4 48.2 47.8 47.3 47.3 47.2 47.1 46.0 45.1 45.0 44.5 44.2 44.1 43.7 42.5 40.9 40.8 40.6 40.2 39.3 39.2 38.9 38.5 37.8 37.8 36.9 36.8 36.2 34.8 34.3 34.0 32.4 32.3 32.2 31.7 31.5 30.9 30.3 26.5 24.6 24.4 41.9 58.8 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 49 90 80 70 60 50 40 30 20 10 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 ’98 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 2016 edition data source: National Immunization Survey, 2015 For details: http://www.americashealthrankings.org/AR16/ immunize_hpv_female Immunizations, HPV Female—Adolescents by State Percentage of females aged 13 to 17 years who received ≥3 doses of human papillomavirus (HPV) vaccine, either quadrivalent or bivalent >=48.4% 44.5% to 48.3% 12 :0 1a 39.2% to 44.4% DC 34.0% to 39.1% RI <=33.9% DE Top 5 States Bottom 5 States Rhode Island 68.0% Mississippi 24.4% Connecticut 55.2% Utah 24.6% Vermont 54.4% Wyoming 26.5% Delaware Massachusetts United States 41.9% (tie) 52.8% Value (%) 1 Rhode Island 2 Connecticut 3 Vermont 4 Delaware 4 Massachusetts 6 Hawaii 7 New Hampshire 8 Iowa 9 Oregon 10 California 11 Nebraska 12 Pennsylvania 13 New York 13 Wisconsin 15 Michigan 16 North Dakota 17 Colorado 18 Washington 19 New Jersey 20 Minnesota 21 Arizona 22 Maine 23 Maryland 24 Nevada 25 Texas 26 Alabama 27 New Mexico 28 Illinois 29 Louisiana 30 West Virginia 31 Tennessee 32 Virginia 33 North Carolina 33 Ohio 35 Alaska 36 Florida 37 Kentucky 38 Montana 39 South Carolina 40 Arkansas 41 South Dakota 42 Georgia 43 Oklahoma 44 Kansas 45 Missouri 46 Indiana 47 Idaho 48 Wyoming 49 Utah 50 Mississippi United States District of Columbia 100 0 1990 ’92 ’94 ’96 EDITION YEAR by HPV Female— Adolescents Idaho 30.3% Indiana 30.9% United States 41.9% Policy C ORE M E AS URE S Immunizations—Adolescents, continued HPV Male—Adolescents 100 90 80 70 60 50 40 30 20 10 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 0 1990 ’92 ’94 ’96 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, 2016 edition data source: National Immunization Survey, 2015 For details: http://www.americashealthrankings.org/AR16/ immunize_hpv_male Immunizations, HPV Male—Adolescents by State Percentage of males aged 13 to 17 years who received ≥3 doses of human papillomavirus (HPV) vaccine, either quadrivalent or bivalent >=38.1% 30.5% to 38.0% 12 :0 1a 26.4% to 30.4% Top 5 States DC 21.4% to 26.3% RI <=21.3% DE Bottom 5 States Rhode Island 58.1% Tennessee 16.0% New Hampshire 47.1% Arkansas 16.4% Maine 46.7% Kentucky 17.1% Delaware 43.0% Kansas 18.5% Connecticut 42.0% Alaska & Wyoming 18.8% United States 28.1% United States 28.1% 50 w w w. a m e r i c a s h e a l th ra n kin g s.o r g by HPV Male— Adolescents Rank State PERCENTAGE OF FEMALES AGED 13 TO 17 YEARS Human papillomavirus (HPV) is the most common sexually transmitted infection, affecting nearly all sexually active people. HPV vaccination can prevent HPV infections that cause penile cancer in men and anal cancer, throat cancer, and genital warts in both men and women. Ranking Value (%) 1 Rhode Island 2 New Hampshire 3 Maine 4 Delaware 5 Connecticut 6 Vermont 7 New Mexico 8 North Dakota 9 Pennsylvania 10 New York 11 Colorado 12 Hawaii 13 Oklahoma 13 Oregon 15 Massachusetts 16 Wisconsin 17 Nebraska 18 Maryland 19 New Jersey 20 Louisiana 21 North Carolina 22 California 23 Michigan 24 Washington 25 Georgia 25 Indiana 27 West Virginia 28 Arizona 29 Illinois 30 Idaho 31 Virginia 32 Missouri 33 Texas 34 Iowa 35 Nevada 36 Alabama 37 Minnesota 38 South Dakota 39 Montana 40 Mississippi 41 Ohio 41 South Carolina 43 Utah 44 Florida 45 Alaska 45 Wyoming 47 Kansas 48 Kentucky 49 Arkansas 50 Tennessee United States District of Columbia 58.1 47.1 46.7 43.0 42.0 41.1 40.3 38.4 38.3 38.1 37.1 36.2 35.7 35.7 35.2 33.5 32.2 31.3 30.9 30.5 29.8 29.5 28.6 28.0 27.5 27.5 27.1 27.0 26.8 26.4 25.7 25.1 24.0 23.9 23.7 22.6 22.4 22.0 21.7 21.4 21.0 21.0 19.9 19.8 18.8 18.8 18.5 17.1 16.4 16.0 28.1 40.9 Policy C OR E M EASURES Ranking Meningococcal—Adolescents Rank State ’98 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 51 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 6 2016 edition data source: National Immunization Survey, 2015 For details: http://www.americashealthrankings.org/AR16/ Immunize_mcv4 m Em ES ba T, rg De oe ce d U m nt be il r1 5, Immunizations, Meningococcal—Adolescents by State Percentage of adolescents aged 13 to 17 years who received ≥1 dose of meningococcal conjugate vaccine (MenACWY) >=89.5% 83.6% to 89.4% 12 :0 1a 77.7% to 83.5% Top 5 States DC 70.4% to 77.6% RI <=70.3% DE Bottom 5 States Rhode Island 97.7% Mississippi 55.3% New Jersey 95.7% South Dakota 55.5% Michigan 95.0% Alaska 55.7% Pennsylvania 94.7% Wyoming 58.7% Connecticut 93.5% Kansas 63.7% United States 81.3% United States 81.3% Value (%) 97.7 95.7 95.0 94.7 93.5 92.3 91.6 90.9 89.6 89.5 87.7 87.6 87.5 87.3 87.0 86.2 86.0 85.6 84.4 83.6 81.6 81.5 81.4 79.0 79.0 78.7 78.5 78.1 78.0 77.7 77.2 76.7 76.1 75.4 75.2 75.0 72.5 72.1 71.5 70.4 69.7 69.0 68.1 66.8 65.8 63.7 58.7 55.7 55.5 55.3 81.3 90.9 100 90 80 70 60 50 40 30 20 10 0 1990 ’92 ’94 ’96 EDITION YEAR by Meningococcal— Adolescents 1 Rhode Island 2 New Jersey 3 Michigan 4 Pennsylvania 5 Connecticut 6 Indiana 7 North Dakota 8 Louisiana 9 Texas 10 Massachusetts 11 New Hampshire 12 Arizona 13 Delaware 14 Maryland 15 Georgia 16 New York 17 West Virginia 18 Colorado 19 Vermont 20 Minnesota 21 Wisconsin 22 Arkansas 23 Idaho 24 Illinois 24 Kentucky 26 Hawaii 27 North Carolina 28 Nebraska 29 Nevada 30 Maine 31 California 32 Tennessee 33 Ohio 34 Washington 35 Oregon 36 Iowa 37 New Mexico 38 Alabama 39 Utah 40 Florida 41 Missouri 42 South Carolina 43 Oklahoma 44 Virginia 45 Montana 46 Kansas 47 Wyoming 48 Alaska 49 South Dakota 50 Mississippi United States District of Columbia 20 1 Meningococcal disease is a potentially lifethreatening illness caused by the bacterium Neisseria meningitidis, a leading cause of bacterial meningitis in US persons aged two to 18 years. The meningococcal vaccine protects against two of the most common forms of meningococcal disease—meningitis and septicemia. PERCENTAGE OF ADOLESCENTS AGED 13 TO 17 YEARS Immunizations—Adolescents, continued Policy C ORE M E AS URE S Ranking Tdap—Adolescents Rank State 100 80 60 40 20 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 6 2016 edition data source: National Immunization Survey, 2015 For details: http://www.americashealthrankings.org/AR16/ Immunize_tdap m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 The Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine can provide protection from three serious diseases caused by bacteria, tetanus (lockjaw), diphtheria, and pertussis (whooping cough). Since Tdap vaccination began, reported tetanus and diphtheria cases dropped 99%, and reported pertussis dropped 80%. PERCENTAGE OF ADOLESCENTS AGED 13 TO 17 YEARS Immunizations—Adolescents, continued Immunizations, Tdap—Adolescents by State Percentage of adolescents aged 13 to 17 years who received ≥1 dose of tetanus-diphtheria-acellular pertussis (Tdap) since age 10 years >=91.2% 88.7% to 91.1% 12 :0 1a 86.6% to 88.6% Top 5 States Bottom 5 States Alaska 69.7% Vermont 95.8% South Dakota 72.4% Connecticut 93.7% Michigan 74.0% North Carolina 93.4% Mississippi 74.7% Alabama & Colorado 93.3% South Carolina 77.8% United States 86.4% United States 86.4% w w w. a m e r i c a s h e a l th ra n kin g s.o r g 82.5% to 86.5% RI <=82.4% DE Rhode Island 97.1% 52 DC by Tdap—Adolescents Value (%) 1 Rhode Island 2 Vermont 3 Connecticut 4 North Carolina 5 Alabama 5 Colorado 7 New Hampshire 8 Pennsylvania 9 Arkansas 9 Massachusetts 11 Louisiana 12 Minnesota 13 Georgia 14 Indiana 15 Montana 16 Oregon 17 Illinois 18 New York 19 North Dakota 20 Delaware 21 Nevada 22 Wisconsin 23 Wyoming 24 Maine 24 Nebraska 26 Florida 26 Kansas 28 New Jersey 29 Ohio 30 Arizona 31 Maryland 32 New Mexico 33 West Virginia 34 Missouri 35 Iowa 36 Washington 37 Texas 38 Oklahoma 39 Kentucky 40 California 40 Idaho 42 Virginia 43 Utah 44 Tennessee 45 Hawaii 46 South Carolina 47 Mississippi 48 Michigan 49 South Dakota 50 Alaska United States District of Columbia 97.1 95.8 93.7 93.4 93.3 93.3 92.4 91.7 91.2 91.2 91.0 90.4 90.2 89.7 89.5 89.4 89.1 89.0 88.9 88.7 88.3 88.0 87.9 87.7 87.7 87.3 87.3 87.2 86.7 86.6 86.5 85.9 85.8 85.7 85.5 85.3 85.1 84.4 84.0 82.5 82.5 82.2 82.0 79.7 79.6 77.8 74.7 74.0 72.4 69.7 86.4 81.3 Policy C OR E M EASURES 100 80 60 40 20 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: National Immunization Survey, 2015 For details: http://www.americashealthrankings.org/AR16/ Immunize m Em ES ba T, rg De oe ce d U m nt be il r1 5, Early childhood immunization is a safe and cost-effective means of protecting infants and children from potentially life-threatening diseases early in life when children are most vulnerable. Infants receiving recommended immunizations by age two are protected from 14 diseases. Among all children born between 1994 and 2013, routine childhood vaccinations will prevent 322 million cases of disease and about 732,000 early deaths, saving society a total of $1.38 trillion. There is significant geographic, racial, and socioeconomic variation in US childhood vaccination coverage levels. Non-Hispanic black children and children from households living below the federal poverty level had the lowest immunization coverage in 2014. PERCENTAGE OF CHILDREN AGED 19 TO 35 MONTHS Immunizations—Children Immunizations—Children by State Percentage of children aged 19 to 35 months who received recommended doses of diphtheria, tetanus, and acellular pertussis (DTaP), measles, mumps, and rubella (MMR), polio, Haemophilus influenzae (Hib), hepatitis B, varicella, and pneumococcal conjugate vaccines 73.8% to 76.3% 1a >=76.4% 68.3% to 71.2% <=68.2% DC 12 :0 Top 5 States 71.3% to 73.7% RI DE Bottom 5 States Connecticut 80.6% Virginia 64.4% North Dakota 80.2% West Virginia 64.9% Delaware 79.3% Alaska 66.3% Massachusetts 78.5% Arkansas Iowa 77.9% Florida United States 72.2% United States 72.2% (tie) 66.6% A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 53 Policy C ORE M E AS URE S Lack of Health Insurance PERCENTAGE OF POPULATION Individuals without health insurance have more difficulty accessing the health care system, are often unable to participate in preventive care programs, and tend to have more unmet health needs than those with health insurance. Unmet health needs may develop into more serious conditions requiring more costly treatments. Lack of health insurance often leads to emergency department visits that can be 10 times more costly than treatment in a clinic. Since the passage of the Affordable Care Act in 2010, the percentage of uninsured Americans is the lowest it has been in over 50 years. 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 2016 edition data source: American Community Survey, 20142015 For details: http://www.americashealthrankings.org/AR16/ HealthInsurance Lack of Health Insurance by State Percentage of the population that does not have health insurance privately, through their employer, or through the government 7.4% to 8.4% 1a <=7.3% DC 12 :0 Top 5 States RI DE Bottom 5 States Massachusetts 3.1% Texas 18.1% Vermont 4.4% Alaska 16.1% Hawaii 4.7% Florida 15.0% Minnesota 5.2% Georgia 14.9% Iowa 5.6% Oklahoma 14.7% United States 10.6% United States 10.6% 54 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 8.5% to 10.7% 10.8% to 12.3% >=12.4% Policy C OR E M EASURES 100 90 80 70 60 50 40 30 20 10 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Trust For America’s Health, 20142015 For details: http://www.americashealthrankings.org/AR16/ PH_Spending m Em ES ba T, rg De oe ce d U m nt be il r1 5, Public health funding allows states to proactively implement preventive and education programs that improve health. Public health program spending represents only a small fraction of all health care spending, yet its impact can be substantial. Increased spending on public health programs is associated with a decrease in mortality from preventable causes of death. Research shows investing $10 per person per year in community-based programs proven to increase physical activity, improve nutrition, and prevent smoking or other tobacco use could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1 invested. DOLLARS PER PERSON Public Health Funding Public Health Funding by State State dollars dedicated to public health and federal dollars directed to states by the Centers for Disease Control and Prevention (CDC) and the Health Resources Services Administration (HRSA) per person $86 to $105 1a >=$106 $56 to $67 <=$55 DC 12 :0 Top 5 States $68 to $85 RI DE Bottom 5 States Alaska $261 Nevada $34 Hawaii $220 Indiana $41 West Virginia $205 Arizona $42 New York $154 Wisconsin $43 Idaho $142 Missouri $45 United States $94 United States $94 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 55 Clinical Care CORE M E AS URE S Dentists Number of practicing dentists per 100,000 population 40 20 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 6 20 1 1a 59.9 to 69.6 52.9 to 59.8 12 :0 RI DE Bottom 5 States Arkansas 40.9 Alaska 80.8 Mississippi 42.9 Massachusetts 78.3 Alabama 43.8 California 77.1 Delaware 45.6 Connecticut 75.8 Georgia 47.0 United States 60.9 United States 60.9 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 60 DC New Jersey 81.5 56 80 2016 edition data source: American Dental Association, 2015 For details: http://www.americashealthrankings.org/AR16/ dentists >=69.7 Top 5 States 100 m Em ES ba T, rg De oe ce d U m nt be il r1 5, Dentists by State NUMBER PER 100,000 POPULATION Oral health is a vital part of overall health and a window into an individual’s general health. Many underlying conditions such as nutritional deficiencies, microbial infections, and immune disorders have oral manifestations that dentists identify in oral examinations. Periodontal disease is associated with diabetes, cardiovascular disease, and adverse pregnancy outcomes. Nearly one-third of US adults have untreated tooth decay, and despite steady growth in working dentists, the Health Resources and Services Administration has identified many areas and populations that do not have an adequate supply of dentists to meet current needs. The most significant US oral health care disparities exist in rural communities. 49.6 to 52.8 <=49.5 Clinical Care C OR E M EASURES 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: National Vital Statistics System, 2014 For details: http://www.americashealthrankings.org/AR16/ birthweight m Em ES ba T, rg De oe ce d U m nt be il r1 5, Low birthweight (LBW)—one of the five leading causes of US infant mortality—indicates current and future child health as well as maternal health. Potential medical problems in infants with LBW include respiratory distress syndrome, bleeding in the brain, heart problems, retinopathy, and intestinal disorders. There may be a connection between LBW and chronic adulthood diseases such as type 2 diabetes and coronary heart disease. Pregnant women who smoke are nearly twice as likely to have a LBW baby as women who do not smoke. Other significant maternal risk factors include diabetes, high blood pressure, insufficient weight gain during pregnancy, unemployment, and low education or income level. PERCENTAGE OF LIVE BIRTHS Low Birthweight Low Birthweight by State Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth 6.8% to 7.6% 1a <=6.7% >=8.9% 12 :0 RI DE Bottom 5 States Alaska 5.9% Mississippi 11.3% (tie) 6.2% Louisiana 10.5% Alabama 10.1% Oregon Idaho 8.3% to 8.8% DC Top 5 States North Dakota 7.7% to 8.2% (tie) 6.4% Georgia 9.5% Washington South Carolina 9.4% United States 8.0% United States 8.0% A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 57 Clinical Care C ORE M E AS URE S Preventable Hospitalizations Preventable hospitalizations reflect the efficiency of a population’s use of primary care and the quality of the primary health care received. Accessible and effective primary care can reduce hospitalizations for many preventable infectious diseases, asthma attacks, diabetes, and hypertension. Routine care in outpatient settings for non-emergent acute or chronic conditions can prevent complications, more severe disease, and the need for hospitalization. Preventable hospitalizations are more common among the uninsured and often occur because of failure to treat conditions early in an outpatient setting. Preventable hospitalizations impose a nonessential financial burden on health care systems estimated at $30.8 billion. DISCHARGES PER 1,000 MEDICARE ENROLLEES 100 80 60 40 20 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 2016 edition data source: The Dartmouth Atlas of Health Care, 2014 For details: http://www.americashealthrankings.org/AR16/ preventable Preventable Hospitalizations by State Number of discharges for ambulatory care-sensitive conditions per 1,000 Medicare enrollees 1a <=37.1 RI DE Bottom 5 States Hawaii 23.5 Kentucky 77.0 Utah 28.8 West Virginia 71.9 Colorado Idaho (tie) 32.1 Mississippi 67.8 Louisiana 67.5 Washington 32.6 Arkansas 61.9 United States 49.9 United States 49.9 58 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 46.3 to 50.3 DC 12 :0 Top 5 States 37.2 to 46.2 50.4 to 56.6 >=56.7 Clinical Care C OR E M EASURES Primary Care Physicians NUMBER PER 100,000 POPULATION Primary care physicians (PCPs) provide direct patient care and counsel patients on the appropriate use of specialists and advanced treatment options. The Health Services and Resource Administration estimates that an additional 8,200 PCPs are needed to meet unmet needs. PCPs are typically the first point of contact with the health care system for patients and provide critical preventive care, ongoing care, and referrals to specialists. PCP availability has a documented influence on health; having a greater number of primary care physicians has been linked to better health outcomes including lower rates of low birthweight, lower all-cause mortality, and longer life spans. 200 180 160 140 120 100 80 60 40 20 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 2016 edition data source: American Medical Association, Special data request for information on active state licensed physicians provided by Redi-Data, Inc, Oct 24, 2016 For details: http://www.americashealthrankings.org/AR16/PCP Primary Care Physicians by State Number of active primary care physicians (including general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics, and internal medicine) per 100,000 population 141.4 to 172.5 1a >=172.6 117.7 to 131.4 <=117.6 DC 12 :0 Top 5 States 131.5 to 141.3 RI DE Bottom 5 States Rhode Island 247.7 Idaho 93.7 Massachusetts 227.5 Utah 96.7 New York 206.2 Mississippi 102.3 Connecticut 197.8 Wyoming 103.7 Pennsylvania 192.9 Nevada 104.3 United States 145.3 United States 145.3 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 59 Outcomes C ORE M E AS URE S Cancer Deaths 500 400 300 200 100 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: National Vital Statistics System, 2012-2014 For details: http://www.americashealthrankings.org/AR16/ CancerDeaths m Em ES ba T, rg De oe ce d U m nt be il r1 5, Cancer Deaths by State DEATHS PER 100,000 POPULATION Cancer is the second-leading cause of death. More than 1.6 million new cancer cases and 585,000 cancer deaths occur annually. Lung, prostate, breast, and colorectal cancers contribute substantially to cancer mortality. Quitting smoking at any age lowers the risk of developing lung cancer. However, lung cancer does not only develop in those who smoke; an estimated 7,300 people die from lung cancer caused by secondhand smoke annually. Deaths from breast cancer, colorectal cancer, and cervical cancer may be avoided through screening programs that detect cancer in early stages while it is most susceptible to treatment. The direct medical cost of cancer was $88.7 billion in 2011. Number of deaths due to all causes of cancer per 100,000 population 177.9 to 186.9 1a <=177.8 DC 12 :0 Top 5 States RI DE Bottom 5 States Utah 149.3 Kentucky 232.2 Hawaii 158.4 Mississippi 227.5 Colorado 161.8 West Virginia 223.9 New Mexico 168.3 Louisiana 218.7 California 169.9 Arkansas 218.1 United States 189.9 United States 189.9 60 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 187.0 to 194.4 194.5 to 208.6 >=208.7 Ranking Disparities in Cancer Deaths by Cancer Deaths US Rate Maximum and Minimum Rate by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Rate by Gender Black* Hispanic Female White* Male 100 150 200 0 250 DEATHS PER 100,000 POPULATION 50 100 150 200 DEATHS PER 100,000 POPULATION 250 6 50 * Includes Hispanic ethnicity m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 0 “Getting screening tests regularly may find breast, cervical, and colorectal (colon) cancers early, when treatment is likely to work best.” CENTERS FOR DISEASE CONTROL AND PREVENTION visits ctor •a r do a l u g ysical activity • • re ic ph •a rob e vo •l a id enin im scre se it co f a nd t• ha p nd sm sm ok in ok g e •a •m vo se ai id lfta ex n t a nn am i n ing a s bed he s• al th yw eig ht • les e a t ve ge t a b t immunized • • ge sa fe se x to •s do ct o• cc ba to se ’t u on •d or vi si ts • it ar fru ul eat eg n tio tri nu t• •r it fa id vo es id ic t s pe • lim 1a eat fruit • b e s• 12 :0 • it fat • lim active g am 149.3 158.4 161.8 168.3 169.9 170.0 172.0 173.2 176.2 177.8 179.2 179.6 179.8 182.0 182.1 182.2 183.0 184.8 185.5 186.9 188.0 189.1 189.2 189.2 190.5 190.9 191.6 192.6 193.3 194.4 194.4 195.2 196.2 198.5 199.6 199.8 201.0 202.7 203.1 208.6 209.3 210.5 211.1 215.2 215.6 218.1 218.7 223.9 227.5 232.2 189.9 208.5 -ex Value 1 Utah 2 Hawaii 3 Colorado 4 New Mexico 5 California 6 Arizona 7 Wyoming 8 Connecticut 9 North Dakota 10 Idaho 11 Minnesota 12 New York 13 Montana 14 Washington 15 Florida 16 Texas 17 New Jersey 18 Massachusetts 19 South Dakota 20 Nebraska 21 New Hampshire 22 Nevada 23 Maryland 23 Virginia 25 Vermont 26 Oregon 27 Wisconsin 28 Kansas 29 Alaska 30 Georgia 30 Iowa 32 Rhode Island 33 North Carolina 34 Delaware 35 Illinois 36 Pennsylvania 37 Michigan 38 South Carolina 39 Maine 40 Ohio 41 Missouri 42 Indiana 43 Alabama 44 Oklahoma 45 Tennessee 46 Arkansas 47 Louisiana 48 West Virginia 49 Mississippi 50 Kentucky United States District of Columbia self Rank State A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 61 Outcomes C ORE M E AS URE S Cardiovascular Deaths DEATHS PER 100,000 POPULATION Heart disease and stroke are the US’s leading and fifth-leading causes of death, respectively. While heart disease affects US adults of all races, ages, and income levels, disparities exist. Non-Hispanic blacks have nearly twice the rate of avoidable deaths from heart disease, stroke, and hypertensive disease as non-Hispanic whites. Black men are 30% more likely to experience cardiovascular death than white men. Of cardiovascular deaths among American Indian and Alaska Natives, 36% occur before age 65, compared with a rate of 17% in the total population. Cardiovascular disease is responsible for 17% of medical spending and 30% of Medicare spending. 500 400 300 200 100 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 2016 edition data source: National Vital Statistics System, 2012-2014 For details: http://www.americashealthrankings.org/AR16/ CVDDeaths Cardiovascular Deaths by State Number of deaths due to all cardiovascular diseases including heart disease and stroke per 100,000 population 217.3 to 230.4 1a <=217.2 DC 12 :0 Top 5 States RI DE Bottom 5 States Minnesota 188.2 Mississippi 344.8 Colorado 199.3 Alabama 332.9 Massachusetts 205.6 Oklahoma 325.9 Hawaii 206.6 Arkansas 317.3 Oregon 212.4 Louisiana 312.5 United States 251.7 United States 251.7 62 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 230.5 to 251.9 252.0 to 278.7 >=278.8 Ranking Disparities in Cardiovascular Deaths by Cardiovascular Deaths Rate by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Rate by Gender Black* Hispanic Female White* Male 50 100 150 200 250 300 350 DEATHS PER 100,000 POPULATION 400 0 50 * Includes Hispanic ethnicity 100 150 200 250 300 350 DEATHS PER 100,000 POPULATION 400 6 0 20 1 188.2 199.3 205.6 206.6 212.4 213.3 213.7 213.9 214.1 217.2 217.5 220.8 224.8 225.0 226.9 227.0 227.3 229.2 229.9 230.4 231.4 233.8 234.4 236.8 239.0 245.4 245.9 247.5 249.6 251.9 252.5 253.8 256.2 256.9 259.3 272.9 274.1 277.1 277.8 278.7 283.6 288.7 297.8 297.9 302.7 312.5 317.3 325.9 332.9 344.8 251.7 299.4 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1 Minnesota 2 Colorado 3 Massachusetts 4 Hawaii 5 Oregon 6 Washington 7 Arizona 8 New Hampshire 9 Alaska 10 Connecticut 11 New Mexico 12 Maine 13 Florida 14 Utah 15 Vermont 16 Nebraska 17 Montana 18 Idaho 19 California 20 Rhode Island 21 North Dakota 22 South Dakota 23 Wyoming 24 Wisconsin 25 Virginia 26 New Jersey 27 Iowa 28 Delaware 29 Kansas 30 North Carolina 31 Maryland 32 Illinois 33 New York 34 Texas 35 Pennsylvania 36 Georgia 37 South Carolina 38 Indiana 39 Nevada 40 Ohio 41 Missouri 42 Michigan 43 Kentucky 44 West Virginia 45 Tennessee 46 Louisiana 47 Arkansas 48 Oklahoma 49 Alabama 50 Mississippi United States District of Columbia US Rate Maximum and Minimum “The majority of cardiovascular disease is caused by risk factors that can be controlled, treated or modified, such as high blood pressure, cholesterol, overweight/ obesity, tobacco use, lack of physical activity and diabetes.” WORLD HEART FEDERATION 1a Value 12 :0 Rank State avoid bad smoke-free chol e st e r ol • environments • healthy diet • manage diabetes • eat fruits and vegetables • stay active • massage therapy • manage stress • exercise • maintain a healthy weight • maintain your social life • get sleep • manage anxiety and depression • diet low in saturated fat • regular physical activity • quit smoking • be happy • A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 63 Outcomes C ORE M E AS URE S Diabetes PERCENTAGE OF ADULT POPULATION Diabetes, the nation’s seventh-leading cause of death, has three major types: type 1, type 2, and gestational. It is a chronic condition that contributes to other leading causes of death, including heart disease and stroke. Diabetes is a leading cause of kidney failure, nontraumatic lowerlimb amputations, and blindness in adults. Type 2 diabetes accounts for 90% to 95% of all cases. Onset of type 2 diabetes can be prevented through improving diet, increasing physical activity, and losing weight. Medical expenses for individuals with diabetes are 2.3 times higher than those without diabetes. Costs of type 1, type 2, gestational, undiagnosed diabetes, and prediabetes exceeded $322 billion in 2012. 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/ Diabetes m Em ES ba T, rg De oe ce d U m nt be il r1 5, Diabetes by State ’98 Percentage of adults who reported being told by a health professional that they have diabetes (excludes prediabetes and gestational diabetes) 8.5% to 9.3% 9.4% to 10.4% 1a <=8.4% 12 :0 DC RI DE Top 5 States Bottom 5 States Colorado 6.8% Mississippi 14.7% Utah 7.0% West Virginia 14.5% Alaska Minnesota (tie) 7.6% Alabama 13.5% Kentucky 13.4% Montana 7.9% Louisiana & Tennessee 12.7% United States 9.9% United States 9.9% 64 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 10.5% to 11.5% >=11.6% Ranking Disparities in Diabetes by Diabetes US Rate Maximum and Minimum Prevalence by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Black* Prevalence by Gender Hawaiian/Pacific Islander* Female Hispanic Male 5 10 White* 15 PERCENT OF ADULTS 0 10 6 0 20 30 PERCENT OF ADULTS 20 1 * Non-Hispanic 40 Prevalence by Education m Em ES ba T, rg De oe ce d U m nt be il r1 5, Prevalence by Age College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 5 10 15 20 25 30 PERCENT OF ADULTS 0 5 10 15 20 5 10 15 20 25 PERCENT OF ADULTS AGED 25+ Prevalence by Income Prevalence by Urbanicity $75,000 or More Urban 1a $50,000 to $74,999 $25,000 to $49,999 Rural Less Than $25,000 10 15 20 25 0 PERCENT OF ADULTS y w •e a t re g u la r m ea n it o r b lo o d o th ht •m h l ea g ei ls • be physically active every day • glucose leve maintain a PERCENT OF ADULTS AGED 25+ •i •i ns • d ie t • s e style chang e • stay active ex e r in g • stop smoking ••••• betes lif • healthier eat ••• •• control blood sugar • cholesterol a nsulin pump • di eat less t less salt sugar nsulin injectio •••••• 5 eat less fat • blood pressure • 0 pills • 12 :0 Suburban ea 6.8 7.0 7.6 7.6 7.9 8.1 8.1 8.2 8.4 8.4 8.4 8.5 8.7 8.8 8.8 8.9 9.0 9.0 9.3 9.3 9.7 9.7 9.8 9.9 9.9 10.0 10.1 10.3 10.3 10.4 10.7 10.7 10.7 11.0 11.3 11.3 11.4 11.4 11.5 11.5 11.5 11.7 11.8 12.6 12.7 12.7 13.4 13.5 14.5 14.7 9.9 8.5 •••• Value (%) 1 Colorado 2 Utah 3 Alaska 3 Minnesota 5 Montana 6 Idaho 6 New Hampshire 8 Vermont 9 Washington 9 Wisconsin 9 Wyoming 12 Hawaii 13 North Dakota 14 Iowa 14 Nebraska 16 Massachusetts 17 New Jersey 17 Rhode Island 19 Connecticut 19 South Dakota 21 Kansas 21 Nevada 23 New York 24 Illinois 24 Maine 26 California 27 Arizona 28 Maryland 28 Virginia 30 Pennsylvania 31 Michigan 31 North Carolina 31 Oregon 34 Ohio 35 Florida 35 Georgia 37 Indiana 37 Texas 39 Delaware 39 Missouri 39 New Mexico 42 Oklahoma 43 South Carolina 44 Arkansas 45 Louisiana 45 Tennessee 47 Kentucky 48 Alabama 49 West Virginia 50 Mississippi United States District of Columbia ls • Rank State c i se • health y A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 65 Outcomes C ORE M E AS URE S 50 40 30 20 10 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/ healthstatus_disparity m Em ES ba T, rg De oe ce d U m nt be il r1 5, Education improves health, and this disparity measure showcases the importance of keeping students in school through high school and beyond. Education is a socioeconomic indicator associated with longer life regardless of age, gender, or race. It may improve health directly (healthier lifestyles, better stress-coping, more effective chronic disease management) and indirectly (better work and economic conditions, and social-psychological resources). Each increase in education level generally improves health status. Reducing health disparities between US adults with less education and those with college education would result in savings of more than $1 trillion annually, according to the National Bureau of Economic Research. PERCENT DIFFERENCE Disparity in Health Status Disparity in Health Status by State Difference between the percentage of adults with a high school education compared with those without who reported their health is very good or excellent (adults aged <25 years excluded) 23.9% to 26.9% 1a <=23.8% 12 :0 DC RI DE Top 5 States Bottom 5 States Hawaii 14.8% California 38.0% Oklahoma 19.9% Vermont 35.6% Tennessee 20.5% Colorado 33.9% Wyoming 20.9% Rhode Island 33.7% Kentucky 21.9% Massachusetts 33.1% United States 29.5% United States 29.5% 66 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 27.0% to 28.5% 28.6% to 30.5% >=30.6% Ranking Disparities in Disparity in Health Status by Disparity in Health Status US Rate Maximum and Minimum Percent Difference by Race and Hispanic Origin Alaska Native/ American Indian* (Adults aged <25 years excluded) Asian* Black* Percent Difference by Gender Hawaiian/Pacific Islander* Female Hispanic Male 20 30 40 PERCENT DIFFERENCE 50 White* 60 0 6 10 * Non-Hispanic 10 20 30 40 50 60 PERCENT DIFFERENCE 70 20 1 0 Percent Difference by Education m Em ES ba T, rg De oe ce d U m nt be il r1 5, Percent Difference by Age College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 10 20 30 40 50 60 PERCENT DIFFERENCE 0 70 10 20 30 40 50 PERCENT DIFFERENCE 60 70 Percent Difference by Income Percent Difference by Urbanicity $75,000 or More Urban 1a $50,000 to $74,999 $25,000 to $49,999 Rural Less Than $25,000 60 0 keep students in school rs me families co 50 60 70 s y in c hoo teens • public heal aler ts • productive careers education improves health in 40 th community interventions ns • tio d behavioral interven ete 30 PERCENT DIFFERENCE com mun accurate health information accessible health information ta 20 l• romote hea •p 10 immunization programs PERCENT DIFFERENCE 50 grams • s 40 ro 30 outreach • health literacy 20 preventive health services • ta rg 10 ts for low-in en 0 reduce risk-taking behavio 12 :0 Suburban y environm lth 14.8 19.9 20.5 20.9 21.9 22.0 22.4 22.5 22.6 23.8 24.6 24.8 25.1 25.7 25.7 25.8 25.8 26.3 26.7 26.9 27.2 27.3 27.4 27.4 27.5 27.7 27.7 28.4 28.5 28.5 28.6 29.0 29.1 29.2 29.2 29.4 29.8 30.3 30.3 30.5 30.8 31.3 31.4 31.6 32.4 33.1 33.7 33.9 35.6 38.0 29.5 29.0 -based p Value (%) 1 Hawaii 2 Oklahoma 3 Tennessee 4 Wyoming 5 Kentucky 6 Missouri 7 Indiana 8 South Dakota 9 Mississippi 10 Arkansas 11 West Virginia 12 Louisiana 13 Alaska 14 Minnesota 14 New York 16 Nevada 16 Wisconsin 18 Michigan 19 Washington 20 Alabama 21 South Carolina 22 Kansas 23 Idaho 23 New Hampshire 25 Montana 26 Maryland 26 Ohio 28 Texas 29 Georgia 29 Virginia 31 North Carolina 32 Nebraska 33 Illinois 34 Maine 34 North Dakota 36 New Jersey 37 Pennsylvania 38 Oregon 38 Utah 40 New Mexico 41 Iowa 42 Connecticut 43 Arizona 44 Florida 45 Delaware 46 Massachusetts 47 Rhode Island 48 Colorado 49 Vermont 50 California United States District of Columbia ity Rank State A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 67 Outcomes C ORE M E AS URE S 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/mental_distress m Em ES ba T, rg De oe ce d U m nt be il r1 5, Frequent mental distress (FMD), a measure of healthrelated quality of life, captures the segment of the population experiencing persistent and likely severe mental health issues. FMD is associated with housing and food insecurity, and insufficient sleep. The number of poor mental health days a person experiences is a significant predictor of future adverse health events resulting in a health provider visit, hospitalization, or mortality within 30 days and within one year. Although occasional short periods of mental distress may be unavoidable, more prolonged and serious episodes are treatable and preventable through early intervention. Estimates put the economic burden of serious mental illness at $317 billion, excluding incarceration, homelessness, comorbid conditions, and early mortality. PERCENTAGE OF ADULT POPULATION Frequent Mental Distress Frequent Mental Distress by State Percentage of adults who reported their mental health was not good 14 or more days in the past 30 days 10.1% to 11.0% 1a <=10.0% DC 12 :0 Top 5 States RI DE Bottom 5 States South Dakota 7.1% West Virginia 15.6% Minnesota 8.7% Mississippi 15.0% Hawaii 8.8% Arkansas 14.9% Nebraska 8.9% Louisiana 14.3% North Dakota 9.2% Tennessee 14.0% United States 11.2% United States 11.2% 68 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 11.1% to 11.5% 11.6% to 13.0% >=13.1% Ranking Disparities in Frequent Mental Distress by Frequent Mental Distress US Rate Maximum and Minimum Prevalence by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Black* Prevalence by Gender Hawaiian/Pacific Islander* Female Hispanic Male 10 White* 15 0 6 5 PERCENT OF ADULTS * Non-Hispanic 5 10 20 1 0 15 20 25 PERCENT OF ADULTS 30 35 Prevalence by Education m Em ES ba T, rg De oe ce d U m nt be il r1 5, Prevalence by Age College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 10 20 0 PERCENT OF ADULTS 5 10 15 20 5 10 15 20 25 PERCENT OF ADULTS AGED 25+ Prevalence by Income Prevalence by Urbanicity $75,000 or More $50,000 to $74,999 Suburban $25,000 to $49,999 Rural Less Than $25,000 0 25 PERCENT OF ADULTS AGED 25+ •• • ••• •• ••• ••••••••• •••••••• ••• ••• •• •• •• ••••••••••• •• • • • build a •• •• support system • identify stress triggers • peer support relationships • hope • suicide prevention line • set goals • know warning signs • raise awareness • recognize signs • talk about issues • listen • early treatment • destigmatize • ask for help • medication • therapy • manage stress • • •• •• •• • • • •••• ••• •• •••• •••• • •••• • PERCENT OF ADULTS 20 •• 15 • •• 10 ••• 5 ••• 0 ••• 12 :0 1a Urban •• 7.1 8.7 8.8 8.9 9.2 9.5 9.7 9.7 10.0 10.0 10.3 10.3 10.4 10.5 10.6 10.6 10.6 10.7 10.9 11.0 11.0 11.1 11.1 11.2 11.2 11.2 11.3 11.4 11.5 11.5 11.6 11.6 11.6 11.7 11.9 12.0 12.4 12.4 12.9 13.0 13.1 13.6 13.7 13.8 13.9 14.0 14.3 14.9 15.0 15.6 11.2 10.2 • Value (%) 1 South Dakota 2 Minnesota 3 Hawaii 4 Nebraska 5 North Dakota 6 Iowa 7 Illinois 7 Kansas 9 Texas 9 Wisconsin 11 Idaho 11 Virginia 13 Colorado 14 Maryland 15 Montana 15 Utah 15 Vermont 18 New Jersey 19 New Hampshire 20 Alaska 20 California 22 Connecticut 22 Delaware 24 Arizona 24 Georgia 24 Washington 27 New Mexico 28 Pennsylvania 29 Nevada 29 New York 31 Maine 31 Massachusetts 31 Wyoming 34 North Carolina 35 Michigan 36 Ohio 37 Indiana 37 Rhode Island 39 Missouri 40 Florida 41 Oklahoma 42 Oregon 43 South Carolina 44 Kentucky 45 Alabama 46 Tennessee 47 Louisiana 48 Arkansas 49 Mississippi 50 West Virginia United States District of Columbia • Rank State A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 69 Outcomes C ORE M E AS URE S 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/Physical_distress m Em ES ba T, rg De oe ce d U m nt be il r1 5, Frequent physical distress (FPD) is a measure of healthrelated quality of life and captures the population experiencing persistent and likely severe physical health problems. The prevalence of FPD is higher among adults with a greater number of chronic illnesses. Among adults with chronic conditions, prevalence of FPD is highest among those with cardiovascular disease, including myocardial infarction, angina, and stroke. Research shows that poor physical health days, along with other self-reported measures of health-related quality of life, are significant predictors of future adverse health events resulting in a provider visit, hospitalization, or mortality within 30 days and within one year among older adults. PERCENTAGE OF ADULT POPULATION Frequent Physical Distress Frequent Physical Distress by State Percentage of adults who reported their physical health was not good 14 or more days in the past 30 days 10.3% to 11.0% 1a <=10.2% Hawaii Minnesota Utah RI DE West Virginia 18.6% (tie) 9.2% (tie) 9.5% United States 11.4% 70 >=13.8% Bottom 5 States North Dakota 8.5% Alaska 12.2% to 13.7% DC 12 :0 Top 5 States 11.1% to 12.1% w w w. a m e r i c a s h e a l th ra n kin g s.o r g Tennessee 16.5% Kentucky 16.1% Alabama Mississippi United States 11.4% (tie) 15.0% Ranking Disparities in Frequent Physical Distress US Rate Maximum and Minimum Prevalence by Race and Hispanic Origin Alaska Native/ American Indian* Asian* Black* Prevalence by Gender Hawaiian/Pacific Islander* Female Hispanic Male 10 15 White* 20 0 6 5 PERCENT OF ADULTS * Non-Hispanic 5 10 15 20 25 30 PERCENT OF ADULTS 35 20 1 0 Prevalence by Education m Em ES ba T, rg De oe ce d U m nt be il r1 5, Prevalence by Age College Graduate 18 to 44 Some College 45 to 64 High School 65+ Less Than High School 0 5 10 15 20 PERCENT OF ADULTS 0 25 5 10 15 20 25 10 15 20 25 30 PERCENT OF ADULTS AGED 25+ 35 Prevalence by Income Prevalence by Urbanicity $75,000 or More Urban $50,000 to $74,999 Suburban $25,000 to $49,999 Rural 15 20 Less Than $25,000 25 0 5 PERCENT OF ADULTS AGED 25+ 30 35 • regular doctor visits • • don’t use tobacco • • o a l d i e t • a v lt a act e iv it y • h • do stretching • • • ••• • • • ••• hy ht • ealthy we ah n egetables ig v prevent injuries avoid infections • limit fat • • eat fruit • • • ••• 10 PERCENT OF ADULTS id hy v i r u s e s lif e s ty l e 5 • main • ea tai t 0 lt h e a si c phy 8.5 9.2 9.2 9.5 9.5 9.6 9.8 9.8 10.0 10.2 10.2 10.4 10.6 10.7 10.7 10.9 10.9 10.9 10.9 11.0 11.1 11.2 11.2 11.3 11.4 11.9 12.1 12.1 12.1 12.1 12.1 12.3 12.3 12.8 13.0 13.2 13.2 13.5 13.6 13.7 13.9 14.0 14.4 14.8 14.9 15.0 15.0 16.1 16.5 18.6 11.4 9.5 1a Value (%) 1 North Dakota 2 Alaska 2 Hawaii 4 Minnesota 4 Utah 6 Nebraska 7 Iowa 7 South Dakota 9 Kansas 10 New Jersey 10 Virginia 12 Illinois 13 New Hampshire 14 Colorado 14 Wisconsin 16 Connecticut 16 Delaware 16 Idaho 16 Massachusetts 20 Texas 21 Vermont 22 California 22 Maryland 24 Washington 25 Pennsylvania 26 Maine 27 Arizona 27 Georgia 27 New York 27 Ohio 27 Wyoming 32 Montana 32 Nevada 34 Rhode Island 35 Michigan 36 North Carolina 36 South Carolina 38 Indiana 39 Oregon 40 New Mexico 41 Missouri 42 Florida 43 Louisiana 44 Oklahoma 45 Arkansas 46 Alabama 46 Mississippi 48 Kentucky 49 Tennessee 50 West Virginia United States District of Columbia 12 :0 Rank State • • • •• by Frequent Physical Distress A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 71 Outcomes C ORE M E AS URE S 25 20 15 10 5 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 6 2016 edition data source: National Vital Statistics System, 2013-2014 For details: http://www.americashealthrankings.org/AR16/IMR m Em ES ba T, rg De oe ce d U m nt be il r1 5, More than 23,000 US infants died in 2014. Significant progress has been made in the past 50 years to reduce infant mortality, but the US rate remains consistently higher than other developed countries. The top five causes of infant death are birth defects, preterm birth and low birthweight, maternal complications of pregnancy, sudden infant death syndrome, and injuries. These causes account for 57% of infant deaths. The infant mortality rate is significantly higher for non-Hispanic blacks, unmarried mothers, and mothers younger than 15 years. Differences in infant mortality rates across the United States are largely driven by socioeconomic status. DEATHS PER 1,000 LIVE BIRTHS Infant Mortality Infant Mortality by State Number of infant deaths (before age 1 year) per 1,000 live births 1a <=5.0 DC 12 :0 Top 5 States RI DE Bottom 5 States Massachusetts 4.3 Mississippi 8.9 New Jersey 4.4 Alabama 8.7 Louisiana 8.1 California (tie) 4.5 Iowa Arkansas 7.6 Vermont & Washington Oklahoma 7.5 United States 5.9 United States 5.9 72 w w w. a m e r i c a s h e a l th ra n kin g s.o r g 5.1 to 5.6 5.7 to 6.3 6.4 to 6.9 >=7.0 Outcomes C OR E M EASURES Premature Death YEARS LOST PER 100,000 POPULATION Premature death captures the years of potential life lost before age 75 (YPLL-75). Deaths occurring in youth cause the measure’s value to increase more than a death in someone closer to age 75. Deaths among youth are more likely to be preventable than deaths in seniors and often indicate health care system failures and/or lifestyle factors. Cancer, unintentional injuries, heart disease, suicide, and perinatal deaths are the US’s top five causes of premature death. Nearly half of US premature deaths are due to behavioral factors such as tobacco use, lack of physical activity, and poor diet. 14 12 10 8 6 4 2 0 1990 ’92 ’94 ’96 EDITION YEAR ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 2016 edition data source: CDC, National Vital Statistics System, 2014 For details: http://www.americashealthrankings.org/AR16/YPLL Premature Death by State Number of years of potential life lost before age 75 years per 100,000 population 6,096 to 6,652 1a <=6,095 7,246 to 8,239 >=8,240 DC 12 :0 Top 5 States 6,653 to 7,245 RI DE Bottom 5 States Minnesota 5,369 Mississippi 10,804 Connecticut 5,451 West Virginia 10,245 California 5,528 Alabama 10,097 New York 5,658 Louisiana 9,958 Massachusetts 5,755 Oklahoma 9,895 United States 7,054 United States 7,054 A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 73 6 20 1 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, Supplemental Measures A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 75 SU PP L E M E NTAL M EA SU R E S Binge Drinking Behaviors Excessive alcohol use caused 1 in 10 deaths among adults aged 20 to 64 years from 2006 to 2010; more than half were from binge drinking. Roughly 38 million US adults report binge drinking an average of four times per month. While binge drinking accounts for more than half of all alcohol consumed by adults, most binge drinkers are not considered alcohol- dependent. Binge drinking contributes to motor vehicle injuries and deaths, increased aggression, and risky sexual behavior. In 2010 excessive drinking cost the United States $249 billion due to missed work, additional health care expenses, and increased crime. Binge drinking was responsible for 77% of these costs. 15.8% to 16.7% RI 16.8% to 18.2% DE >= 18.3% 12% 8% 4% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, DC 16% 6 14.2% to 15.7% 20% 20 1 <= 14.1% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported having four or more (women) or five or more (men) drinks on one occasion in the past month 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/Binge Chronic Drinking Behaviors years of life are lost to those who die from excessive alcohol consumption. The US Preventive Services Task Force recommends clinicians screen adults aged 18 years and older for alcohol misuse. A variety of evidence-based strategies have been shown to be effective in preventing excessive drinking and reducing alcohol-related health and social costs. 12 :0 1a Chronic drinking is a symptom of alcohol addiction or alcoholism but is not an exclusive behavior of alcohol dependence. Drinking in excess for prolonged periods of time increases the risk of developing health problems such as liver disease, high blood pressure, heart disease, stroke, some cancers, and unintentional injuries. On average, 30 <= 4.8% DC 4.9% to 5.6% RI 5.7% to 6.1% DE 6.2% to 6.5% >= 6.6% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported having eight or more (women) or 15 or more (men) drinks per week 10% 8% 6% 4% 2% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/chronic_drinking 76 w w w. a m e r i c a s h e a l t h r a n k i n g s . o r g S U P P LE ME N TA L M EASURES Fruit Behaviors Roughly half of US adults suffer from one or more preventable chronic diseases related to poor diet and physical inactivity. Diets high in fruit and vegetables reduce the risk of chronic diseases and assist with weight management. The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study showed a 27% reduction in cardiovascular disease mortality and a 15% decrease in all-cause mortality in those consuming fruits and vegetables three or more times daily compared with those eating them less than once daily. Unfortunately, US adults only consume 1.4 fruits daily on average, and less than 18% consume the recommended daily amount of fruit. FRUITS PER DAY Mean number of fruits consumed per day by adults DE <= 1.1 2 1 20 1 1.2 3 0 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1.3 RI 4 6 >= 1.4 DC 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/Fruit Insufficient Sleep 12 :0 1a Insufficient sleep has become a public health epidemic. About 70 million US adults suffer from chronic sleep and wakefulness disorders. Adults averaging fewer than seven hours of sleep per night are more likely to have obesity, diabetes, cancer, hypertension, and depression. An estimated $15.9 billion of health care costs are attributable to sleep Behaviors disorders, sleep deprivation, and sleepiness, not including the costs of accidents, lost productivity, and sleeprelated health problems. The National Sleep Foundation recommends adults sleep seven to eight hours and school-aged children sleep at least 10 hours nightly. <= 30.9% DC RI DE 31.0% to 32.7% 32.8% to 35.7% 35.8% to 37.4% >= 37.5% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported sleeping less than seven hours in a 24-hour period on average 50% 40% 30% 20% 10% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2014 For details: http://www.americashealthrankings.org/AR16/sleep A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 77 SU PP L E M E NTAL M EA SU R E S Seat Belt Use Behaviors States with primary seat belt laws tend to have higher rates of seat belt use, compared with states with only secondary or no seat belt laws. Non-fatal injuries to drivers and passengers result in more than $45 billion in lifetime medical costs and lost work productivity. Motor vehicle accidents (MVA) are the leading cause of death among those aged 1 to 54 years in the United States. Wearing a seat belt—the most effective way to prevent deaths and injuries in MVAs—reduces injuries and deaths approximately 50%. More than half of teens and adults who died in MVAs in 2014 were not wearing their seat belts. 88.3% to 91.0% RI 85.6% to 88.2% DE 83.0% to 85.5% 60% 40% 20% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, <= 82.9% 80% 6 DC 100% 20 1 >= 91.1% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported always using a seat belt when driving or riding in a car 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/seatbelt_use Vegetables Behaviors average per day, and less than 14% consume the daily recommended amount of vegetables. States with a higher density of healthy food retailers, farmers markets, and nutrition-assistance program benefits accepted by farmers markets show a higher consumption of fruit and vegetables than other states. 12 :0 1a Epidemiological data show quantity, not variety, of fruit and vegetable intake is associated with lower cardiovascular disease risk. Higher fruit and vegetable intake is also associated with a lower risk of myocardial infarction, ischemic heart disease, and ischemic stroke. Unfortunately, US adults only consume 2.0 servings of vegetables on >= 2.1 DC 2.0 RI 1.9 DE 1.8 VEGETABLES PER DAY Mean number of vegetables consumed per day by adults 5 4 3 2 1 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR <= 1.7 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/Veggie 78 w w w. a m e r i c a s h e a l t h r a n k i n g s . o r g S U P P LE ME N TA L M EASURES Income Disparity Community & Environment Over the past 45 years median family income has decreased while the top tier of income distribution experienced growth, widening the US income disparity. Countries with greater income disparity have higher rates of obesity, imprisonment, violence, and chronic stress, as well as lower levels of social cohesion and trust. Individuals in states with the largest income disparity are more likely to self-report poor health compared with individuals in states with the smallest income disparity. Most developed European nations and Canada have Gini indices between 0.22 and 0.38, while the United States Gini index has stayed between 0.45 and 0.48 since the mid-1990s. GINI RATIO A coefficient representing income distribution; zero indicates total income equality and one indicates complete income inequality (Gini coefficient) 1.0 0.8 0.6 0.4 DC 0.459 to 0.470 RI 0.471 to 0.480 0.2 20 1 0.448 to 0.458 6 <= 0.447 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR >= 0.481 m Em ES ba T, rg De oe ce d U m nt be il r1 5, DE 2016 edition data source: American Community Survey, 2015 For details: http://www.americashealthrankings.org/AR16/gini Median Household Income 12 :0 1a Median household income (MHI) reflects a household’s ability to afford a healthy diet, preventive medicine, and curative care. MHI tends to more accurately reflect the “typical” household than average household income does, which is based on a mean that can be distorted by a few extremely wealthy households. The 2015 US MHI was $56,516, up 5.2% from Community & Environment 2014—the first annual increase in MHI since 2007. The largest difference in health is between those with the highest and lowest incomes, and there are health differences at every income level between those with lower versus those with higher income. >= $66,258 DC $59,494 to $66,257 RI $54,203 to $59,493 DE $48,825 to $54,202 DOLLARS PER HOUSEHOLD Dollar amount that divides the household income distribution into two equal groups $10,000 $8,000 $6,000 $4,000 $2,000 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR <= $48,824 2016 edition data source: Current Population Survey, Annual Social and Economic Supplement, 2015 For details: http://www.americashealthrankings.org/AR16/Medianincome A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 79 SU PP L E M E NTAL M EA SU R E S Personal Income Community & Environment Personal income reflects a person’s ability to make purchases supporting a healthy lifestyle including preventive medicine and curative care. National Longitudinal Mortality Survey data indicate the relative risk of premature death decreases with increasing family income, adjusted for sex and age. The most significant mortality increase occurs at incomes below $30,000; this increase flattens above $35,000. This relationship is independent of the classification of poverty, meaning people with low personal income—regardless of whether they are classified as living in poverty—are more likely to have poorer health than higher income people. $47,753 to $52,650 RI $43,252 to $47,752 DE $40,551 to $43,251 $40,000 $30,000 $20,000 $10,000 6 >= $52,651 DC $50,000 20 1 CURRENT DOLLARS Per capita personal income in dollars 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, <= $40,550 2016 edition data source: US Bureau of Economic Analysis, 2015 For details: http://www.americashealthrankings.org/AR16/income Underemployment Rate 12 :0 1a Underemployment is associated with a lack of health insurance and potentially leads to heightened stress, depression, and decreased earnings—all of which contribute to poor health. The underemployed are more likely than others to report lower levels of general well-being, and those who are underemployed based solely on income report more Community & Environment depression and alcohol abuse. Racial and ethnic minorities have significantly higher underemployment rates than white Americans. Underemployment is also inversely associated with educational attainment—rates among those with less than a high school degree are nearly four times higher than among those with a bachelor’s degree or higher. <= 8.2% 8.3% to 9.5% DC 9.6% to 10.7% RI 10.8% to 11.4% DE >= 11.5% PERCENTAGE OF CIVILIAN LABOR FORCE Percentage of the civilian labor force that is unemployed, plus all marginally attached workers, plus the total employed part-time for economic reasons (U-6 definition) 20% 16% 12% 8% 4% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: US Bureau of Labor Statistics, 2015 For details: http://www.americashealthrankings.org/AR16/Underemployed 80 w w w. a m e r i c a s h e a l t h r a n k i n g s . o r g S U P P LE ME N TA L M EASURES Unemployment Rate Community & Environment Unemployed adults are more burdened by medical care costs, more likely to experience delays in treatment, and report more chronic disease and poorer physical and mental health compared with those who are employed. Unemployment is also associated with an increase in unhealthy behaviors such as poor diet, lack of exercise, tobacco use, and excessive alcohol consumption. High unemployment rates increase the economic burden on states due to decreased revenue from income taxes and increased demand for unemployment insurance and social welfare programs. RI 5.5% to 5.9% >= 6.0% m Em ES ba T, rg De oe ce d U m nt be il r1 5, DE 4.9% to 5.4% 8% 6% 4% 2% 20 1 DC 4.0% to 4.8% 10% 6 <= 3.9% PERCENTAGE OF CIVILIAN LABOR FORCE Percentage of the civilian labor force that is unemployed (U-3 definition) 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: US Bureau of Labor Statistics, 2015 For details: http://www.americashealthrankings.org/AR16/Unemployed Water Fluoridation 12 :0 1a Community water fluoridation is an effective way of preventing dental caries—an infectious disease in which bacteria dissolve the enamel of a tooth. Dental caries can lead to pain, bacterial infections, and tooth extraction. Fluoride enhances remineralization and inhibits demineralization in tooth enamel and inhibits bacterial activity in dental plaque. Community Policy water fluoridation is a safe and cost-effective intervention to widely deliver fluoride to all members of a community, regardless of age, education, and income. It was named one of 10 great public health achievements of the 20th century by the Centers for Disease Control and Prevention. >= 93.3% DC RI DE 85.5% to 93.2% 71.6% to 85.4% 56.1% to 71.5% <= 56.0% PERCENTAGE OF POPULATION SERVED BY COMMUNITY WATER SYSTEMS Percentage of population served by community water systems who receive fluoridated water 100% 80% 60% 40% 20% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: CDC, Water Fluoridation Reporting System, 2014 For details: http://www.americashealthrankings.org/AR16/water_fluoridation A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 81 SU PP L E M E NTAL M EA SU R E S Cholesterol Check Clinical Care Elevated total serum cholesterol is a major and modifiable risk factor for heart disease, the United States’ leading cause of death. Approximately one in six people have high cholesterol, which increases risk of stroke, cardiovascular disease, and premature death. Because high cholesterol has no symptoms, a blood test is needed to measure total cholesterol, LDL (low-density lipoprotein, “bad”) cholesterol, HDL (high- density lipoprotein, “good”) cholesterol, and triglycerides. The US Preventive Services Task Force recommends that all men aged 35 years and older be screened for lipid disorders, as well as both men and women aged 20 years or older who are at increased risk for coronary heart disease. 76.6% to 78.9% RI 74.3% to 76.5% DE 60% 40% 20% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, <= 74.2% 80% 6 79.0% to 81.1% DC 100% 20 1 >= 81.2% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported having their blood cholesterol checked within the past five years 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/cholesteroltest Colorectal Cancer Screening Clinical Care 1a 12 :0 Percentage of adults aged 50 to 75 years who reported receiving one or more of the recommended colorectal cancer screening tests within the recommended time interval (fecal occult blood test (FOBT) within the past year, colonoscopy within the past 10 years, or sigmoidoscopy within the past five years and a home FOBT within the past three years) >= 70.6% 67.1% to 70.5% DC 64.9% to 67.0% RI 61.6% to 64.8% DE <= 61.5% PERCENTAGE OF ADULTS AGED 50 TO 75 YEARS Earlier screening is recommended for those with particular risk factors or a family history of colorectal cancer. Black adults are at higher risk for colorectal cancer but are less likely to be screened. Screening can save lives—an estimated 20 to 24 colorectal cancer deaths can be averted for every 1,000 adults screened. Colorectal cancer is the second-leading cause of cancer death and the third most common cancer among men and women in the United States. Screening for colorectal cancer, which may include fecal sample testing, colonoscopy, and/or sigmoidoscopy, is recommended for all adults aged 50 to 74 years, according to the US Preventive Services Task Force. 100% 80% 60% 40% 20% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2014 For details: http://www.americashealthrankings.org/AR16/cancer_screening 82 w w w. a m e r i c a s h e a l t h r a n k i n g s . o r g S U P P LE ME N TA L M EASURES Dental Visit, Annual Clinical Care Oral health problems are preventable through routine visits to the dentist and good oral hygiene. An estimated 42% of adults with unmet dental needs could not afford treatment or did not have dental insurance, making cost the biggest obstacle. Other obstacles include fear, low oral health literacy, and limited access to and availability of dental services. Use of preventive dental services is low in non-Hispanic blacks, Hispanics, low-income families, and families with low educational attainment. These groups have more untreated tooth decay than the general population. The Institute of Medicine recommends increasing dental workforce diversity to improve patient access, satisfaction, and communication. 80% 60% 40% 20% 0 20 1 66.8% to 70.0% 100% 6 >= 70.1% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported visiting the dentist or dental clinic within the past year for any reason 64.2% to 66.7% RI 59.9% to 64.1% DE <= 59.8% 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, DC 2016 edition data source: Behavioral Risk Factor Surveillance System, 2014 For details: http://www.americashealthrankings.org/AR16/dental Heart Attack 12 :0 1a An estimated 550,000 heart attacks and 200,000 recurrent heart attacks occur yearly in US adults aged 35 years and older. Roughly 15% of those who have a heart attack die as a result. The average age at first heart attack, or myocardial infarction (MI), is 65 years for men and 71.8 years for women. Adjusting for age, patient, and hospital characteristics, black Outcomes men, white men, and white women have similar in-hospital mortality rates. Black women have the highest in-hospital mortality rate and the lowest rate of in-hospital interventions for acute MI treatment. MI’s estimated direct and indirect costs were $11.5 billion in 2010. <= 3.7% 3.8% to 4.0% DC 4.1% to 4.5% RI 4.6% to 5.2% DE >= 5.3% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported being told by a health professional that they had a heart attack (myocardial infarction) 5% 4% 3% 2% 1% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/heart_attack A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 83 SU PP L E M E NTAL M EA SU R E S Heart Disease Outcomes increasing physical activity. Yet more than 365,000 deaths were attributable to CHD in 2014. For men with two or more risk factors, the lifetime risk of CHD is 37.5%; for women, it is 18.3%. Costs associated with CHD are projected to exceed $218 billion annually by 2030. Coronary heart disease (CHD) prevalence is projected to increase 16.6% between 2010 and 2030, affecting 9.3% of the US population. CHD deaths decreased 44% from 1980 to 2000, largely due to lowering total cholesterol, systolic blood pressure, and smoking prevalence, as well as DC RI 4.3% to 4.8% >= 4.9% 3% 2% 1% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, DE 3.9% to 4.2% 4% 6 3.5% to 3.8% 5% 20 1 <= 3.4% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported being told by a health professional that they have angina or coronary heart disease 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/CHD High Blood Pressure 12 :0 1a High blood pressure is a modifiable risk factor for heart disease and stroke, two of the five US leading causes of death. Hypertension often has no symptoms and is estimated to afflict one in three—or 70 million—Americans. Only 52% of individuals with hypertension have it controlled, and many do not know they have it. Hypertension expenses—medical, Outcomes medication, and lost productivity costs—are an estimated $46 billion annually. Blacks are more likely to develop high blood pressure than whites and Hispanics, and blacks are more likely to develop it at a younger age. Reducing sodium intake could prevent 11 million hypertension cases annually. <= 29.4% DC RI DE 29.5% to 30.4% 30.5% to 32.4% 32.5% to 35.2% >= 35.3% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported being told by a health professional that they have high blood pressure 100% 80% 60% 40% 20% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/Hypertension 84 w w w. a m e r i c a s h e a l t h r a n k i n g s . o r g S U P P LE ME N TA L M EASURES High Cholesterol Outcomes including stroke. High cholesterol can be managed through medication and/or lifestyle modifications such as diet and physical activity. To lower cholesterol, the 2010 Dietary Guidelines suggest eating vegetables, beans, whole grains, nuts, and seafood and limiting solid fats, added sugars, refined grains, and red meat. Total blood cholesterol higher than 240 mg/dL is unhealthy, especially when maintained for long periods of time. Of an estimated 73.5 million US adults who have high cholesterol, only 48.1% of them receive treatment and less than a third manage their condition. High cholesterol doubles the risk of heart attack and is a risk factor for cardiovascular diseases, 40% 30% 20% 10% 20 1 34.6% to 36.1% 50% 6 <= 34.5% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported having their cholesterol checked and were told by a health professional that it was high 36.2% to 36.8% RI 36.9% to 38.5% DE >= 38.6% m Em ES ba T, rg De oe ce d U m nt be il r1 5, DC 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/High_Chol High Health Status 12 :0 1a Research shows that adults with a higher self-reported health status have lower rates of all-cause mortality, compared with those with lower self-reported health status. The subpopulation with the highest proportion reporting “very good” or “excellent” health is white adults without disabilities. A greater proportion of women report “fair” or “poor” health Outcomes compared with men. Adults aged 18 to 44 years have a higher self-reported health status than adults aged 65 years and older. Adults with high annual household incomes, who are employed by others or self, and who are married have a higher self-reported health status than those near or in poverty, unemployed, and single, widowed, or divorced. >= 56.2% DC RI DE 53.9% to 56.1% 51.2% to 53.8% 47.9% to 51.1% <= 47.8% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported that their health is very good or excellent 100% 80% 60% 40% 20% 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/Health_Status A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 85 SU PP L E M E NTAL M EA SU R E S Injury Deaths Outcomes Injuries are a leading cause of morbidity and mortality in the United States. Accidental poisonings, motor vehicle accidents, and falls are the top three causes of unintentional injury deaths—the fourth leading cause of US deaths. Drugs cause the majority of poisonings, and 81% of drug poisoning deaths are unintentional. Intentional injury fatalities mainly occur via suicide by firearm, suffocation, poisoning, and homicide by firearm. Firearm discharge causes more than half of suicides, and 2.5 times as many deaths annually are from suicide as homicide. Unintentional and intentional injury fatalities cost nearly $214 billion in 2013 due to work loss and medical costs. 57.2 to 64.3 RI 64.4 to 70.0 DE 70.1 to 77.1 80 60 40 20 6 DC 100 20 1 <= 57.1 DEATHS PER 100,000 POPULATION Number of deaths due to injury per 100,000 population 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, >= 77.2 2016 edition data source: National Vital Statistics System, 2012-2014 For details: http://www.americashealthrankings.org/AR16/injury_deaths Poor Mental Health Days 12 :0 1a The number of poor mental health days a person experiences is a predictor of future health, forecasting one-month and 12-month office visits and hospitalizations. Poor mental health in extreme cases can lead to suicide, the 10th-leading cause of death for all ages and the second-leading cause of death Outcomes for adults aged 25 to 34 years. Medical costs of mental illness are not far behind those of heart disease and traumatic injury in the United States. The 2013 annual direct and indirect costs of untreated serious mental illness were estimated to be $300 billion, an increase of $200 billion from 2003 estimates. <= 3.3 DC 3.4 to 3.6 RI 3.7 to 3.8 DE 3.9 to 4.1 DAYS IN THE PREVIOUS 30 DAYS Number of days in the past 30 days adults reported their mental health was not good 5.0 4.0 3.0 2.0 1.0 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR >= 4.2 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/MentalHealth 86 w w w. a m e r i c a s h e a l t h r a n k i n g s . o r g S U P P LE ME N TA L M EASURES Poor Physical Health Days Poor physical health days are an indicator of the population’s health-related quality of life. The number of poor physical health days a person experiences reveals information about all-cause morbidity within the population, regardless of disease or health condition. Poor physical health days Outcomes also predict future health and future medical care, such as adverse health events resulting in a provider visit, hospitalization, or mortality within 30 days or one year among older adults. The number of physically unhealthy days tend to increase with age. DAYS IN THE PREVIOUS 30 DAYS Number of days in the past 30 days adults reported their physical health was not good RI DE 3.0 3.5 to 3.6 2.0 1.0 20 1 DC 4.0 6 <= 3.4 5.0 3.7 to 4.0 4.1 to 4.3 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, >= 4.4 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/PhysicalHealth Stroke 12 :0 1a Roughly 795,000 people yearly experience a new or recurrent stroke, which is among the five leading causes of US deaths. The incidence of stroke is higher among white women aged 85 years and older, compared with men of the same age, and in blacks versus whites. The prevalence is greater in people with lower income levels and educational attainment, and in Outcomes those in the southeastern United States. Stroke prevalence is estimated to increase 22% by 2030, with the greatest increase in Hispanic men (29%). The total cost of stroke— health care services, treatment medications, and missed days of work—in the US is roughly $34 billion each year. <= 2.4% DC RI DE 2.5% to 2.7% 2.8% to 3.1% 3.2% to 3.7% >= 3.8% PERCENTAGE OF ADULT POPULATION Percentage of adults who reported being told by a health professional that they had a stroke 5 4 3 2 1 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR 2016 edition data source: Behavioral Risk Factor Surveillance System, 2015 For details: http://www.americashealthrankings.org/AR16/Stroke A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L R E P ORT 87 SU PP L E M E NTAL M EA SU R E S Suicide Outcomes in young adults. The suicide rate in 2012 to 2013 among American Indian/Alaska Native men aged 18 to 24 years was higher than any other racial or ethnic subgroups at 34.3 per 100,000 population, much higher than the rate of 20.4 for all males in this age group. More than 42,700 suicides occurred in 2014, making it the 10th-leading cause of death. Firearms account for half of these deaths. Each year 2.5 times more deaths occur from suicide than from homicide. For each successful suicide, 25 attempts are made. While the highest rates occur in adults aged 85 years and older, suicide is of great concern 12.7 to 13.6 RI 13.7 to 16.0 DE 16.1 to 19.1 6 DC 20 18 16 14 12 10 8 6 4 2 0 20 1 <= 12.6 DEATHS PER 100,000 POPULATION Number of deaths due to intentional self-harm per 100,000 population 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR m Em ES ba T, rg De oe ce d U m nt be il r1 5, >= 19.2 2016 edition data source: National Vital Statistics System, 2014 12 :0 1a For details: http://www.americashealthrankings.org/AR16/Suicide 88 w w w. a m e r i c a s h e a l t h r a n k i n g s . o r g 6 20 1 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, State Summaries A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 89 State Summaries 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 The following pages describe the overall rank, strengths, challenges, and highlights—including notable changes in measures—for each state. The table outlines the values and ranks for all core measures. Each state summary also contains trend graphs of smoking and obesity allowing states to compare their prevalence with the US prevalence. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Alabama 18 4 3 47 45 41 39 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★ ★ ★ ★ ★★★★ ★ ★★ ★ ★ 9.1 22.3 0.777 600.2 5.9 24.1 5.5 472 -0.128 36 42 47 47 16 46 38 41 48 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★ ★★★ ★★ ★★ ★★★★★ ★★ ★★ ★★★★★ ★★★ -0.005 40.8 22.6 72.1 93.3 70.6 11.1 $106 -0.011 26 26 36 38 5 35 33 10 27 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★ ★ ★ ★ ★ 43.8 10.1 61.1 116.4 -0.197 -0.427 48 48 45 42 48 46 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★ ★ ★ ★ ★ ★ ★ 211.1 332.9 13.5 26.9 13.9 15.0 8.7 10,097 -0.366 -0.793 43 49 48 20 45 46 49 48 49 47 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 47 ALABAM A 13.1 13.0 89.3 35.6 31.9 21.4 -0.091 Change: 1 Determinants Rank: 46 Outcomes Rank: 49 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of excessive drinking • High percentage of high school graduation • High Tdap immunization coverage among adolescents m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★ ★★★★★ ★★★★★ ★ ★ ★ ★★ 6 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* No. 1 State OVERALL RANK CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 40 35 30 25 20 15 15 10 10 5 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 Challenges: • High prevalence of smoking • High prevalence of low birthweight • High infant mortality rate Ranking: Alabama is 47th this year; it was 46th in 2015. The state ranks 44th for senior health and 44th for the health of women and children. Highlights: • In the past two years, drug deaths increased 12% from 11.7 to 13.1 deaths per 100,000 population. • In the past year, physical inactivity increased 16% from 27.6% to 31.9% of adults. • In the past year, children in poverty decreased 12% from 25.2% to 22.3% of children. • In the past year, HPV immunization among males aged 13 to 17 years increased 151% from 9.0% to 22.6%. • In the past year, immunizations among children aged 19 to 35 months decreased 8% from 76.9% to 70.6%. State Health Department Website: www.adph.org 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 91 U N I T E D H E A LT H F O U N D AT I O N Alaska A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Overall Rank: 30 Change: 3 Determinants Rank: 33 Outcomes Rank: 15 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low percentage of children in poverty • Low prevalence of low birthweight • Low prevalence of diabetes Challenges: • Low percentage of high school graduation • High violent crime rate • High percentage of population without insurance 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★ ★ ★ ★★★ ★★★★★ ★★ ★ 16.0 22.1 75.6 29.8 22.0 19.1 -0.130 34 48 46 24 10 34 42 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★ ★★★★★ ★ ★ ★ ★★★★★ ★★★ ★ ★★ 8.8 12.5 0.673 787.5 23.0 9.3 4.7 730 -0.069 33 6 46 50 45 2 29 50 39 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★★ ★ ★ ★ ★ ★ ★★★★★ ★ -1.597 36.9 18.8 55.7 69.7 66.3 16.1 $261 -0.111 48 35 45 48 50 48 49 1 47 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★★★ ★★★★★ ★★★ ★★★★★ ★★ 80.8 5.9 36.0 134.1 0.170 -0.139 2 1 8 28 1 33 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★★★ ★★★★★ ★★★★ ★★★★ ★★★★★ ★★★ ★★ ★★★★ ★★★ 193.3 214.1 7.6 25.1 11.0 9.2 6.1 7,857 0.108 -0.031 29 9 3 13 20 2 27 35 15 30 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Alaska is 30th this year; it was 27th in 2015. The state ranks 21st for senior health and 28th for the health of women and children. State Health Department Website: dhss.alaska.gov/Pages/default.aspx OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h e a lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 92 OBESITY 40 % OF ADULTS Highlights: • In the past year, children in poverty decreased 20% from 15.6% to 12.5% of children. • In the past year, Salmonella incidence decreased 22% from 11.9 to 9.3 cases per 100,000 population. • In the past two years, violent crime increased 21% from 603 to 730 offenses per 100,000 population. • In the past seven years, preventable hospitalizations decreased 42% from 62.4 to 36.0 discharges per 1,000 Medicare enrollees. • In the past year, infant mortality increased 13% from 5.4 to 6.1 deaths per 1,000 live births. % OF ADULTS 12 :0 ALAS K A Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* No. 1 State ★ ★★★★ ★ ★★★★ ★★★★ ★★★★★ ★★★ 18.6 16.0 77.4 28.4 24.7 14.0 0.038 41 13 44 17 18 6 21 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★ ★★ ★★ ★★★ ★★ ★★★★★ ★★ ★★ 9.3 25.5 -0.010 488.9 7.8 15.8 3.4 410 -0.079 43 47 31 37 27 33 8 34 40 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★ ★★★ ★★★ ★★★★ ★★★ ★★★ ★★ ★ ★★ 0.227 44.2 27.0 87.6 86.6 72.3 12.2 $42 -0.047 20 21 28 12 30 26 37 48 36 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★ ★★★★★ ★★ ★★★ ★★★ 53.9 7.0 37.0 123.3 0.026 -0.062 28 12 9 37 22 30 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★★ ★★★ ★ ★★★ ★★★ ★★★ ★★★ ★★★ ★★★ 170.0 213.7 10.1 31.4 11.2 12.1 5.7 7,148 0.042 -0.020 6 7 27 43 24 27 23 24 24 29 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 29 Change: 1 Determinants Rank: 30 Outcomes Rank: 24 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of smoking • Low rate of preventable hospitalizations • Low rate of cancer deaths m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank ARIZ O NA Star Rating 6 Arizona A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 OVERALL RANK 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 20 Ranking: Arizona is 29th this year; it was 30th in 2015. The state ranks 27th for senior health and 43rd for the health of women and children. Highlights: • In the past year, smoking decreased 15% from 16.5% to 14.0% of adults. • In the past six years, chlamydia incidence increased 79% from 273.5 to 488.9 cases per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years increased 23% from 35.8% to 44.2%. • Since the 1990 edition, cardiovascular deaths decreased 36% from 332.5 to 213.7 deaths per 100,000 population. • In the past year, infant mortality increased 4% from 5.5 to 5.7 deaths per 1,000 live births. 15 15 10 10 5 5 0 35 Challenges: • Low percentage of high school graduation • High percentage of children in poverty • Large disparity in health status by educational attainment 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. State Health Department Website: www.azdhs.gov A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 93 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Arkansas Overall Rank: 48 Change: no change Determinants Rank: 48 Outcomes Rank: 46 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of excessive drinking • High Tdap immunization coverage among adolescents • Small disparity in health status by educational attainment Challenges: • High prevalence of obesity • High prevalence of smoking • High prevalence of frequent mental distress 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★★ ★★★★★ ★★★ ★ ★ ★ ★ 12.1 15.3 84.9 34.5 34.2 24.9 -0.214 14 9 25 45 49 48 46 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★ ★★ ★ ★ ★★★ ★ ★ ★ ★ 7.5 20.8 0.573 527.3 9.7 22.6 6.7 521 -0.082 15 35 45 43 30 44 43 45 42 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★ ★★ ★ ★★★ ★★★★★ ★ ★★★ ★★★★ ★★ -0.080 34.0 16.4 81.5 91.2 66.6 10.7 $96 -0.037 28 40 49 22 9 46 30 16 34 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★ ★ ★ ★ ★ 40.9 8.9 61.9 114.7 -0.173 -0.506 50 41 46 43 47 48 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★★ ★ ★ ★ ★ ★ ★ 218.1 317.3 12.6 23.8 14.9 14.9 7.6 9,762 -0.328 -0.834 46 47 44 10 48 45 47 45 46 48 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Arkansas is 48th this year; it was 48th in 2015. The state ranks 47th for senior health and 49th for the health of women and children. OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS Highlights: • In the past two years, excessive drinking increased 12% from 13.7% to 15.3% of adults. • In the past year, children in poverty decreased 30% from 29.7% to 20.8% of children. • From the previous edition, violent crime increased 13% from 460 to 521 offenses per 100,000 population. • In the past year, meningococcal immunization among adolescents aged 13 to 17 years increased 26% from 64.8% to 81.5%. • In the past five years, the percentage of the population without health insurance decreased 43% from 18.9% to 10.7%. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 ARK AN S AS Star Rating 35 30 25 20 94 w w w. a m e r i c a s h e a lth ra n kin g s.o r g 35 30 25 20 15 15 10 10 5 State Health Department Website: www.healthy.arkansas.gov 40 0 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 California ★ ★★★ ★★ ★★★ ★ ★★★ ★★★★★ ★★ ★ 11.4 19.5 0.287 459.9 22.8 14.0 3.0 426 -0.103 50 30 35 29 43 26 5 38 44 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★ ★★★★★ ★★★ ★★ ★★ ★★★★ ★★★ ★★★★ ★★★ -0.202 48.4 29.5 77.2 82.5 75.0 10.5 $98 0.016 34 10 22 31 40 17 29 15 22 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★★★ ★★★★★ ★★★ ★★★★★ ★★★★ 77.1 6.7 35.7 131.5 0.130 0.277 4 9 7 30 7 16 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★ ★★★ ★ ★★★★ ★★★ ★★★★★ ★★★★★ ★★★ ★★★★ 169.9 229.9 10.0 38.0 11.0 11.2 4.5 5,528 0.069 0.346 5 19 26 50 20 22 3 3 21 16 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 CALIFO RN IA COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 16 Change: no change Determinants Rank: 16 Outcomes Rank: 21 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 12 29 31 4 4 2 2 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of smoking • Low rate of preventable hospitalizations • Low infant mortality rate m Em ES ba T, rg De oe ce d U m nt be il r1 5, 11.4 18.0 82.0 24.2 20.0 11.7 0.234 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★ ★★★ ★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 Ranking: California is 16th this year; it was 16th in 2015. The state ranks 28th for senior health and 10th for the health of women and children. Highlights: • In the past year, physical inactivity decreased 8% from 21.7% to 20.0% of adults. • Pertussis incidence is now 22.8 cases per 100,000 population. • From the previous edition, violent crime increased 6% from 402 to 426 offenses per 100,000 population. • In the past year, Tdap immunization among adolescents aged 13 to 17 years decreased 6% from 87.7% to 82.5%. • Since the 1990 edition, premature death decreased 35% from 8,453 to 5,528 years lost per 100,000 population. 15 15 10 10 State Health Department Website: www.cdph.ca.gov 5 5 0 35 Challenges: • High levels of air pollution • High incidence of pertussis • Large disparity in health status by educational attainment 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 95 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Colorado Overall Rank: 10 Change: 2 Determinants Rank: 10 Outcomes Rank: 4 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • Low prevalence of obesity • Low prevalence of physical inactivity • Low prevalence of diabetes Challenges: • Low percentage of high school graduation • High incidence of pertussis • Large disparity in health status by educational attainment m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★ ★★ ★ ★★★★★ ★★★★★ ★★★★ ★★★★★ 15.9 19.1 77.3 20.2 17.9 15.6 0.112 33 36 45 1 1 15 10 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★★ ★★★★ ★★ ★★★ ★ ★★★★ ★★★★ ★★★ ★★★★ 6.6 14.5 0.057 415.0 24.3 11.7 3.9 321 0.149 8 11 32 22 46 12 18 23 12 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★★ ★★★★ ★★★★ ★★★★ ★★★★★ ★★★★ ★★★ ★★★★ ★★★★ 0.768 46.0 37.1 85.6 93.3 75.4 9.2 $90 0.058 8 17 11 18 5 14 23 18 14 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★ ★★★★★ ★★★ ★★★★ ★★★★★ 69.7 8.8 32.1 136.3 0.054 0.373 10 38 3 25 17 10 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★★ ★★★★★ ★ ★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 161.8 199.3 6.8 33.9 10.4 10.7 4.9 6,095 0.186 0.559 3 2 1 48 13 14 9 10 4 10 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Colorado is 10th this year; it was 8th in 2015. The state ranks 7th for senior health and 14th for the health of women and children. State Health Department Website: www.cdphe.state.co.us OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h e a lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 96 OBESITY 40 % OF ADULTS Highlights: • In the past year, children in poverty decreased 16% from 17.2% to 14.5% of children. • In the past year, chlamydia incidence increased 6% from 393.0 to 415.0 cases per 100,000 population. • In the past year, HPV immunization among males aged 13 to 17 years increased 69% from 21.9% to 37.1%. • In the past 15 years, preventable hospitalizations decreased 49% from 63.0 to 32.1 discharges per 1,000 Medicare enrollees. • In the past year, cardiovascular deaths increased 2% from 196.2 to 199.3 deaths per 100,000 population. % OF ADULTS 12 :0 CO LO RADO Star Rating Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Connecticut ★★ ★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ 8.8 14.8 -0.730 372.1 2.8 12.7 2.9 219 0.160 33 13 5 11 5 15 4 6 9 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★ ★★★★★ 1.300 55.2 42.0 93.5 93.7 80.6 6.5 $76 0.135 2 2 5 5 3 1 6 25 5 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★★ ★★★ ★★★★★ ★★★★★ ★★★★★ 75.8 7.6 46.3 197.8 0.136 0.618 5 20 22 4 5 3 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★★ ★★★★ ★ ★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 173.2 217.2 9.3 31.3 11.1 10.9 4.8 5,451 0.130 0.747 8 10 19 42 22 16 7 2 10 3 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 CO N N E CT ICU T COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 3 Change: 3 Determinants Rank: 3 Outcomes Rank: 10 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 28 33 14 9 16 3 4 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of smoking • Low incidence of infectious disease • High immunization coverage among children m Em ES ba T, rg De oe ce d U m nt be il r1 5, 15.1 18.6 87.2 25.3 23.5 13.5 0.186 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★ ★★ ★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 5 5 Highlights: • In the past three years, drug deaths increased 44% from 10.5 to 15.1 deaths per 100,000 population. • In the past year, physical inactivity increased 14% from 20.6% to 23.5% of adults. • In the past year, children in poverty increased 20% from 12.3% to 14.8% of children. • In the past year, HPV immunization among males aged 13 to 17 years increased 56% from 27.0% to 42.0%. • In the past nine years, cancer deaths decreased 9% from 191.2 to 173.2 deaths per 100,000 population. State Health Department Website: www.dph.state.ct.us 10 10 Ranking: Connecticut is 3rd this year; it was 6th in 2015. The state ranks 9th for senior health and 4th for the health of women and children. 20 15 15 0 35 Challenges: • High prevalence of excessive drinking • High levels of air pollution • Large disparity in health status by educational attainment 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 97 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Delaware Overall Rank: 31 Change: 1 Determinants Rank: 28 Outcomes Rank: 34 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • High immunization coverage among adolescents • High immunization coverage among children • Low percentage of population without insurance Challenges: • High violent crime rate • Lower number of dentists • Large disparity in health status by educational attainment m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★ ★★★★ ★★★ ★★★ ★★ ★★★ ★★★ 18.1 16.6 85.6 29.7 29.4 17.4 -0.003 39 15 22 23 40 24 27 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★★★★ ★ ★★ ★ ★★ ★★ ★ ★★ 9.5 16.3 0.510 483.2 22.1 17.0 4.9 499 -0.068 45 18 43 36 42 36 31 43 38 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ 0.800 52.8 43.0 87.5 88.7 79.3 6.9 $102 0.125 7 4 4 13 20 3 9 12 7 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★★ ★★★ ★★★★ ★★ ★★★ 45.6 8.3 50.2 151.4 -0.057 -0.003 47 31 29 17 32 28 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★★ ★★ ★ ★★★ ★★★★ ★★ ★★ ★★ ★★ 198.5 247.5 11.5 32.4 11.1 10.9 6.5 7,372 -0.074 -0.077 34 28 39 45 22 16 34 31 34 31 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Delaware is 31st this year; it was 32nd in 2015. The state ranks 22nd for senior health and 22nd for the health of women and children. OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS Highlights: • In the past five years, drug deaths increased 37% from 13.2 to 18.1 deaths per 100,000 population. • In the past year, physical inactivity increased 18% from 24.9% to 29.4% of adults. • In the past year, HPV immunization among females aged 13 to 17 years increased 25% from 42.3% to 52.8%. • In the past year, immunizations among children aged 19 to 35 months increased 6% from 74.5% to 79.3%. • Since the 1990 edition, cardiovascular deaths decreased 41% from 422.4 to 247.5 deaths per 100,000 population. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 DE LA WARE Star Rating 35 30 25 20 w w w. a m e r i c a s h e a lth ra n kin g s.o r g 20 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 98 25 10 5 0 30 15 15 10 State Health Department Website: www.dhss.delaware.gov/dhss 35 Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★★★ ★★★ ★ ★★★★ ★★★ ★★★★ ★★★ 13.2 17.4 77.9 26.8 26.2 15.8 0.031 21 21 42 16 25 16 22 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★★ ★ ★★ ★★★ ★★★★★ ★ ★★★ ★★ ★★ 6.8 24.4 0.363 430.6 3.7 30.8 4.3 462 -0.032 10 44 40 24 8 49 24 40 34 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★ ★★ ★ ★★ ★★★ ★ ★ ★★ ★ -0.527 36.8 19.8 70.4 87.3 66.6 15.0 $57 -0.136 38 36 44 40 26 46 48 39 50 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★ ★★ ★★ ★★ ★★ 52.0 8.7 55.1 128.0 -0.090 -0.227 33 37 36 33 37 36 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★★ ★★ ★ ★★ ★ ★★★ ★★★ ★★ ★★ 182.1 224.8 11.3 31.6 13.0 14.0 6.1 7,179 -0.081 -0.307 15 13 35 44 40 42 27 25 35 36 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 36 Change: 3 Determinants Rank: 36 Outcomes Rank: 35 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low levels of air pollution • Low incidence of pertussis • Low rate of cardiovascular deaths m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* No. 1 State FLO RIDA CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 6 Star Rating OVERALL RANK Florida 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 5 5 Highlights: • In the past four years, drug deaths decreased 24% from 17.4 to 13.2 deaths per 100,000 population. • In the past year, smoking decreased 10% from 17.6% to 15.8% of adults. • In the past year, HPV immunization among females aged 13 to 17 years increased 29% from 28.5% to 36.8%. • In the past year, immunizations among children aged 19 to 35 months decreased 8% from 72.7% to 66.6%. • In the past four years, preventable hospitalizations decreased 16% from 65.3 to 55.1 discharges per 1,000 Medicare enrollees. State Health Department Website: www.floridahealth.gov 10 10 Ranking: Florida is 36th this year; it was 33rd in 2015. The state ranks 24th for senior health and 40th for the health of women and children. 20 15 15 0 35 Challenges: • Low percentage of high school graduation • High percentage of children in poverty • High percentage of population without insurance 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A MER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 99 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Georgia Overall Rank: 41 Change: 1 Determinants Rank: 43 Outcomes Rank: 37 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low rate of drug deaths • Low incidence of pertussis • High immunization coverage among children Challenges: • High percentage of children in poverty • High percentage of population without insurance • High prevalence of low birthweight POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★★★ ★★★★ ★★ ★★ ★★ ★★★ ★★ 11.2 16.8 78.8 30.7 27.3 17.7 -0.044 10 17 40 31 36 27 32 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★ ★ ★★ ★ ★★★★★ ★ ★★★★ ★★★ ★ 9.1 28.7 0.357 519.9 4.1 22.4 4.0 378 -0.119 36 49 39 42 10 43 20 27 46 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★ ★ ★★★ ★★★★ ★★★★ ★★★★ ★ ★★ ★★ 0.198 32.3 27.5 87.0 90.2 75.6 14.9 $62 -0.058 21 42 25 15 13 11 47 36 40 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★ ★★ ★ ★ ★ 47.0 9.5 51.8 117.2 -0.134 -0.355 46 47 32 41 44 43 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★ ★★ ★★★ ★★★ ★★★ ★ ★★ ★★ ★ 194.4 272.9 11.3 28.5 11.2 12.1 7.2 7,980 -0.109 -0.464 30 36 35 29 24 27 43 37 37 41 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Georgia is 41st this year; it was 40th in 2015. The state ranks 39th for senior health and 45th for the health of women and children. 20 1 ’00 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 State Health Department Website: dph.georgia.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 100 OBESITY 40 % OF ADULTS Highlights: • In the past year, physical inactivity increased 16% from 23.6% to 27.3% of adults. • In the past 15 years, children in poverty increased 75% from 16.4% to 28.7% of children. • In the past year, meningococcal immunization among adolescents aged 13 to 17 years increased 16% from 74.9% to 87.0%. • In the past year, HPV immunization among males aged 13 to 17 years increased 31% from 21.0% to 27.5%. • In the past year, infant mortality increased 9% from 6.6 to 7.2 deaths per 1,000 live births. % OF ADULTS 12 :0 G E O RG IA Star Rating Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 4.0 11.2 90.8 20.2 17.9 9.1 0.273 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★★★★ ★★★★ ★★ ★★★ ★★★★★ ★ ★★★★★ ★★★★ ★★★★ 7.0 14.6 0.140 457.2 2.7 23.0 3.5 293 0.145 12 12 33 28 4 45 10 20 13 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★ ★★★★★ ★★★★ ★★★ ★ ★★★★ ★★★★★ ★★★★★ ★★★★★ -0.123 52.4 36.2 78.7 79.6 73.8 4.7 $220 0.147 30 6 12 26 45 20 3 2 4 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 75.6 7.9 23.5 172.6 0.160 0.616 6 22 1 10 2 4 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ 158.4 206.6 8.5 14.8 8.8 9.2 5.5 5,898 0.289 0.905 2 4 12 1 3 2 16 7 1 1 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 1 H A WAII 10 43 33 2 12 8 5 Change: no change Determinants Rank: 4 Outcomes Rank: 1 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of obesity • Low percentage of population without insurance • Low rate of preventable hospitalizations m Em ES ba T, rg De oe ce d U m nt be il r1 5, 11.2 20.5 81.6 22.7 22.5 14.1 0.163 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★★ ★ ★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 6 Star Rating OVERALL RANK Hawaii 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 5 5 Highlights: • In the past two years, drug deaths decreased 4% from 11.7 to 11.2 deaths per 100,000 population. • In the past year, physical inactivity increased 15% from 19.6% to 22.5% of adults. • In the past two years, violent crime increased 23% from 239 to 293 offenses per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years increased 38% from 38.0% to 52.4%. • In the past year, diabetes decreased 13% from 9.8% to 8.5% of adults. State Health Department Website: health.hawaii.gov 10 10 Ranking: Hawaii is 1st this year; it was 1st in 2015. The state ranks 5th for senior health and 7th for the health of women and children. 20 15 15 0 35 Challenges: • High prevalence of excessive drinking • High incidence of Salmonella • Low Tdap immunization coverage among adolescents 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 101 U N I T E D H E A LT H F O U N D AT I O N Idaho A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Star Rating Change: 2 Determinants Rank: 18 Outcomes Rank: 12 OVERALL RANK 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • Low prevalence of smoking • Low violent crime rate • Low prevalence of low birthweight Challenges: • Low percentage of high school graduation • High incidence of pertussis • Lower number of primary care physicians m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* No. 1 State ★★★★ ★★★★★ ★★ ★★★★ ★★★★★ ★★★★★ ★★★★ 13.1 15.4 78.9 28.6 21.2 13.8 0.107 18 10 39 18 6 5 11 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★ ★★★ ★★★★ ★★★★★ ★ ★★★★★ ★★★ ★★★★★ ★★★★ 8.5 17.7 -0.297 337.6 22.8 10.8 4.3 216 0.101 28 22 18 7 43 9 24 5 18 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★ ★ ★★★ ★★★ ★★ ★★★ ★★ ★★★★★ ★★ -0.472 30.3 26.4 81.4 82.5 71.6 12.3 $142 -0.016 36 47 30 23 40 29 39 5 31 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★★ ★★★★★ ★ ★★★★ ★★★★ 56.7 6.4 32.1 93.7 0.038 0.231 21 4 3 50 19 18 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★ ★★★★★ ★★★ ★★★★ ★★★★ ★★★★ ★★★★ ★★★★ ★★★★ 177.8 229.2 8.1 27.4 10.3 10.9 5.6 6,652 0.125 0.356 10 18 6 23 11 16 20 20 12 15 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Idaho is 15th this year; it was 17th in 2015. The state ranks 15th for senior health and 26th for the health of women and children. State Health Department Website: www.healthandwelfare.idaho.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 102 OBESITY 40 % OF ADULTS Highlights: • In the past five years, drug deaths increased 31% from 10.0 to 13.1 deaths per 100,000 population. • In the past year, children in poverty increased 21% from 14.6% to 17.7% of children. • In the past year, Tdap immunization among adolescents aged 13 to 17 years increased 17% from 70.8% to 82.5%. • In the past year, disparity in health status by education decreased 5% from 28.7% to 27.4%. • In the past three years, infant mortality increased 10% from 5.1 to 5.6 deaths per 1,000 live births. % OF ADULTS 12 :0 IDAH O Overall Rank: 15 BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 4.0 11.2 90.8 20.2 17.9 9.1 0.273 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★ ★★★★ ★★★ ★ ★★★★ ★★★ ★★★★ ★★★ ★★ 10.8 15.6 -0.093 516.5 5.9 13.8 3.7 384 -0.017 48 16 29 41 16 22 13 30 33 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★ ★★★ ★★★ ★★★ ★★★★ ★★ ★★★★ ★★ ★★★ 0.032 40.2 26.8 79.0 89.1 70.8 8.4 $65 0.010 25 28 29 24 17 33 20 34 23 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★ ★★ ★★★★ ★★★ ★★★ 67.6 8.2 55.8 169.5 0.024 0.063 12 28 38 11 24 24 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★ ★★★ ★★ ★★★★★ ★★★★ ★★★ ★★★ ★★★ ★★★ 199.6 253.8 9.9 29.1 9.7 10.4 6.3 6,743 0.021 0.084 35 32 24 33 7 12 30 21 25 26 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 26 ILLIN O IS 16 46 22 33 20 10 19 Change: 2 Determinants Rank: 24 Outcomes Rank: 25 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of smoking • Higher number of primary care physicians • Low prevalence of frequent mental distress m Em ES ba T, rg De oe ce d U m nt be il r1 5, 12.6 21.2 85.6 30.8 24.8 15.1 0.046 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★ ★ ★★★ ★★ ★★★★ ★★★★★ ★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 6 Star Rating OVERALL RANK Illinois 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 20 Ranking: Illinois is 26th this year; it was 28th in 2015. The state ranks 36th for senior health and 21st for the health of women and children. Highlights: • In the past three years, drug deaths increased 21% from 10.4 to 12.6 deaths per 100,000 population. • In the past year, children in poverty decreased 24% from 20.5% to 15.6% of children. • In the past year, HPV immunization among females aged 13 to 17 years decreased 16% from 47.7% to 40.2%. • In the past year, the percentage of the population without health insurance decreased 25% from 11.2% to 8.4%. • In the past 10 years, preventable hospitalizations decreased 35% from 86.4 to 55.8 discharges per 1,000 Medicare enrollees. 15 15 10 10 State Health Department Website: www.dph.illinois.gov 5 5 0 35 Challenges: • High prevalence of excessive drinking • High levels of air pollution • High rate of cancer deaths 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 103 U N I T E D H E A LT H F O U N D AT I O N Indiana A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Overall Rank: 39 Change: 2 Determinants Rank: 37 Outcomes Rank: 41 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • High percentage of high school graduation • Low incidence of Salmonella • Small disparity in health status by educational attainment Challenges: • High levels of air pollution • Lower number of dentists • High infant mortality rate m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★ ★★★★ ★★★★ ★★ ★★ ★★ ★★ 16.7 16.8 87.1 31.3 29.4 20.6 -0.073 35 17 15 36 40 39 35 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★★ ★★★★ ★★★ ★★★ ★★★★★ ★★ ★★ ★★ 10.5 19.7 -0.473 434.0 7.5 11.0 5.0 388 -0.049 47 32 12 25 25 10 33 31 35 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★ ★ ★★★ ★★★★★ ★★★★ ★★★★ ★★ ★ ★★★ 0.305 30.9 27.5 92.3 89.7 74.7 10.8 $41 -0.009 14 46 25 6 14 18 31 49 26 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★★★ ★ ★★ ★★ ★★ 47.7 8.0 57.0 121.3 -0.096 -0.228 45 25 41 38 40 37 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★★ ★★ ★★★★★ ★★ ★★ ★ ★★ ★ ★★ 210.5 277.1 11.4 22.4 12.4 13.5 7.2 8,208 -0.144 -0.372 42 38 37 7 37 38 43 39 41 39 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Indiana is 39th this year; it was 41st in 2015. The state ranks 37th for senior health and 36th for the health of women and children. State Health Department Website: www.in.gov/isdh OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 104 OBESITY 40 % OF ADULTS Highlights: • In the past five years, drug deaths increased 27% from 13.1 to 16.7 deaths per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years decreased 30% from 44.4% to 30.9%. • In the past year, HPV immunization among males aged 13 to 17 years increased 115% from 12.8% to 27.5%. • In the past three years, preventable hospitalizations decreased 25% from 76.0 to 57.0 discharges per 1,000 Medicare enrollees. • In the past year, disparity in health status by education decreased 17% from 27.0% to 22.4%. % OF ADULTS 12 :0 IN DIANA Star Rating Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 4.0 11.2 90.8 20.2 17.9 9.1 0.273 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★★★ ★★★★★ ★★★★ ★★★★ ★★★ ★★ ★★ ★★★★ ★★★★ 8.6 13.9 -0.303 382.0 7.2 17.1 5.5 286 0.097 29 10 17 13 23 37 38 18 19 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★ ★★★★★ ★★ ★★ ★★ ★★★★★ ★★★★★ ★★ ★★★★★ -0.173 49.8 23.9 75.0 85.5 77.9 5.6 $67 0.093 32 8 34 36 35 5 5 31 8 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★★ ★★★ ★★★ ★★★ ★★★★ 52.9 6.7 48.2 139.1 0.012 0.229 30 9 27 23 27 19 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★ ★★★★ ★ ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★ ★★★★ 194.4 245.9 8.8 30.8 9.5 9.8 4.5 6,328 0.114 0.343 30 27 14 41 6 7 3 15 13 17 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 17 Change: 5 Determinants Rank: 19 Outcomes Rank: 13 IOWA 4 44 1 39 28 29 23 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • High percentage of high school graduation • Low percentage of population without insurance • Low prevalence of low birthweight m Em ES ba T, rg De oe ce d U m nt be il r1 5, 8.9 21.0 90.8 32.1 26.3 18.1 0.027 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★★ ★ ★★★★★ ★★ ★★★ ★★★ ★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 6 Star Rating OVERALL RANK Iowa 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 20 15 15 10 10 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation Ranking: Iowa is 17th this year; it was 22nd in 2015. The state ranks 19th for senior health and 8th for the health of women and children. Highlights: • In the past year, physical inactivity increased 16% from 22.6% to 26.3% of adults. • In the past year, HPV immunization among females aged 13 to 17 years increased 32% from 37.6% to 49.8%. • Since the 1990 edition, cardiovascular deaths decreased 34% from 374.6 to 245.9 deaths per 100,000 population. • In the past year, disparity in health status by education increased 8% from 28.6% to 30.8%. • In the past four years, infant mortality decreased 12% from 5.1 to 4.5 deaths per 1,000 live births. State Health Department Website: idph.iowa.gov 5 5 0 35 Challenges: • High prevalence of excessive drinking • High prevalence of obesity • Large disparity in health status by educational attainment 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 105 U N I T E D H E A LT H F O U N D AT I O N Kansas A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Overall Rank: 27 Change: 1 Determinants Rank: 29 Outcomes Rank: 23 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • Low prevalence of low birthweight • Low prevalence of frequent mental distress • Low prevalence of frequent physical distress Challenges: • High prevalence of obesity • Low immunization coverage among adolescents • Low per capita public health funding m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★★ ★★★★ ★★★★ ★ ★★★ ★★★ ★★★ 11.7 16.9 85.7 34.2 26.5 17.7 -0.023 13 19 20 44 29 27 30 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★ ★★ ★★★ ★★★★ ★★ ★★★ ★★ ★★ ★★★ 8.0 20.4 -0.173 384.1 14.9 14.8 5.5 390 0.006 22 33 25 14 38 29 38 32 27 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★ ★ ★ ★★★ ★★★★ ★★★ ★ ★★★ -0.852 31.7 18.5 63.7 87.3 75.2 9.7 $49 -0.014 44 44 47 46 26 16 25 42 30 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★★★ ★★ ★★ ★★★ ★★★ 50.9 7.0 51.9 129.0 -0.028 -0.058 35 12 33 31 30 29 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★ ★★★ ★★★ ★★★★★ ★★★★★ ★★ ★★★ ★★★ ★★★ 192.6 249.6 9.7 27.3 9.7 10.0 6.4 7,180 0.047 -0.012 28 29 21 22 7 9 33 26 23 27 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Kansas is 27th this year; it was 26th in 2015. The state ranks 32nd for senior health and 25th for the health of women and children. State Health Department Website: www.kdheks.gov OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 40 35 30 25 20 15 15 10 10 5 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 106 OBESITY 40 % OF ADULTS Highlights: • In the past three years, drug deaths increased 22% from 9.6 to 11.7 deaths per 100,000 population. • In the past year, obesity increased 9% from 31.3% to 34.2% of adults. • In the past year, children in poverty increased 23% from 16.6% to 20.4% of children. • In the past two years, HPV immunization among females aged 13 to 17 years increased 51% from 21.0% to 31.7%. • In the past year, disparity in health status by education decreased 6% from 29.1% to 27.3%. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 K AN S AS Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Kentucky ★★ ★ ★★★★ ★★★★ ★★★ ★★★★ ★★ ★★★★★ ★★★ 9.1 25.0 -0.463 401.9 6.8 13.3 5.1 219 0.003 36 46 13 18 22 19 35 7 28 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★ ★★ ★ ★★★ ★★ ★★★ ★★★★★ ★★★ ★★★★ -0.515 36.2 17.1 79.0 84.0 73.0 7.3 $71 0.030 37 37 48 24 39 24 10 27 19 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★ ★ ★★ ★ ★ 55.3 8.8 77.0 117.7 -0.151 -0.360 25 38 50 40 46 44 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★★ ★ ★ ★★ ★ ★ ★ 232.2 297.8 13.4 21.9 13.8 16.1 6.7 9,626 -0.291 -0.651 50 43 47 5 44 48 36 44 45 45 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 K E N T U CK Y COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 45 Change: 1 Determinants Rank: 44 Outcomes Rank: 45 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 48 14 8 46 47 50 48 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • High percentage of high school graduation • Low violent crime rate • Small disparity in health status by educational attainment m Em ES ba T, rg De oe ce d U m nt be il r1 5, 24.1 16.3 88.0 34.6 32.5 25.9 -0.242 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★ ★★★★ ★★★★★ ★ ★ ★ ★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 40 35 30 25 20 15 15 10 10 5 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 Challenges: • High prevalence of smoking • High rate of cancer deaths • High prevalence of frequent physical distress Ranking: Kentucky is 45th this year; it was 44th in 2015. The state ranks 45th for senior health and 34th for the health of women and children. Highlights: • In the past five years, drug deaths increased 33% from 18.1 to 24.1 deaths per 100,000 population. • In the past year, obesity increased 9% from 31.6% to 34.6% of adults. • In the past seven years, violent crime decreased 26% from 296 to 219 offenses per 100,000 population. • In the past two years, diabetes increased 26% from 10.6% to 13.4% of adults. • In the past year, disparity in health status by education decreased 20% from 27.5% to 21.9%. State Health Department Website: chfs.ky.gov/dph/ 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 107 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Louisiana Overall Rank: 49 Change: 1 Determinants Rank: 49 Outcomes Rank: 47 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • Low incidence of pertussis • High meningococcal immunization coverage among adolescents • Small disparity in health status by educational attainment Challenges: • High prevalence of obesity • High prevalence of low birthweight • High infant mortality rate m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★ ★★ ★ ★ ★ ★ ★ 15.6 18.8 77.5 36.2 31.9 21.9 -0.285 30 34 43 50 45 43 50 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★ ★ ★ ★ ★★★★★ ★ ★ ★ ★ 8.1 24.7 0.843 626.0 1.9 26.2 7.6 540 -0.174 25 45 48 48 2 47 46 46 50 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★ ★★★ ★★★★ ★★★★★ ★★★★ ★★ ★ ★★★ ★★ 0.550 39.3 30.5 90.9 91.0 70.8 13.4 $73 -0.050 12 29 20 8 11 33 43 26 38 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★ ★ ★★ ★ ★ 48.4 10.5 67.5 125.7 -0.199 -0.707 42 49 47 34 49 49 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★ ★ ★ ★ ★ ★ ★ 218.7 312.5 12.7 24.8 14.3 14.4 8.1 9,958 -0.335 -1.043 47 46 45 12 47 43 48 47 47 49 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Louisiana is 49th this year; it was 50th in 2015. The state ranks 50th for senior health and 48th for the health of women and children. State Health Department Website: dhh.louisiana.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 35 30 25 20 15 10 10 5 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g 40 15 0 108 OBESITY 40 % OF ADULTS Highlights: • In the past year, children in poverty decreased 27% from 33.7% to 24.7% of children. • In the past year, HPV immunization among males aged 13 to 17 years increased 42% from 21.5% to 30.5%. • In the past four years, public health funding decreased 28% from $102 to $73 per person. • In the past eight years, preventable hospitalizations decreased 40% from 111.9 to 67.5 discharges per 1,000 Medicare enrollees. • In the past year, diabetes increased 12% from 11.3% to 12.7% of adults. % OF ADULTS 12 :0 LO U IS IANA Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 4.0 11.2 90.8 20.2 17.9 9.1 0.273 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★★★★★ ★★★ ★★★★ ★★★★★ ★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 6.8 19.5 -0.340 265.8 41.9 9.6 3.5 130 0.184 10 30 14 2 49 3 10 2 5 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★ ★★★ ★★★★★ ★★★ ★★★ ★★★ ★★★ ★★★ ★★★★ 0.338 44.1 46.7 77.7 87.7 71.8 9.3 $85 0.021 13 22 3 30 24 28 24 21 20 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★★★ ★★★ ★★★★★ ★★★ ★★★★ 50.7 7.6 47.5 183.7 0.029 0.224 37 20 25 7 21 20 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★★★ ★★★ ★★ ★★ ★★★ ★★ ★★★ ★★ ★★★ 203.1 220.8 9.9 29.2 11.6 11.9 6.9 6,812 -0.032 0.192 39 12 24 34 31 26 39 22 32 22 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 22 M AIN E 24 39 12 26 20 36 28 Change: 7 Determinants Rank: 20 Outcomes Rank: 32 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low levels of air pollution • Low violent crime rate • Higher number of primary care physicians m Em ES ba T, rg De oe ce d U m nt be il r1 5, 13.6 19.6 87.5 30.0 24.8 19.5 -0.010 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★ ★★ ★★★★ ★★★ ★★★★ ★★ ★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 6 Star Rating OVERALL RANK Maine 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 Highlights: • In the past two years, drug deaths increased 24% from 11.0 to 13.6 deaths per 100,000 population. • In the past year, HPV immunization among males aged 13 to 17 years increased 70% from 27.5% to 46.7%. • In the past year, immunizations among children aged 19 to 35 months decreased 15% from 84.7% to 71.8%. • In the past two years, low birthweight increased 15% from 6.6% to 7.6% of live births. • In the past year, disparity in health status by education increased 10% from 26.6% to 29.2%. State Health Department Website: www.maine.gov/dhhs 20 10 10 Ranking: Maine is 22nd this year; it was 15th in 2015. The state ranks 8th for senior health and 11th for the health of women and children. 25 15 15 5 5 0 35 Challenges: • High prevalence of smoking • High incidence of pertussis • High infant mortality rate 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 109 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Maryland Overall Rank: 18 Change: no change Determinants Rank: 13 Outcomes Rank: 27 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of smoking • Low percentage of children in poverty • Higher number of dentists Challenges: • High violent crime rate • High prevalence of low birthweight • High infant mortality rate Ranking: Maryland is 18th this year; it was 18th in 2015. The state ranks 14th for senior health and 23rd for the health of women and children. 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* State Health Department Website: dhmh.maryland.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* ★★★ ★★★★ ★★★★ ★★★★ ★★★★ ★★★★★ ★★★★★ 15.3 15.5 87.0 28.9 24.1 15.1 0.125 29 11 16 20 17 10 8 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★ ★★★★★ ★★★★ ★★★ ★★★★★ ★★ ★★★★ ★★ ★★★ 9.1 13.8 -0.280 462.6 3.4 15.1 4.0 457 0.038 36 9 19 30 6 31 20 39 24 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★ ★★★ ★★★★ ★★★★ ★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ 0.283 43.7 31.3 87.3 86.5 76.8 7.3 $88 0.082 16 23 18 14 31 8 10 19 10 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★ ★★★★ ★★★★★ ★★★★ ★★★★ 72.0 8.6 46.1 179.2 0.070 0.315 9 36 18 8 14 13 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★ ★★★ ★★★ ★★★★ ★★★ ★★ ★★★ ★★★ ★★★★ 189.2 252.5 10.3 27.7 10.5 11.2 6.6 6,836 0.007 0.322 23 31 28 26 14 22 35 23 27 18 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 OBESITY 40 % OF ADULTS % OF ADULTS SMOKING 35 30 25 20 35 30 25 20 15 15 10 10 0 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g No. 1 State * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. 5 110 2016 Value Rank 1a Highlights: • In the past three years, drug deaths increased 30% from 11.8 to 15.3 deaths per 100,000 population. • In the past year, excessive drinking decreased 8% from 16.8% to 15.5% of adults. • In the past two years, HPV immunization among females aged 13 to 17 years increased 31% from 33.4% to 43.7%. • In the past eight years, preventable hospitalizations decreased 39% from 75.1 to 46.1 discharges per 1,000 Medicare enrollees. • In the past year, disparity in health status by education decreased 17% from 33.2% to 27.7%. 12 :0 M ARYLAN D Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Massachusetts ★★★★★ ★★★★ ★★★★ ★★★★★ ★★★★ ★★ ★★★★★ ★★ ★★★★★ 6.4 14.8 -0.523 317.8 4.6 18.3 2.0 391 0.180 7 13 11 5 12 38 1 33 6 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ 0.862 52.8 35.2 89.5 91.2 78.5 3.1 $102 0.165 6 4 15 10 9 4 1 13 1 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★★ ★★ ★★★★★ ★★★★★ ★★★★★ 78.3 7.5 52.8 227.5 0.142 0.648 3 19 34 2 4 1 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★★★ ★★★★ ★ ★★ ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ 184.8 205.6 8.9 33.1 11.6 10.9 4.3 5,755 0.112 0.760 18 3 16 46 31 16 1 5 14 2 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 M AS S ACH U S E T T S COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 2 Change: 1 Determinants Rank: 1 Outcomes Rank: 14 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 31 38 13 5 29 6 6 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of obesity • Low percentage of population without insurance • Higher number of primary care physicians m Em ES ba T, rg De oe ce d U m nt be il r1 5, 15.7 19.5 87.3 24.3 26.5 14.0 0.162 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★ ★★ ★★★★ ★★★★★ ★★★ ★★★★★ ★★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 15 15 10 10 5 5 0 35 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 Challenges: • High prevalence of excessive drinking • High incidence of Salmonella • Large disparity in health status by educational attainment Ranking: Massachusetts is 2nd this year; it was 3rd in 2015. The state ranks 1st for senior health and 1st for the health of women and children. Highlights: • In the past three years, drug deaths increased 34% from 11.7 to 15.7 deaths per 100,000 population. • In the past two years, smoking decreased 16% from 16.6% to 14.0% of adults. • In the past year, children in poverty decreased 16% from 17.6% to 14.8% of children. • In the past 10 years, the percentage of the population without health insurance decreased 70% from 10.3% to 3.1%. • In the past year, premature death increased 5% from 5,468 to 5,755 years lost per 100,000 population. State Health Department Website: 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. www.mass.gov/eohhs/gov/departments/dph/ AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 111 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Michigan Overall Rank: 34 Change: 1 Determinants Rank: 32 Outcomes Rank: 38 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • Low incidence of Salmonella • Low percentage of population without insurance • Higher number of primary care physicians Challenges: • High prevalence of smoking • Low immunization coverage among children • High rate of cardiovascular deaths m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★ ★ ★★ ★★ ★★★ ★★ ★ 15.7 20.0 79.8 31.2 25.5 20.7 -0.143 31 41 36 35 24 40 43 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★ ★★ ★★★ ★★★ ★★ ★★★★★ ★★★★ ★★ ★★★ 8.6 21.1 -0.227 447.2 14.4 10.6 3.8 416 -0.006 29 38 22 27 37 8 16 36 29 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★ ★★★★ ★★★ ★★★★★ ★ ★ ★★★★★ ★★ ★★★ -0.138 47.2 28.6 95.0 74.0 67.6 7.3 $58 -0.001 31 15 23 3 48 44 10 38 24 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★ ★★ ★★★★★ ★★★ ★★ 61.0 8.4 56.1 187.5 0.015 -0.136 17 34 39 6 25 32 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★ ★★ ★★★★ ★★ ★★ ★★ ★★ ★★ ★★ 201.0 288.7 10.7 26.3 11.9 13.0 6.8 7,689 -0.115 -0.251 37 42 31 18 35 35 38 33 38 34 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Michigan is 34th this year; it was 35th in 2015. The state ranks 26th for senior health and 32nd for the health of women and children. OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS Highlights: • In the past five years, drug deaths increased 21% from 13.0 to 15.7 deaths per 100,000 population. • In the past two years, violent crime decreased 9% from 455 to 416 offenses per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years increased 15% from 40.9% to 47.2%. • In the past year, Tdap immunization among adolescents aged 13 to 17 years decreased 7% from 79.3% to 74.0%. • In the past two years, disparity in health status by education decreased 11% from 29.7% to 26.3%. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 M ICH IG AN Star Rating 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 20 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 112 25 10 5 0 30 15 15 10 State Health Department Website: www.michigan.gov/mdhhs 35 Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Minnesota ★★★ ★★★★★ ★★★ ★★★★★ ★★ ★★★ ★★★★★ ★★★★ ★★★★★ 8.0 8.0 -0.223 367.3 17.5 13.4 3.1 243 0.201 22 1 23 10 39 21 6 12 4 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★ ★★★★ ★★ ★★★★ ★★★★ ★★★ ★★★★★ ★ ★★★★ 0.247 44.5 22.4 83.6 90.4 73.2 5.2 $47 0.070 19 20 37 20 12 23 4 44 11 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ 60.3 6.6 37.1 159.3 0.101 0.456 19 7 10 14 9 6 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 179.2 188.2 7.6 25.7 8.7 9.5 5.0 5,369 0.271 0.727 11 1 3 14 2 4 10 1 2 4 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 M IN N E S OTA COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 4 Change: no change Determinants Rank: 6 Outcomes Rank: 2 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 5 45 32 12 9 19 13 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low rate of drug deaths • Low percentage of children in poverty • Low percentage of population without insurance m Em ES ba T, rg De oe ce d U m nt be il r1 5, 9.3 21.1 81.9 26.1 21.8 16.2 0.085 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★★ ★ ★★ ★★★★ ★★★★★ ★★★★ ★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 Ranking: Minnesota is 4th this year; it was 4th in 2015. The state ranks 4th for senior health and 5th for the health of women and children. Highlights: • In the past five years, drug deaths increased 31% from 7.1 to 9.3 deaths per 100,000 population. • In the past year, children in poverty decreased 33% from 11.9% to 8.0% of children. • In the past year, meningococcal immunization among adolescents aged 13 to 17 years increased 11% from 75.5% to 83.6%. • In the past eight years, preventable hospitalizations decreased 43% from 65.6 to 37.1 discharges per 1,000 Medicare enrollees. • In the past year, disparity in health status by education increased 4% from 24.6% to 25.7%. 15 15 10 10 State Health Department Website: www.health.state.mn.us 5 5 0 35 Challenges: • High prevalence of excessive drinking • High incidence of pertussis • Low per capita public health funding 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 113 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Mississippi Overall Rank: 50 Change: 1 Determinants Rank: 50 Outcomes Rank: 50 BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 6 40 50 Strengths: • Low rate of drug deaths • Low prevalence of excessive drinking • Small disparity in health status by educational attainment Challenges: • High prevalence of smoking • High percentage of children in poverty • High prevalence of low birthweight 12 :0 Highlights: • In the past year, excessive drinking decreased 4% from 13.8% to 13.3% of adults. • In the past year, physical inactivity increased 16% from 31.6% to 36.8% of adults. • In the past year, meningococcal immunization among adolescents aged 13 to 17 years increased 20% from 46.0% to 55.3%. • In the past eight years, preventable hospitalizations decreased 38% from 109.8 to 67.8 discharges per 1,000 Medicare enrollees. • In the past four years, diabetes increased 19% from 12.4% to 14.7% of adults. State Health Department Website: www.msdh.state.ms.us POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* w w w. a m e r i c a s h ea lth ra n kin g s.o r g No. 1 State ★★★★★ ★★★★★ ★ ★ ★ ★ ★ 11.0 13.3 75.4 35.6 36.8 22.5 -0.257 8 5 47 47 50 47 49 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★ ★ ★ ★ ★★★★★ ★ ★ ★★★★ ★ 8.1 28.4 1.050 655.4 2.3 33.1 8.0 276 -0.127 25 48 50 49 3 50 48 16 47 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★ ★★ ★ ★ ★★ ★ ★★ ★ -1.788 24.4 21.4 55.3 74.7 70.6 13.6 $66 -0.116 50 50 40 50 47 35 44 32 48 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★ ★ ★ ★ ★ 42.9 11.3 67.8 102.3 -0.246 -0.745 49 50 48 48 50 50 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★★ ★ ★ ★ ★ ★ ★ 227.5 344.8 14.7 22.6 15.0 15.0 8.9 10,804 -0.378 -1.123 49 50 50 9 49 46 50 50 50 50 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 35 30 25 20 40 35 30 25 20 15 15 10 10 5 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 114 2016 Value Rank 1a Ranking: Mississippi is 50th this year; it was 49th in 2015. The state ranks 48th for senior health and 50th for the health of women and children. 20 1 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, ’00 % OF ADULTS 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* % OF ADULTS OVERALL RANK M IS S IS S IP P I Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Missouri 36 25 10 40 33 46 41 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★ ★★★★★ ★★★ ★★ ★★★ ★★★ ★★★ ★ ★★★ 9.1 12.4 -0.157 462.9 9.2 13.9 4.6 497 0.024 36 5 27 31 29 24 28 42 25 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★ ★★ ★ ★★ ★★ ★★ ★ ★★ -0.647 31.5 25.1 69.7 85.7 71.0 10.8 $45 -0.054 41 45 32 41 34 32 31 46 39 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★★★ ★★ ★★★★ ★★ ★★ 48.4 8.2 56.6 155.9 -0.060 -0.202 43 28 40 16 34 34 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★★ ★★★★★ ★★ ★ ★★★ ★★ ★★ ★★ 209.3 283.6 11.5 22.0 12.9 13.9 6.3 8,239 -0.136 -0.338 41 41 39 6 39 41 30 40 39 37 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 37 M IS S O U RI 17.0 17.7 87.8 32.4 27.0 22.3 -0.112 Change: 1 Determinants Rank: 34 Outcomes Rank: 39 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • High percentage of high school graduation • Low percentage of children in poverty • Small disparity in health status by educational attainment m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★ ★★★ ★★★★★ ★★ ★★ ★ ★ 6 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* No. 1 State OVERALL RANK CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 Ranking: Missouri is 37th this year; it was 36th in 2015. The state ranks 40th for senior health and 35th for the health of women and children. Highlights: • In the past year, excessive drinking increased 10% from 16.1% to 17.7% of adults. • In the past year, obesity increased 7% from 30.2% to 32.4% of adults. • In the past year, HPV immunization among males aged 13 to 17 years increased 122% from 11.3% to 25.1%. • In the past eight years, preventable hospitalizations decreased 36% from 88.6 to 56.6 discharges per 1,000 Medicare enrollees. • In the past two years, diabetes increased 20% from 9.6% to 11.5% of adults. 15 15 10 10 State Health Department Website: www.dhss.mo.gov 5 5 0 35 Challenges: • High prevalence of smoking • Lower number of dentists • High prevalence of frequent physical distress 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 115 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Montana Overall Rank: 23 Change: no change Determinants Rank: 23 Outcomes Rank: 19 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of obesity • Low levels of air pollution • Low prevalence of diabetes Challenges: • High prevalence of excessive drinking • High percentage of population without insurance • Lower number of primary care physicians POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★★ ★ ★★★★ ★★★★★ ★★★★ ★★ ★★★★ 12.8 21.8 86.0 23.6 22.5 18.9 0.072 17 47 19 3 12 32 16 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★★ ★★★ ★ ★★★★ ★ ★★★ ★★ ★★★ ★★★★ 6.3 17.8 0.417 413.0 48.7 14.4 5.2 350 0.079 5 24 41 20 50 27 36 26 20 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★ ★★ ★★ ★ ★★★★ ★ ★ ★★★★ ★ -0.545 34.8 21.7 65.8 89.5 68.1 12.9 $101 -0.071 39 38 39 45 15 42 42 14 42 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★★ ★★★★ ★ ★★★ ★★★ 59.9 7.4 39.8 110.8 0.011 0.090 20 18 12 44 28 23 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★★ ★★★★★ ★★★ ★★★★ ★★ ★★★★ ★★★ ★★★★ ★★★ 179.8 227.3 7.9 27.5 10.6 12.3 5.6 7,213 0.088 0.178 13 17 5 25 15 32 20 29 19 23 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Montana is 23rd this year; it was 23rd in 2015. The state ranks 31st for senior health and 31st for the health of women and children. 20 1 ’00 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 State Health Department Website: www.dphhs.mt.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 116 OBESITY 40 % OF ADULTS Highlights: • In the past year, chlamydia incidence increased 9% from 379.8 to 413.0 cases per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years decreased 19% from 42.9% to 34.8%. • In the past year, HPV immunization among males aged 13 to 17 years increased 67% from 13.0% to 21.7%. • In the past six years, preventable hospitalizations decreased 41% from 67.0 to 39.8 discharges per 1,000 Medicare enrollees. • In the past five years, infant mortality decreased 15% from 6.6 to 5.6 deaths per 1,000 live births. % OF ADULTS 12 :0 M O N TANA Star Rating Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Nebraska ★★★★ ★★★★ ★★★ ★★★★ ★ ★★★ ★★ ★★★★ ★★★★ 7.3 15.0 -0.017 401.3 19.6 13.9 5.4 275 0.120 13 15 30 17 41 23 37 15 16 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★ ★★★★ ★★★★ ★★★ ★★★ ★★★★ ★★★ ★★★ ★★★★ 0.172 48.2 32.2 78.1 87.7 73.8 9.0 $84 0.033 22 11 17 28 24 20 22 23 18 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★★★ ★★★ ★★★★ ★★★★ ★★★★ 65.9 6.6 46.9 148.0 0.075 0.286 13 7 23 19 13 15 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★★ ★★★★ ★★ ★★★★★ ★★★★★ ★★★★ ★★★★ ★★★★★ ★★★★ 186.9 227.0 8.8 29.0 8.9 9.6 5.2 6,529 0.146 0.432 20 16 14 32 4 6 14 18 8 12 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 N E BRAS K A COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 12 Change: 2 Determinants Rank: 15 Outcomes Rank: 8 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 3 42 5 37 23 21 18 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low rate of drug deaths • Low prevalence of low birthweight • Low prevalence of frequent mental distress m Em ES ba T, rg De oe ce d U m nt be il r1 5, 7.1 20.4 88.9 31.4 25.3 17.1 0.058 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★★ ★ ★★★★★ ★★ ★★★ ★★★ ★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 15 15 10 10 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation Ranking: Nebraska is 12th this year; it was 10th in 2015. The state ranks 20th for senior health and 17th for the health of women and children. Highlights: • In the past year, children in poverty decreased 18% from 18.3% to 15.0% of children. • In the past year, immunizations among children aged 19 to 35 months decreased 8% from 80.2% to 73.8%. • In the past four years, the percentage of the population without health insurance decreased 30% from 12.8% to 9.0%. • In the past five years, preventable hospitalizations decreased 29% from 65.7 to 46.9 discharges per 1,000 Medicare enrollees. • In the past year, premature death increased 7% from 6,125 to 6,529 years lost per 100,000 population. State Health Department Website: www.dhhs.ne.gov/ 5 5 0 35 Challenges: • High prevalence of excessive drinking • High prevalence of obesity • High incidence of pertussis 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 117 U N I T E D H E A LT H F O U N D AT I O N Nevada A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Overall Rank: 35 Change: 3 Determinants Rank: 40 Outcomes Rank: 28 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • Low prevalence of obesity • Low incidence of Salmonella • Low rate of preventable hospitalizations Challenges: • Low percentage of high school graduation • High violent crime rate • High percentage of population without insurance m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★ ★★★★ ★ ★★★★ ★★★★ ★★★ ★★ 20.9 15.8 71.3 26.7 24.7 17.5 -0.068 43 12 49 15 18 25 34 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★★★ ★★★★★ ★★★ ★★★★ ★★★★★ ★★ ★ ★ 9.2 19.3 -0.857 424.4 5.2 6.2 5.0 696 -0.080 41 29 2 23 14 1 33 49 41 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★ ★★★ ★★ ★★★ ★★★ ★★★ ★ ★ ★ -0.058 42.5 23.7 78.0 88.3 71.3 13.8 $34 -0.089 27 24 35 29 21 30 45 50 45 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★ ★★★★ ★ ★★ ★★ 52.8 8.3 42.4 104.3 -0.059 -0.295 31 31 13 46 33 40 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★ ★★★ ★★★★ ★★★ ★★ ★★★★ ★★ ★★★ ★★ 189.1 277.8 9.7 25.8 11.5 12.3 5.5 7,533 -0.008 -0.304 22 39 21 16 29 32 16 32 28 35 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Nevada is 35th this year; it was 38th in 2015. The state ranks 42nd for senior health and 47th for the health of women and children. OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS Highlights: • In the past year, drug deaths decreased 7% from 22.4 to 20.9 deaths per 100,000 population. • In the past two years, children in poverty decreased 24% from 25.3% to 19.3% of children. • In the past two years, meningococcal immunization among adolescents aged 13 to 17 years increased 22% from 64.0% to 78.0%. • In the past two years, immunizations among children aged 19 to 35 months increased 18% from 60.6% to 71.3%. • In the past year, low birthweight increased 4% from 8.0% to 8.3% of live births. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 N E VADA Star Rating 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 20 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 118 25 10 5 0 30 15 15 10 State Health Department Website: dhhs.nv.gov/ 35 Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 New Hampshire ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★ ★★★★★ ★★★★★ ★★★★★ 6.6 8.7 -0.843 271.0 6.3 14.4 3.4 199 0.290 8 2 3 3 19 28 8 4 1 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★ ★★★★ ★★ ★★★★ 1.057 51.4 47.1 87.7 92.4 74.1 7.8 $66 0.066 4 7 2 11 7 19 16 33 12 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★★ ★★★★ ★★★★ ★★★★ ★★★★★ 64.0 6.9 44.8 157.4 0.076 0.556 14 11 16 15 12 5 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★★★ ★★★★★ ★★★ ★★★★ ★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ 188.0 213.9 8.1 27.4 10.9 10.6 5.0 6,277 0.139 0.696 21 8 6 23 19 13 10 12 9 6 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 N E W H AM P S H IRE COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 6 Change: 1 Determinants Rank: 5 Outcomes Rank: 9 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 38 32 7 13 14 17 9 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low percentage of children in poverty • High immunization coverage among adolescents • Low prevalence of diabetes m Em ES ba T, rg De oe ce d U m nt be il r1 5, 17.9 18.4 88.1 26.3 22.6 15.9 0.124 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★ ★★ ★★★★★ ★★★★ ★★★★ ★★★★ ★★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 Ranking: New Hampshire is 6th this year; it was 5th in 2015. The state ranks 3rd for senior health and 3rd for the health of women and children. Highlights: • In the past three years, drug deaths increased 60% from 11.2 to 17.9 deaths per 100,000 population. • In the past year, HPV immunization among males aged 13 to 17 years increased 43% from 33.0% to 47.1%. • In the past four years, the percentage of the population without health insurance decreased 31% from 11.3% to 7.8%. • In the past three years, preventable hospitalizations decreased 23% from 58.2 to 44.8 discharges per 1,000 Medicare enrollees. • In the past two years, premature death increased 12% from 5,580 to 6,277 years lost per 100,000 population. 15 15 10 10 State Health Department Website: www.dhhs.state.nh.us 5 5 0 35 Challenges: • High rate of drug deaths • High prevalence of excessive drinking • Low per capita public health funding 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 119 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 New Jersey Overall Rank: 9 Change: 2 Determinants Rank: 7 Outcomes Rank: 11 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* Strengths: • Low prevalence of smoking • Low incidence of chlamydia • Low infant mortality rate Challenges: • High prevalence of physical inactivity • Low per capita public health funding • Large disparity in health status by educational attainment m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★ ★★★ ★★★★★ ★★★★★ ★★ ★★★★★ ★★★★★ 14.0 17.6 89.7 25.6 27.2 13.5 0.199 26 24 2 10 35 3 3 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★ ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★ ★★★★★ ★★★★ ★★★★ 8.8 16.9 -0.770 336.0 4.3 13.1 3.5 255 0.120 33 19 4 6 11 18 10 13 16 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★★ ★★★★ ★★★★ ★★★★★ ★★★ ★★★★★ ★★★ ★★ ★★★★ 0.597 45.0 30.9 95.7 87.2 76.5 9.8 $60 0.035 10 19 19 2 28 9 26 37 17 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★ ★★★ ★★★★ ★★★★★ ★★★★★ 81.5 8.1 50.3 165.2 0.089 0.443 1 27 30 12 10 7 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★ ★★★★ ★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ 183.0 245.4 9.0 29.4 10.7 10.2 4.4 5,820 0.128 0.571 17 26 17 36 18 10 2 6 11 9 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: New Jersey is 9th this year; it was 11th in 2015. The state ranks 16th for senior health and 19th for the health of women and children. State Health Department Website: www.state.nj.us/health OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS Highlights: • In the past three years, drug deaths increased 103% from 6.9 to 14.0 deaths per 100,000 population. • In the past three years, smoking decreased 22% from 17.3% to 13.5% of adults. • In the past five years, chlamydia incidence increased 22% from 275.3 to 336.0 cases per 100,000 population. • In the past year, immunizations among children aged 19 to 35 months increased 14% from 67.2% to 76.5%. • In the past five years, infant mortality decreased 19% from 5.4 to 4.4 deaths per 1,000 live births. 12 :0 N E W JE RS E Y Star Rating 35 30 25 20 20 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g 25 10 10 5 120 30 15 15 0 35 Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 New Mexico ★★★★★ ★ ★ ★ ★★ ★★ ★ ★ ★ 6.0 29.5 0.543 554.3 17.7 16.0 6.5 656 -0.164 4 50 44 45 40 35 42 48 49 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★ ★★★ ★★★★★ ★★ ★★ ★★ ★ ★★★★★ ★★ -0.103 40.6 40.3 72.5 85.9 70.1 12.7 $114 -0.037 29 27 7 37 32 37 41 9 34 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★ ★★★★ ★★★ ★★ ★ 50.8 8.8 43.1 133.4 -0.051 -0.334 36 38 14 29 31 41 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★ ★★ ★★ ★★★ ★★ ★★★★ ★ ★★ ★★ 168.3 217.5 11.5 30.5 11.3 13.7 5.4 8,887 -0.029 -0.363 4 11 39 40 27 40 15 42 31 38 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 N E W M E XICO COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 38 Change: 1 Determinants Rank: 41 Outcomes Rank: 31 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 49 6 50 19 14 25 37 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of excessive drinking • Low levels of air pollution • Low rate of cancer deaths m Em ES ba T, rg De oe ce d U m nt be il r1 5, 24.7 13.8 68.6 28.8 22.6 17.5 -0.082 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★ ★★★★★ ★ ★★★★ ★★★★ ★★★ ★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 Highlights: • In the past year, smoking decreased 8% from 19.1% to 17.5% of adults. • In the past year, HPV immunization among males aged 13 to 17 years increased 73% from 23.3% to 40.3%. • In the past year, immunizations among children aged 19 to 35 months decreased 8% from 75.9% to 70.1%. • In the past eight years, preventable hospitalizations decreased 36% from 67.0 to 43.1 discharges per 1,000 Medicare enrollees. • In the past year, premature death increased 9% from 8,190 to 8,887 years lost per 100,000 population. State Health Department Website: www.health.state.nm.us 20 10 10 Ranking: New Mexico is 38th this year; it was 37th in 2015. The state ranks 33rd for senior health and 37th for the health of women and children. 25 15 15 5 5 0 35 Challenges: • High rate of drug deaths • Low percentage of high school graduation • High percentage of children in poverty 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 121 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 New York Overall Rank: 13 Change: no change Determinants Rank: 12 Outcomes Rank: 18 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of obesity • Higher number of primary care physicians • Low premature death rate Challenges: • Low percentage of high school graduation • High prevalence of physical inactivity • High percentage of children in poverty POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★★★ ★★ ★★ ★★★★★ ★★ ★★★★ ★★★★ 11.1 18.2 79.2 25.0 29.3 15.2 0.065 9 31 38 7 39 12 17 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★ ★★ ★★★★ ★★ ★★★★ ★★★★ ★★★★★ ★★★ ★★★ 7.5 21.3 -0.273 502.8 5.2 11.8 2.2 380 0.065 15 39 20 40 14 13 2 28 22 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★ ★★★★ ★★★★★ ★★★★ ★★★★ ★★★ ★★★★ ★★★★★ ★★★★★ 0.585 47.3 38.1 86.2 89.0 71.9 7.9 $154 0.087 11 13 10 16 18 27 17 4 9 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★ ★★★ ★★★★★ ★★★★★ ★★★★ 73.6 7.9 47.6 206.2 0.124 0.341 7 22 26 3 8 12 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★ ★★★ ★★★★ ★★★ ★★★ ★★★★★ ★★★★★ ★★★★ ★★★★ 179.6 256.2 9.8 25.7 11.5 12.1 4.8 5,658 0.089 0.430 12 33 23 14 29 27 7 4 18 13 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: New York is 13th this year; it was 13th in 2015. The state ranks 23rd for senior health and 20th for the health of women and children. 20 1 ’00 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 State Health Department Website: www.health.state.ny.us OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS Highlights: • IIn the past three years, drug deaths increased 35% from 8.2 to 11.1 deaths per 100,000 population. • In the past year, smoking increased 6% from 14.4% to 15.2% of adults. • In the past year, HPV immunization among females aged 13 to 17 years increased 18% from 40.1% to 47.3%. • In the past five years, the percentage of the population without health insurance decreased 46% from 14.5% to 7.9%. • In the past two years, disparity in health status by education decreased 27% from 35.3% to 25.7%. % OF ADULTS 12 :0 N E W YO RK Star Rating 35 30 25 20 20 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g 25 10 10 5 122 30 15 15 0 35 Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 North Carolina 22 8 22 28 25 33 25 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★ ★ ★★ ★★ ★★★ ★ ★★★★ ★★★ ★★★ 8.0 23.7 0.247 478.7 7.6 20.9 3.7 347 -0.010 22 43 34 35 26 42 13 25 30 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★ ★★ ★★★ ★★★ ★★★★★ ★★★★★ ★★ ★ ★★ 0.270 37.8 29.8 78.5 93.4 76.4 12.2 $48 -0.017 17 33 21 27 4 10 37 43 32 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★ ★★★ ★★ ★★ ★★ 50.2 8.9 49.0 128.3 -0.082 -0.096 39 41 28 32 36 31 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★★ ★★ ★★ ★★ ★★ ★ ★★ ★★ ★★ 196.2 251.9 10.7 28.6 11.7 13.2 7.0 7,746 -0.099 -0.194 33 30 31 31 34 36 41 34 36 32 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 N O RT H CARO LINA 13.3 14.9 85.6 30.1 26.2 19.0 0.014 Overall Rank: 32 Change: 1 Determinants Rank: 31 Outcomes Rank: 36 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of excessive drinking • High Tdap immunization coverage among adolescents • High immunization coverage among children m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★ ★★★★★ ★★★ ★★★ ★★★ ★★ ★★★ 6 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* No. 1 State OVERALL RANK CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 Ranking: North Carolina is 32nd this year; it was 31st in 2015. The state ranks 30th for senior health and 30th for the health of women and children. Highlights: • In the past seven years, violent crime decreased 26% from 467 to 347 offenses per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years decreased 30% from 54.0% to 37.8%. • In the past year, HPV immunization among males aged 13 to 17 years increased 43% from 20.9% to 29.8%. • In the past five years, preventable hospitalizations decreased 23% from 63.7 to 49.0 discharges per 1,000 Medicare enrollees. • In the past year, disparity in health status by education decreased 21% from 36.4% to 28.6%. 15 15 10 10 State Health Department Website: www.dhhs.state.nc.us 5 5 0 35 Challenges: • High percentage of children in poverty • High prevalence of low birthweight • High infant mortality rate 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 123 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 North Dakota Overall Rank: 11 Change: 1 Determinants Rank: 13 Outcomes Rank: 5 BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 6 40 50 Strengths: • Low rate of drug deaths • High immunization coverage among children • Low prevalence of low birthweight Challenges: • High prevalence of excessive drinking • High prevalence of obesity • Large disparity in health status by educational attainment CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* SMOKING ★★★★★ ★ ★★★★ ★★ ★★ ★★ ★★★ 4.0 24.7 86.6 31.0 26.8 18.7 -0.013 1 50 17 34 32 31 29 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★★ ★★★★ ★★★★ ★★ ★★★ ★★★★ ★ ★★★★★ ★★★★★ 4.9 15.7 -0.273 477.1 7.2 12.2 10.4 239 0.157 2 17 20 34 23 14 49 10 10 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ 0.742 47.1 38.4 91.6 88.9 80.2 7.9 $131 0.130 9 16 8 7 19 2 17 6 6 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★★ ★★★★ ★★★ ★★★★ ★★★★ 55.4 6.2 46.2 136.3 0.041 0.315 23 2 20 25 18 13 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★ ★★★★ ★★ ★★★★★ ★★★★★ ★★★★ ★★★★ ★★★★★ ★★★★ 176.2 231.4 8.7 29.2 9.2 8.5 5.6 6,637 0.158 0.473 9 21 13 34 5 1 20 19 5 11 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 OBESITY 40 35 30 25 20 35 30 25 20 15 15 10 10 0 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g No. 1 State * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. 5 124 2016 Value Rank 1a Highlights: • In the past year, children in poverty increased 31% from 12.0% to 15.7% of children. • In the past year, HPV immunization among males aged 13 to 17 years increased 52% from 25.3% to 38.4%. • In the past four years, public health funding increased 68% from $78 to $131 per person. • In the past two years, disparity in health status by education increased 47% from 19.9% to 29.2%. • In the past three years, infant mortality decreased 14% from 6.5 to 5.6 deaths per 1,000 live births. State Health Department Website: www.ndhealth.gov POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* 12 :0 Ranking: North Dakota is 11th this year; it was 12th in 2015. The state ranks 17th for senior health and 13th for the health of women and children. 20 1 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 m Em ES ba T, rg De oe ce d U m nt be il r1 5, ’00 % OF ADULTS 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* % OF ADULTS OVERALL RANK N O RT H DAKOTA Star Rating Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★ ★★ ★★ ★★★ ★★ ★ ★ 21.1 19.2 80.7 29.8 27.0 21.6 -0.163 45 37 34 24 33 42 44 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★★ ★★★ ★★ ★★ ★★★★★ ★★★★ ★★★★ ★★ 10.2 20.9 -0.210 474.1 12.6 10.4 3.9 292 -0.016 46 37 24 33 35 6 18 19 32 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★ ★★ ★ ★★ ★★★ ★★ ★★★★ ★ ★★★ -0.350 37.8 21.0 76.1 86.7 68.3 7.5 $46 -0.012 35 33 41 33 29 40 14 45 29 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★ ★ ★★★★ ★★ ★★ 52.3 8.5 59.8 162.0 -0.060 -0.251 32 35 43 13 34 39 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★ ★★ ★★★ ★★ ★★★ ★ ★★ ★★ ★★ 208.6 278.7 11.0 27.7 12.0 12.1 7.1 8,063 -0.140 -0.391 40 40 34 26 36 27 42 38 40 40 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 40 Change: 1 Determinants Rank: 39 Outcomes Rank: 40 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low incidence of Salmonella • Low percentage of population without insurance • Higher number of primary care physicians m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* No. 1 State O H IO CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 6 Star Rating OVERALL RANK Ohio 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 5 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation Highlights: • In the past three years, drug deaths increased 51% from 14.0 to 21.1 deaths per 100,000 population. • In the past year, obesity decreased 9% from 32.6% to 29.8% of adults. • In the past year, HPV immunization among males aged 13 to 17 years decreased 10% from 23.3% to 21.0%. • In the past three years, preventable hospitalizations decreased 24% from 78.5 to 59.8 discharges per 1,000 Medicare enrollees. • In the past two years, infant mortality decreased 8% from 7.7 to 7.1 deaths per 1,000 live births. State Health Department Website: www.odh.ohio.gov 10 10 Ranking: Ohio is 40th this year; it was 39th in 2015. The state ranks 38th for senior health and 33rd for the health of women and children. 20 15 15 0 35 Challenges: • High prevalence of smoking • High levels of air pollution • High infant mortality rate 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 125 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Oklahoma Overall Rank: 46 Change: 1 Determinants Rank: 47 Outcomes Rank: 44 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of excessive drinking • Low incidence of pertussis • Small disparity in health status by educational attainment Challenges: • High prevalence of smoking • High percentage of population without insurance • High premature death rate 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★ ★★★★★ ★★★ ★ ★ ★ ★ 20.9 13.9 82.5 33.9 33.2 22.2 -0.205 43 7 30 43 48 45 45 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★ ★★★ ★★ ★ ★★★★★ ★ ★ ★★ ★★ 8.7 19.0 0.300 536.6 3.7 20.7 7.8 422 -0.066 32 27 37 44 8 41 47 37 37 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★ ★ ★★★★ ★ ★★ ★★★★ ★ ★★★ ★ -0.567 32.2 35.7 68.1 84.4 75.4 14.7 $80 -0.065 40 43 13 43 38 14 46 24 41 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★★ ★ ★★ ★★ ★ 50.3 8.0 59.2 123.7 -0.092 -0.428 38 25 42 36 38 47 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★★ ★ ★ ★ ★ ★ ★ 215.2 325.9 11.7 19.9 13.1 14.8 7.5 9,895 -0.264 -0.691 44 48 42 2 41 44 46 46 44 46 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Oklahoma is 46th this year; it was 45th in 2015. The state ranks 49th for senior health and 46th for the health of women and children. State Health Department Website: www.ok.gov/health OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 40 35 30 25 20 15 15 10 10 5 0 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 126 OBESITY 40 % OF ADULTS Highlights: • In the past three years, drug deaths increased 11% from 18.8 to 20.9 deaths per 100,000 population. • In the past three years, immunizations among children aged 19 to 35 months increased 24% from 61.0% to 75.4%. • In the past three years, chlamydia incidence increased 42% from 377.9 to 536.6 cases per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years decreased 12% from 36.4% to 32.2%. • In the past year, HPV immunization among males aged 13 to 17 years increased 79% from 19.9% to 35.7%. % OF ADULTS 12 :0 O K LAH O M A Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. 15 34 48 28 2 21 32 4.0 11.2 90.8 20.2 17.9 9.1 0.273 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★★★★ ★★★ ★★★★★ ★★★★ ★★ ★★★★★ ★★★★★ ★★★★ ★★★★ 7.3 17.7 -0.543 394.6 10.6 10.2 3.3 260 0.151 13 22 9 15 33 5 7 14 11 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★ ★★★★★ ★★★★ ★★ ★★★★ ★ ★★★★ ★★★ ★★★ 0.258 48.9 35.7 75.2 89.4 67.4 8.4 $68 -0.004 18 9 13 35 16 45 20 29 25 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★★★ ★★★★★ ★★★ ★★★★★ ★★★★ 69.1 6.2 33.4 139.6 0.135 0.239 11 2 6 22 6 17 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★★★ ★★ ★★ ★ ★★ ★★★★ ★★★★ ★★★ ★★★ 190.9 212.4 10.7 30.3 13.6 13.6 5.1 6,523 -0.028 0.211 26 5 31 38 42 39 13 17 30 21 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 21 Change: 1 Determinants Rank: 17 Outcomes Rank: 30 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of physical inactivity • Low prevalence of low birthweight • Low rate of cardiovascular deaths m Em ES ba T, rg De oe ce d U m nt be il r1 5, 12.3 18.8 73.8 30.1 18.8 17.1 -0.044 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★ ★★ ★ ★★★ ★★★★★ ★★★ ★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank O RE G O N Star Rating 6 Oregon A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 OVERALL RANK 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 20 Ranking: Oregon is 21st this year; it was 20th in 2015. The state ranks 12th for senior health and 27th for the health of women and children. Highlights: • In the past year, obesity increased 8% from 27.9% to 30.1% of adults. • In the past year, HPV immunization among males aged 13 to 17 years increased 190% from 12.3% to 35.7%. • In the past five years, the percentage of the population without health insurance decreased 50% from 16.8% to 8.4%. • In the past 10 years, preventable hospitalizations decreased 35% from 51.2 to 33.4 discharges per 1,000 Medicare enrollees. • In the past year, diabetes increased 19% from 9.0% to 10.7% of adults. 15 15 10 10 State Health Department Website: public.health.oregon.gov/ 5 5 0 35 Challenges: • Low percentage of high school graduation • Low immunization coverage among children • High prevalence of frequent mental distress 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 127 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Pennsylvania Overall Rank: 28 Change: 1 Determinants Rank: 25 Outcomes Rank: 33 BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 6 40 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, Strengths: • Low incidence of Salmonella • High immunization coverage among adolescents • Higher number of primary care physicians Challenges: • High rate of drug deaths • High levels of air pollution • Low per capita public health funding OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* SMOKING ★ ★★★ ★★★ ★★★ ★★ ★★★ ★★ 19.8 18.1 84.8 30.0 27.8 18.1 -0.041 42 30 26 26 37 29 31 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★★★ ★★★★★ ★★★★ ★★★★ ★★★★ ★★★ ★★★ ★★ 11.0 19.0 -0.603 395.6 6.4 11.5 4.1 315 -0.015 49 27 7 16 20 11 23 22 31 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★ ★★★★ ★ ★★★★ 1.013 47.8 38.3 94.7 91.7 72.8 7.5 $51 0.053 5 12 9 4 8 25 14 41 16 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★ ★★ ★★★★★ ★★★★ ★★★ 60.7 8.3 51.5 192.9 0.038 0.035 18 31 31 5 19 25 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★ ★★★ ★★ ★★★ ★★★ ★★★ ★★★ ★★ ★★★ 199.8 259.3 10.4 29.8 11.4 11.4 6.3 7,189 -0.052 -0.016 36 35 30 37 28 25 30 28 33 28 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 OBESITY 40 35 30 25 20 0 35 30 25 20 15 15 10 5 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g No. 1 State * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. 10 128 2016 Value Rank 1a Highlights: • In the past five years, drug deaths increased 36% from 14.6 to 19.8 deaths per 100,000 population. • In the past year, physical inactivity increased 19% from 23.3% to 27.8% of adults. • In the past four years, smoking decreased 19% from 22.4% to 18.1% of adults. • In the past year, HPV immunization among males aged 13 to 17 years increased 47% from 26.0% to 38.3%. • In the past year, diabetes decreased 7% from 11.2% to 10.4% of adults. State Health Department Website: www.health.state.pa.us CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 12 :0 Ranking: Pennsylvania is 28th this year; it was 29th in 2015. The state ranks 18th for senior health and 24th for the health of women and children. 20 1 ’00 % OF ADULTS 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* % OF ADULTS OVERALL RANK P E N N S YLVAN IA Star Rating Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Rhode Island ★★★★ ★★★★★ ★★★★ ★★★ ★★ ★★★★ ★★★★ ★★★★ ★★★★★ 7.5 13.4 -0.310 413.6 10.3 13.3 3.7 243 0.179 15 7 16 21 32 20 13 11 7 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 1.783 68.0 58.1 97.7 97.1 77.2 6.6 $124 0.153 1 1 1 1 1 6 8 7 3 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★ ★★ ★★★★★ ★★★★ ★★★★★ 54.2 7.1 55.3 247.7 0.063 0.438 26 15 37 1 15 8 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★★★ ★★★★ ★ ★★ ★★ ★★★★ ★★★★ ★★★ ★★★★ 195.2 230.4 9.0 33.7 12.4 12.8 5.5 6,129 -0.017 0.422 32 20 17 47 37 34 16 11 29 14 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 RH O DE IS LAN D COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 14 Change: no change Determinants Rank: 8 Outcomes Rank: 29 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 46 28 29 11 38 14 20 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low percentage of children in poverty • High immunization coverage among adolescents • Higher number of primary care physicians m Em ES ba T, rg De oe ce d U m nt be il r1 5, 21.4 17.9 83.2 26.0 28.1 15.5 0.044 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★ ★★★ ★★★ ★★★★ ★★ ★★★★ ★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 15 15 10 10 5 5 0 35 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. Challenges: • High rate of drug deaths • Large disparity in health status by educational attainment • High prevalence of frequent mental distress Ranking: Rhode Island is 14th this year; it was 14th in 2015. The state ranks 11th for senior health and 9th for the health of women and children. Highlights: • In the past four years, drug deaths increased 39% from 15.4 to 21.4 deaths per 100,000 population. • In the past year, physical inactivity increased 25% from 22.5% to 28.1% of adults. • In the past two years, children in poverty decreased 42% from 23.2% to 13.4% of children. • In the past year, the percentage of the population without health insurance decreased 31% from 9.5% to 6.6%. • In the past year, infant mortality decreased 15% from 6.5 to 5.5 deaths per 1,000 live births. State Health Department Website: www.health.state.ri.us AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 129 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 South Carolina Overall Rank: 42 Change: no change Determinants Rank: 42 Outcomes Rank: 42 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of excessive drinking • Low incidence of pertussis • Low rate of preventable hospitalizations Challenges: • High incidence of infectious disease • Low immunization coverage among adolescents • High prevalence of low birthweight 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★ ★★★★ ★★ ★★ ★★ ★★ ★★ 13.4 16.6 80.3 31.7 26.7 19.7 -0.090 23 15 35 38 31 37 38 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★ ★★★ ★ ★ ★★★★★ ★ ★★★ ★ ★★ 7.9 18.8 0.873 588.2 3.6 29.3 4.8 505 -0.059 19 26 49 46 7 48 30 44 36 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★★ ★ ★ ★ ★ ★★ ★★ ★ -1.147 34.3 21.0 69.0 77.8 68.2 12.3 $65 -0.095 47 39 41 42 46 41 39 35 46 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★ ★★★★ ★★ ★ ★ 48.0 9.4 46.2 124.3 -0.101 -0.345 44 46 20 35 42 42 81.5 5.9 23.5 247.7 0.170 0.648 ★★ ★★ ★ ★★★ ★ ★★ ★★ ★ ★ ★ 202.7 274.1 11.8 27.2 13.7 13.2 6.7 8,796 -0.187 -0.532 38 37 43 21 43 36 36 41 42 42 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: South Carolina is 42nd this year; it was 42nd in 2015. The state ranks 34th for senior health and 39th for the health of women and children. State Health Department Website: www.scdhec.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS Highlights: • In the past year, smoking decreased 8% from 21.5% to 19.7% of adults. • In the past year, Salmonella incidence increased 22% from 24.1 to 29.3 cases per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years decreased 4% from 35.9% to 34.3%. • In the past year, immunizations among children aged 19 to 35 months decreased 6% from 72.6% to 68.2%. • In the past 10 years, infant mortality decreased 23% from 8.7 to 6.7 deaths per 1,000 live births. % OF ADULTS 12 :0 S O U T H CARO LINA Star Rating 35 30 25 20 20 5 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g 25 10 10 130 30 15 15 0 35 Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 South Dakota 2 25 28 30 7 38 26 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★★ ★★ ★ ★★ ★★ ★★ ★ ★★★ ★★★ 6.3 20.8 0.430 493.1 13.0 20.1 7.0 383 0.011 5 35 42 38 36 40 45 29 26 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★ ★★ ★ ★ ★★★★ ★★★ ★★★★ ★★★ -1.625 32.4 22.0 55.5 72.4 75.6 10.0 $94 -0.011 49 41 38 49 49 11 27 17 27 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★★ ★★★ ★★ ★★★ ★★★ 53.6 6.5 47.0 120.2 0.004 0.012 29 6 24 39 29 26 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ ★★★ ★★★ ★★★★★ ★★★ 185.5 233.8 9.3 22.5 7.1 9.8 6.2 7,245 0.157 0.169 19 22 19 8 1 7 29 30 6 24 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 S O U T H DAKOTA 6.6 17.7 83.9 30.4 21.5 20.1 0.008 Overall Rank: 24 Change: 5 Determinants Rank: 26 Outcomes Rank: 6 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low rate of drug deaths • Low levels of air pollution • Low prevalence of frequent mental distress m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★★ ★★★ ★★★ ★★★ ★★★★★ ★★ ★★★ 6 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* No. 1 State OVERALL RANK CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 15 15 10 10 5 5 0 35 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. Challenges: • High incidence of infectious disease • Low immunization coverage among adolescents • Lower number of primary care physicians Ranking: South Dakota is 24th this year; it was 19th in 2015. The state ranks 25th for senior health and 18th for the health of women and children. Highlights: • In the past two years, drug deaths increased 8% from 6.1 to 6.6 deaths per 100,000 population. • In the past 10 years, violent crime increased 114% from 179 to 383 offenses per 100,000 population. • In the past year, HPV immunization among males aged 13 to 17 years decreased 6% from 23.5% to 22.0%. • In the past year, preventable hospitalizations decreased 9% from 51.8 to 47.0 discharges per 1,000 Medicare enrollees. • In the past year, infant mortality decreased 16% from 7.4 to 6.2 deaths per 1,000 live births. State Health Department Website: doh.sd.gov AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 131 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Tennessee Overall Rank: 44 Change: 1 Determinants Rank: 45 Outcomes Rank: 43 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of excessive drinking • High percentage of high school graduation • Small disparity in health status by educational attainment Challenges: • High prevalence of smoking • High violent crime rate • High prevalence of frequent physical distress 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★ ★★★★★ ★★★★★ ★ ★ ★ ★★ 18.3 11.2 87.9 33.8 30.4 21.9 -0.097 40 1 9 42 43 43 40 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★ ★ ★★★ ★★ ★★★★ ★★ ★★ ★ ★ 8.6 22.0 -0.170 474.0 5.1 15.4 4.9 612 -0.104 29 41 26 32 13 32 31 47 45 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★★ ★ ★★ ★ ★★ ★★ ★★★ ★★ -0.803 38.9 16.0 76.7 79.7 70.1 11.2 $84 -0.048 43 31 50 32 44 37 34 22 37 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★ ★ ★★★ ★ ★ 49.6 9.0 59.9 135.1 -0.116 -0.365 40 43 44 27 43 45 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★★ ★ ★ ★★ ★ ★ ★ 215.6 302.7 12.7 20.5 14.0 16.5 6.9 9,369 -0.262 -0.626 45 45 45 3 46 49 39 43 43 44 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Tennessee is 44th this year; it was 43rd in 2015. The state ranks 43rd for senior health and 42nd for the health of women and children. OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS Highlights: • In the past three years, drug deaths increased 17% from 15.7 to 18.3 deaths per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years increased 94% from 20.1% to 38.9%. • In the past year, Tdap immunization among adolescents aged 13 to 17 years decreased 7% from 86.0% to 79.7%. • In the past eight years, preventable hospitalizations decreased 39% from 97.8 to 59.9 discharges per 1,000 Medicare enrollees. • In the past two years, disparity in health status by education decreased 36% from 32.1% to 20.5%. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 TENNESSEE Star Rating 35 30 25 20 132 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 35 30 25 20 15 15 10 10 5 State Health Department Website: health.state.tn.us 40 0 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* ★★★★★ ★★★★ ★★★★★ ★★ ★ ★★★★ ★★★★ 9.6 17.3 89.0 32.4 29.5 15.2 0.076 6 20 4 40 42 12 15 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★★ ★★ ★★ ★★★ ★★ ★★ ★★ ★ 9.4 21.4 0.290 496.1 9.7 19.5 5.5 412 -0.083 44 40 36 39 30 39 38 35 43 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★ ★★★ ★★ ★★★★★ ★★ ★★ ★ ★★ ★ 0.087 40.9 24.0 89.6 85.1 71.2 18.1 $56 -0.125 23 25 33 9 37 31 50 40 49 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★ ★★★ ★★ ★ ★★ ★★ 51.9 8.2 54.3 110.3 -0.092 -0.224 34 28 35 45 38 35 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★ ★★ ★★★ ★★★★★ ★★★★ ★★★ ★★★ ★★★ ★★ 182.2 256.9 11.4 28.4 10.0 11.0 5.9 7,183 0.016 -0.208 16 34 37 28 9 20 24 27 26 33 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 33 Change: 1 Determinants Rank: 35 Outcomes Rank: 26 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low rate of drug deaths • High percentage of high school graduation • Low prevalence of frequent mental distress m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* No. 1 State T E XAS CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 6 Star Rating OVERALL RANK Texas 20 1 U N I T E D H E A LT H F O U N D AT I O N 35 30 25 20 30 25 20 15 15 Ranking: Texas is 33rd this year; it was 34th in 2015. The state ranks 41st for senior health and 41st for the health of women and children. Highlights: • In the past year, smoking increased 5% from 14.5% to 15.2% of adults. • In the past five years, chlamydia incidence increased 16% from 427.4 to 496.1 cases per 100,000 population. • In the past year, HPV immunization among females aged 13 to 17 years increased 21% from 33.9% to 40.9%. • In the past 10 years, preventable hospitalizations decreased 38% from 87.5 to 54.3 discharges per 1,000 Medicare enrollees. • In the past year, disparity in health status by education decreased 16% from 34.0% to 28.4%. 10 10 5 5 0 35 Challenges: • High percentage of population without insurance • Lower number of primary care physicians • High prevalence of diabetes 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. State Health Department Website: www.dshs.state.tx.us AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 133 U N I T E D H E A LT H F O U N D AT I O N Utah A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Star Rating Change: 1 Determinants Rank: 11 Outcomes Rank: 3 OVERALL RANK 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of smoking • Low percentage of children in poverty • Low rate of cancer deaths Challenges: • High rate of drug deaths • Low immunization coverage among adolescents • Lower number of primary care physicians 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* No. 1 State ★ ★★★★★ ★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 22.8 12.4 84.8 24.5 20.3 9.1 0.273 47 3 26 6 5 1 1 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★ ★★★★★ ★★★ ★★★★★ ★ ★★★★ ★★★★ ★★★★★ ★★★★ 9.2 12.3 -0.100 283.5 32.4 12.8 4.0 236 0.121 41 4 28 4 48 16 20 9 15 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★ ★ ★★ ★ ★ ★★ ★★★ ★ -1.030 24.6 19.9 71.5 82.0 68.1 11.5 $69 -0.079 45 49 43 39 43 42 35 28 44 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★★ ★★★★★ ★ ★★★★ ★★★★ 62.9 7.0 28.8 96.7 0.055 0.370 16 12 2 49 16 11 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★★ ★★★★★ ★★ ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ 149.3 225.0 7.0 30.3 10.6 9.5 5.0 6,279 0.208 0.578 1 14 2 38 15 4 10 13 3 8 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Utah is 8th this year; it was 7th in 2015. The state ranks 6th for senior health and 6th for the health of women and children. State Health Department Website: www.health.utah.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 134 OBESITY 40 % OF ADULTS Highlights: • In the past year, physical inactivity increased 21% from 16.8% to 20.3% of adults. • In the past year, Salmonella incidence increased 13% from 11.3 to 12.8 cases per 100,000 population. • In the past year, HPV immunization among males aged 13 to 17 years increased 60% from 12.4% to 19.9%. • In the past five years, preventable hospitalizations decreased 22% from 36.7 to 28.8 discharges per 1,000 Medicare enrollees. • In the past two years, disparity in health status by education increased 14% from 26.5% to 30.3%. % OF ADULTS 12 :0 U TAH Overall Rank: 8 BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Vermont ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★ ★★★ ★★★ ★★★★★ ★★★★★ 5.6 17.3 -0.527 357.0 6.7 14.8 4.3 118 0.239 3 20 10 9 21 30 24 1 2 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ ★★★★★ 1.108 54.4 41.1 84.4 95.8 75.6 4.4 $115 0.155 3 3 6 19 2 11 2 8 2 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★ ★★★★ ★★★★★ ★★★★ ★★★★★ 56.7 7.1 38.8 173.0 0.083 0.627 22 15 11 9 11 2 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★★ ★★★★★ ★ ★★★★ ★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ 190.5 226.9 8.2 35.6 10.6 11.1 4.5 5,980 0.082 0.709 25 15 8 49 15 21 3 9 20 5 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 VE RM O N T COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 5 Change: 3 Determinants Rank: 2 Outcomes Rank: 20 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 18 39 11 8 11 18 7 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of obesity • Low violent crime rate • Low percentage of population without insurance m Em ES ba T, rg De oe ce d U m nt be il r1 5, 13.1 19.6 87.7 25.1 22.2 16.0 0.150 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★★ ★★ ★★★★ ★★★★★ ★★★★ ★★★★ ★★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 15 15 10 10 Ranking: Vermont is 5th this year; it was 2nd in 2015. The state ranks 2nd for senior health and 2nd for the health of women and children. Highlights: • In the past year, physical inactivity increased 17% from 19.0% to 22.2% of adults. • In the past year, children in poverty increased 50% from 11.5% to 17.3% of children. • In the past 10 years, the percentage of the population without health insurance decreased 60% from 11.1% to 4.4%. • In the past two years, low birthweight increased 15% from 6.2% to 7.1% of live births. • In the past year, preventable hospitalizations decreased 10% from 43.2 to 38.8 discharges per 1,000 Medicare enrollees. 5 5 0 35 Challenges: • High prevalence of excessive drinking • High rate of cancer deaths • Large disparity in health status by educational attainment 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. State Health Department Website: www.healthvermont.gov AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 135 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Virginia Overall Rank: 19 Change: 2 Determinants Rank: 21 Outcomes Rank: 22 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low rate of drug deaths • Low percentage of children in poverty • Low prevalence of frequent physical distress Challenges: • Low immunization coverage among adolescents • Low immunization coverage among children • Large disparity in health status by educational attainment 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★★★★ ★★★ ★★★★ ★★★ ★★★ ★★★★ ★★★★ 10.1 17.4 85.7 29.2 25.1 16.5 0.081 7 21 20 22 22 20 14 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★ ★★★★★ ★★★★ ★★★ ★★★★ ★★★ ★★★ ★★★★★ ★★★★★ 7.8 13.6 -0.340 436.4 6.1 13.9 4.4 196 0.176 18 8 14 26 18 25 27 3 8 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★★ ★★ ★ ★ ★ ★★★ ★★★ ★ -0.795 38.5 25.7 66.8 82.2 64.4 10.0 $68 -0.074 42 32 31 44 42 50 27 30 43 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★ ★★★ ★★★★ ★★★ ★★★ ★★★ 63.6 7.9 43.6 138.1 0.026 0.209 15 22 15 24 22 21 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★ ★★★ ★★★ ★★★★ ★★★★★ ★★★ ★★★★ ★★★ ★★★★ 189.2 239.0 10.3 28.5 10.3 10.2 6.0 6,508 0.055 0.264 23 25 28 29 11 10 25 16 22 19 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Virginia is 19th this year; it was 21st in 2015. The state ranks 29th for senior health and 12th for the health of women and children. State Health Department Website: www.vdh.state.va.us OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 136 OBESITY 40 % OF ADULTS Highlights: • In the past year, smoking decreased 15% from 19.5% to 16.5% of adults. • In the past year, immunizations among children aged 19 to 35 months decreased 13% from 73.7% to 64.4%. • In the past 10 years, preventable hospitalizations decreased 37% from 69.3 to 43.6 discharges per 1,000 Medicare enrollees. • In the past year, diabetes increased 6% from 9.7% to 10.3% of adults. • In the past five years, infant mortality decreased 18% from 7.3 to 6.0 deaths per 1,000 live births. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 VIRG IN IA Star Rating Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Washington ★★★ ★★★ ★★★★★ ★★★★ ★★★ ★★★★★ ★★★★★ ★★★★ ★★★★ 8.3 17.4 -0.630 381.2 8.6 10.6 2.6 284 0.125 27 21 6 12 28 7 3 17 14 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★ ★★★★ ★★★ ★★ ★★ ★★★★★ ★★★★ ★★★★ ★★★★ -0.183 45.1 28.0 75.4 85.3 77.1 7.9 $86 0.063 33 18 24 34 36 7 17 20 13 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★★★ ★★★★★ ★★★★★ ★★★★ ★★★★★ ★★★★★ 72.8 6.4 32.6 141.4 0.146 0.427 8 4 5 20 3 9 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★ ★★★★★ ★★★★★ ★★★★ ★★★ ★★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ 182.0 213.3 8.4 26.7 11.2 11.3 4.5 5,973 0.156 0.582 14 6 9 19 24 24 3 8 7 7 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 WAS H IN G TO N COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* Overall Rank: 7 Change: 2 Determinants Rank: 9 Outcomes Rank: 7 0 10 20 30 40 6 4.0 11.2 90.8 20.2 17.9 9.1 0.273 OVERALL RANK 25 27 41 14 3 9 12 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low prevalence of smoking • High immunization coverage among children • Low prevalence of low birthweight m Em ES ba T, rg De oe ce d U m nt be il r1 5, 13.8 17.8 78.2 26.4 19.0 15.0 0.093 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS No. 1 State ★★★ ★★★ ★ ★★★★ ★★★★★ ★★★★★ ★★★★ % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 15 15 10 10 5 5 0 35 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. Challenges: • High prevalence of excessive drinking • Low percentage of high school graduation • Low immunization coverage among adolescents Ranking: Washington is 7th this year; it was 9th in 2015. The state ranks 10th for senior health and 16th for the health of women and children. Highlights: • In the past four years, drug deaths decreased 13% from 15.9 to 13.8 deaths per 100,000 population. • In the past year, meningococcal immunization among adolescents aged 13 to 17 years decreased 8% from 82.1% to 75.4%. • In the past year, immunizations among children aged 19 to 35 months increased 14% from 67.4% to 77.1%. • In the past two years, the percentage of the population without health insurance decreased 43% from 13.9% to 7.9%. • In the past year, diabetes decreased 6% from 8.9% to 8.4% of adults. State Health Department Website: www.doh.wa.gov AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 137 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 West Virginia Overall Rank: 43 Change: 4 Determinants Rank: 38 Outcomes Rank: 48 BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 6 40 50 Strengths: • Low prevalence of excessive drinking • Low incidence of infectious disease • Low percentage of population without insurance Challenges: • High rate of drug deaths • High prevalence of smoking • Low immunization coverage among children 20 1 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, ’00 Highlights: • In the past three years, drug deaths increased 46% from 22.0 to 32.2 deaths per 100,000 population. • In the past year, high school graduation increased 6% from 81.4% to 86.5% of students. • In the past year, the percentage of the population without health insurance decreased 35% from 11.3% to 7.3%. • In the past year, public health funding increased 71% from $120 to $205 per person. • In the past 10 years, premature death increased 9% from 9,384 to 10,245 years lost per 100,000 population. State Health Department Website: www.dhhr.wv.gov OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* SMOKING ★ ★★★★★ ★★★★ ★ ★ ★ ★ 32.2 11.4 86.5 35.6 30.8 25.7 -0.223 50 2 18 47 44 49 47 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★ ★★ ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★ ★★★ ★★★ 7.9 20.6 -1.347 254.5 1.0 9.7 6.8 338 0.067 19 34 1 1 1 4 44 24 21 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★ ★★★ ★★★ ★★★★ ★★ ★ ★★★★★ ★★★★★ ★★★★ 0.040 39.2 27.1 86.0 85.8 64.9 7.3 $205 0.057 24 30 27 17 33 49 10 3 15 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★ ★ ★ ★★★★ ★ ★★ 48.6 9.1 71.9 151.2 -0.144 -0.243 41 44 49 18 45 38 81.5 5.9 23.5 247.7 0.170 0.648 ★ ★ ★ ★★★★ ★ ★ ★ ★ ★ ★ 223.9 297.9 14.5 24.6 15.6 18.6 7.3 10,245 -0.352 -0.595 48 44 49 11 50 50 45 49 48 43 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 OBESITY 40 35 30 25 20 40 35 30 25 20 15 15 10 10 5 5 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State w w w. a m e r i c a s h ea lth ra n kin g s.o r g No. 1 State * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. 0 138 2016 Value Rank 1a 12 :0 Ranking: West Virginia is 43rd this year; it was 47th in 2015. The state ranks 46th for senior health and 38th for the health of women and children. CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* % OF ADULTS 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* % OF ADULTS OVERALL RANK WE S T VIRG IN IA Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Wisconsin 26 49 6 31 8 23 24 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★ ★★★ ★★ ★★★★ ★ ★★ ★★★★ ★★★ ★★★ 7.9 18.3 0.337 403.2 26.4 16.0 3.8 306 0.058 19 25 38 19 47 34 16 21 23 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★★★★ ★★★★ ★★★★ ★★★ ★★★ ★★ ★★★★★ ★ ★★★★ 0.305 47.3 33.5 81.6 88.0 68.8 6.5 $43 0.021 14 13 16 21 22 39 6 47 20 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★★★★ ★★★★ ★★★ ★★★ ★★★ 55.3 7.3 45.1 140.3 0.014 0.114 24 17 17 21 26 22 81.5 5.9 23.5 247.7 0.170 0.648 ★★★ ★★★ ★★★★★ ★★★★ ★★★★★ ★★★★ ★★★ ★★★★ ★★★★ ★★★★ 191.6 236.8 8.4 25.8 10.0 10.7 6.0 6,324 0.106 0.220 27 24 9 16 9 14 25 14 17 20 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Overall Rank: 20 WIS CO N S IN 14.0 24.5 88.4 30.7 21.6 17.3 0.021 Change: 4 Determinants Rank: 22 Outcomes Rank: 17 0 10 20 30 40 50 1990 ’92 ’94 ’96 ’98 EDITION YEAR ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • High percentage of high school graduation • Low percentage of population without insurance • Low prevalence of diabetes m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* ★★★ ★ ★★★★★ ★★ ★★★★★ ★★★ ★★★ 6 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* No. 1 State OVERALL RANK CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* 12 :0 OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING OBESITY 40 % OF ADULTS % OF ADULTS BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 2016 Value Rank 20 1 Star Rating 35 30 25 20 30 25 20 15 15 10 10 5 5 0 35 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State Nation 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. Challenges: • High prevalence of excessive drinking • High incidence of pertussis • Low per capita public health funding Ranking: Wisconsin is 20th this year; it was 24th in 2015. The state ranks 13th for senior health and 15th for the health of women and children. Highlights: • In the past five years, drug deaths increased 23% from 11.4 to 14.0 deaths per 100,000 population. • In the past year, children in poverty increased 13% from 16.2% to 18.3% of children. • In the past two years, HPV immunization among females aged 13 to 17 years increased 29% from 36.8% to 47.3%. • In the past year, meningococcal immunization among children aged 13 to 17 years increased 11% from 73.8% to 81.6%. • In the past year, disparity in health status by education decreased 20% from 32.2% to 25.8%. State Health Department Website: www.dhs.wisconsin.gov AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 139 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 Wyoming Overall Rank: 25 Change: no change Determinants Rank: 27 Outcomes Rank: 15 OVERALL RANK BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) STAR RATING Stars Rank High School Graduation (% of students) ★★★★★ 1–10 Obesity (% of adults) ★★★★ 11–20 ★★★ 21–30 Physical Inactivity (% of adults) ★★ 31– 40 ★ 41–50 Smoking (% of adults) Behaviors Total* 0 10 20 30 50 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 Strengths: • Low levels of air pollution • Low percentage of children in poverty • Small disparity in health status by educational attainment Challenges: • Low immunization coverage among adolescents • High prevalence of low birthweight • Lower number of primary care physicians 20 1 ’00 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations—Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1990 ’92 ’94 ’96 ’98 EDITION YEAR COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 6 40 CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 2016 Value Rank No. 1 State ★★ ★★★ ★★ ★★★ ★★★ ★★ ★★ 17.7 17.5 79.3 29.0 26.2 19.1 -0.077 37 23 37 21 25 34 36 4.0 11.2 90.8 20.2 17.9 9.1 0.273 ★★★★★ ★★★★★ ★★★★★ ★★★★★ ★★ ★★★★ ★ ★★★★★ ★★★★★ 4.4 12.2 -0.560 338.4 10.8 13.0 12.0 222 0.214 1 3 8 8 34 17 50 8 3 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 ★ ★ ★ ★ ★★★ ★★★ ★★ ★★★★ ★★ -1.042 26.5 18.8 58.7 87.9 73.3 11.8 $103 -0.033 46 48 45 47 23 22 36 11 33 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 ★★★ ★ ★★★★ ★ ★★ ★★★ 54.1 9.2 46.1 103.7 -0.096 0.008 27 45 18 47 40 27 81.5 5.9 23.5 247.7 0.170 0.648 ★★★★★ ★★★ ★★★★★ ★★★★★ ★★ ★★★ ★★★★ ★★ ★★★★ ★★★ 172.0 234.4 8.4 20.9 11.6 12.1 5.5 7,916 0.108 0.116 7 23 9 4 31 27 16 36 15 25 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 1a Ranking: Wyoming is 25th this year; it was 25th in 2015. The state ranks 35th for senior health and 29th for the health of women and children. State Health Department Website: www.health.wyo.gov OVERALL* * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 35 30 25 20 w w w. a m e r i c a s h ea lth ra n kin g s.o r g 30 25 20 10 10 5 5 0 35 15 15 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR State 140 OBESITY 40 % OF ADULTS Highlights: • In the past three years, drug deaths increased 34% from 13.2 to 17.7 deaths per 100,000 population. • In the past year, physical inactivity increased 19% from 22.1% to 26.2% of adults. • In the past year, HPV immunization among females aged 13 to 17 years decreased 21% from 33.6% to 26.5%. • In the past year, HPV immunization among males aged 13 to 17 years increased 54% from 12.2% to 18.8%. • In the past five years, infant mortality decreased 24% from 7.2 to 5.5 deaths per 1,000 live births. OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* % OF ADULTS 12 :0 WYO M IN G Star Rating Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 15.3 30.0 68.5 22.1 19.4 16.0 — 4.0 11.2 90.8 20.2 17.9 9.1 0.273 COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 11.0 26.9 N/A 818.8 3.4 9.9 N/A 1,269 — 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations — Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* N/A 58.8 40.9 90.9 81.3 76.3 4.6 $452 — 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 89.9 9.8 39.1 431.6 — — 81.5 5.9 23.5 247.7 0.170 0.648 208.5 299.4 8.5 29.0 10.2 9.5 7.0 8,415 — — 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 Rank: not ranked Strengths: • Low prevalence of obesity • Low percentage of population without insurance • Higher number of primary care physicians Challenges: • Low percentage of high school graduation • High violent crime rate • High prevalence of low birthweight m Em ES ba T, rg De oe ce d U m nt be il r1 5, BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) High School Graduation (% of students) Obesity (% of adults) Physical Inactivity (% of adults) Smoking (% of adults) Behaviors Total* 6 No. 1 State 20 1 2016 Value DIS T RICT O F CO LU M BIA District of Columbia CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* 1a Highlights: • In the past three years, drug deaths increased 61% from 9.5 to 15.3 deaths per 100,000 population. • In the past four years, smoking decreased 23% from 20.8% to 16.0% of adults. • In the past five years, the percentage of the population without health insurance decreased 63% from 12.4% to 4.6%. • In the past two years, cardiovascular deaths increased 4% from 288.2 to 299.4 deaths per 100,000 population. • In the past five years, infant mortality decreased 41% from 11.9 to 7.0 deaths per 1,000 live births. 12 :0 OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* State Health Department Website: doh.dc.gov * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. N/A = Data not available OBESITY 40 % OF ADULTS % OF ADULTS SMOKING 35 30 25 20 35 30 25 20 15 15 10 10 5 5 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR DC Nation 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. AMER IC A’ S H EA LTH R A N K IN GS ® AN N UA L R E P ORT 141 U N I T E D H E A LT H F O U N D AT I O N A M E R I C A’ S H E A LT H R A N K I N G S ® 2 0 16 State Health Department Website: www.hhs.gov COMMUNITY & ENVIRONMENT Air Pollution (micrograms of fine particles per cubic meter) Children in Poverty (% of children) Infectious Disease (mean z score of chlamydia, pertussis, and Salmonella)* Chlamydia (cases per 100,000 population) Infectious Disease— Pertussis (cases per 100,000 population) Salmonella (cases per 100,000 population) Occupational Fatalities (deaths per 100,000 workers) Violent Crime (offenses per 100,000 population) Community & Environment Total* 20 1 6 m Em ES ba T, rg De oe ce d U m nt be il r1 5, POLICY Immunizations—Adolescents (mean z score of HPV, meningococcal, and Tdap)* HPV Females (% of females aged 13 to 17 years) Immunizations— HPV Males (% of males aged 13 to 17 years) Adolescents Meningococcal (% of adolescents aged 13 to 17 years) Tdap (% of adolescents aged 13 to 17 years) Immunizations — Children (% of children aged 19 to 35 months) Lack of Health Insurance (% of population) Public Health Funding (dollars per person) Policy Total* CLINICAL CARE Dentists (number per 100,000 population) Low Birthweight (% of live births) Preventable Hospitalizations (discharges per 1,000 Medicare enrollees) Primary Care Physicians (number per 100,000 population) Clinical Care Total* ALL DETERMINANTS* OUTCOMES Cancer Deaths (deaths per 100,000 population) Cardiovascular Deaths (deaths per 100,000 population) Diabetes (% of adults) Disparity in Health Status (% difference by high school education) Frequent Mental Distress (% of adults) Frequent Physical Distress (% of adults) Infant Mortality (deaths per 1,000 live births) Premature Death (years lost per 100,000 population) ALL OUTCOMES* OVERALL* 14.0 17.7 83.2 29.8 26.2 17.5 — 4.0 11.2 90.8 20.2 17.9 9.1 0.273 8.9 19.7 0.000 456.1 10.4 16.3 3.7 383 — 4.4 8.0 -1.347 254.5 1.0 6.2 2.0 118 0.290 0.000 41.9 28.1 81.3 86.4 72.2 10.6 $94 — 1.783 68.0 58.1 97.7 97.1 80.6 3.1 $261 0.165 60.9 8.0 49.9 145.3 — — 81.5 5.9 23.5 247.7 0.170 0.648 189.9 251.7 9.9 29.5 11.2 11.4 5.9 7,054 — — 149.3 188.2 6.8 14.8 7.1 8.5 4.3 5,369 0.289 0.905 % OF ADULTS % OF ADULTS OBESITY 40 35 30 25 20 30 25 20 10 10 5 5 0 35 15 15 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR Nation w w w. a m e r i c a s h ea lth ra n kin g s.o r g No. 1 State * Value indicates z score. Negative scores are below US value; positive scores are above US value. For complete definitions of measures including data sources and years, see Table 5. SMOKING 142 2016 Value 1a Highlights: • In the past three years, drug deaths increased 15% from 12.2 to 14.0 deaths per 100,000 population. • In the past three years, high school graduation increased 6% from 78.2% to 83.2% of students. • In the past four years, obesity increased 7% from 27.8% to 29.8% of adults. • In the past four years, smoking decreased 17% from 21.2% to 17.5% of adults. • In the past year, children in poverty decreased 7% from 21.1% to 19.7% of children. • In the past two years, HPV immunization among females aged 13 to 17 years increased 11% from 37.6% to 41.9%. • In the past year, HPV immunization among males aged 13 to 17 years increased 30% from 21.6% to 28.1%. • In the past year, the percentage of the population without health insurance decreased 19% from 13.1% to 10.6% of population. • In the past year, public health funding increased 9% from $86 to $94 per person. • In the past year, preventable hospitalizations decreased 13% from 57.6 to 49.9 discharges per 1,000 Medicare enrollees. • In the past year, cardiovascular deaths increased for the first time in America’s Health Rankings history from 250.8 to 251.7 deaths per 100,000 population. • In the past year, premature death increased for the second consecutive year from 6,997 to 7,054 years lost per 100,000 population. BEHAVIORS Drug Deaths (deaths per 100,000 population) Excessive Drinking (% of adults) High School Graduation (% of students) Obesity (% of adults) Physical Inactivity (% of adults) Smoking (% of adults) Behaviors Total* 12 :0 U N IT E D S TAT E S United States 0 1990 ’92 ’94 ’96 ’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 EDITION YEAR The 2012–2016 data in the above graphs are not directly comparable with prior years. See Methodology (page 150) for additional information. 6 20 1 12 :0 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, Appendix A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L RE P ORT 145 Appendix TABLE 5 Core Measures Drug Deaths Number of deaths due to drug injury of any intent (unintentional, suicide, homicide, or undetermined) per 100,000 population Centers for Disease Control and Prevention (CDC), National Vital Statistics System, 2012-2014 Excessive Drinking Percentage of adults who reported either binge drinking (having four or more [women] or five or more [men] drinks on one occasion in the past month) or chronic drinking (having eight or more [women] or 15 or more [men] drinks per week) CDC, Behavioral Risk Factor Surveillance System, 2015 High School Graduation* Percentage of high school students who graduate with a regular high school diploma within four years of starting ninth grade (ACGR) US Department of Education, National Center for Education Statistics, 2014-2015 Obesity Percentage of adults with a body mass index of 30.0 or higher based on reported height and weight CDC, Behavioral Risk Factor Surveillance System, 2015 Physical Inactivity Percentage of adults who reported doing no physical activity or exercise other than their regular job in the past 30 days CDC, Behavioral Risk Factor Surveillance System, 2015 Smoking Percentage of adults who are smokers (reported smoking at least 100 cigarettes in their lifetime and currently smoke every or some days) CDC, Behavioral Risk Factor Surveillance System, 2015 Measure Description Source, Data Year(s) Air Pollution Average exposure of the general public to particulate matter of 2.5 microns or less in size (PM2.5) US Environmental Protection Agency, 2013-2015 Children in Poverty Percentage of children younger than 18 years who live in households at or below the poverty threshold US Census Bureau, Current Population Survey, 2016 Annual Social and Economic Supplement, 2015 Infectious Disease Mean z score of the incidence of chlamydia, pertussis, and Salmonella per 100,000 population CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) Atlas, 2014 and Morbidity and Mortality Weekly Report (MMWR), Summary of Notifiable Infectious Diseases and Conditions, 2014 20 1 6 Source, Data Year(s) 12 :0 1a Community & Environment Description m Em ES ba T, rg De oe ce d U m nt be il r1 5, Behaviors Measure —Chlamydia Number of new cases of chlamydia per 100,000 population CDC, NCHHSTP Atlas, 2014 —Pertussis Number of new cases of pertussis per 100,000 population CDC, MMWR, Summary of Notifiable Infectious Diseases and Conditions, 2014 —Salmonella Number of new cases of Salmonella per 100,000 population CDC, MMWR, Summary of Notifiable Infectious Diseases and Conditions, 2014 Occupational Fatalities** Number of fatal occupational injuries in construction, manufacturing, trade, transportation, utilities, and professional and business services per 100,000 workers US Bureau of Labor Statistics, Census of Fatal Occupational Injuries & US Bureau of Economic Analysis, 2012-2014 Violent Crime* Number of murders, rapes, robberies, and aggravated assaults per 100,000 population Federal Bureau of Investigation, 2015 *Since the release of the 2015 edition, the data source has published two updates. This edition contains the most recent data, which might cause a jump between 2015 and 2016 edition values. **The data appearing in this edition are the same that appeared in the 2015 edition. An update was not available at the time of this publication. 146 w w w. a m e r i c a s h e a lth ra n kin g s.o r g Health Outcomes Centers for Disease Control and Prevention (CDC), National Immunization Survey, 2015 —HPV Females Percentage of females aged 13 to 17 years who received ≥3 doses of human papillomavirus (HPV) vaccine, either quadrivalent or bivalent CDC, National Immunization Survey, 2015 —HPV Males Percentage of males aged 13 to 17 years who received ≥3 doses of human papillomavirus (HPV) vaccine, either quadrivalent or bivalent CDC, National Immunization Survey, 2015 —Meningococcal Percentage of adolescents aged 13 to 17 years who received ≥1 dose of meningococcal conjugate vaccine (MenACWY) CDC, National Immunization Survey, 2015 —Tdap Percentage of adolescents aged 13 to 17 years who received ≥1 dose of tetanus-diphtheria-acellular pertussis (Tdap) vaccine since age 10 years CDC, National Immunization Survey, 2015 Immunizations —Children Percentage of children aged 19 to 35 months who received recommended doses of diphtheria, tetanus, and acellular pertussis (DTaP), measles, mumps, and rubella (MMR), polio, Haemophilus influenzae (Hib), hepatitis B, varicella, and pneumococcal conjugate vaccines CDC, National Immunization Survey, 2015 Lack of Health Insurance Percentage of the population that does not have health insurance privately, through their employer, or through the government US Census Bureau, American Community Survey, 2014-2015 Public Health Funding State dollars dedicated to public health and federal dollars directed to states by the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) per person Trust For America’s Health, 2014-2015 Measure Description Source, Data Year(s) Dentists* Number of practicing dentists per 100,000 population American Dental Association, 2015 Low Birthweight Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth CDC, National Vital Statistics System, 2014 Preventable Hospitalizations Number of discharges for ambulatory care-sensitive conditions per 1,000 Medicare enrollees The Dartmouth Atlas of Health Care, 2014 Primary Care Physicians Number of active primary care physicians (including general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics, and internal medicine) per 100,000 population American Medical Association, Special data request for information on active state licensed physicians provided by Redi-Data, Inc, Oct 24, 2016 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 Source, Data Year(s) Mean z score of the percentage of adolescents aged 13 to 17 years who received ≥1 dose of Tdap since age 10 years, ≥1 dose of meningococcal conjugate vaccine, and ≥3 doses of human papillomavirus (HPV) vaccine (females and males) 1a Clinical Care Description Immunizations —Adolescents 12 :0 Policy Measure Measure Description Source, Data Year(s) Cancer Deaths Number of deaths due to all causes of cancer per 100,000 population CDC, National Vital Statistics System, 2012-2014 Cardiovascular Deaths Number of deaths due to all cardiovascular diseases including heart disease and stroke per 100,000 population CDC, National Vital Statistics System, 2012-2014 Diabetes Percentage of adults who reported being told by a health professional that they have diabetes (excludes prediabetes and gestational diabetes) CDC, Behavioral Risk Factor Surveillance System, 2015 Disparity in Health Status Difference between the percentage of adults with a high school education compared with those without who reported their health is very good or excellent (adults aged <25 years excluded) CDC, Behavioral Risk Factor Surveillance System, 2015 Frequent Mental Distress Percentage of adults who reported their mental health was not good 14 or more days in the past 30 days CDC, Behavioral Risk Factor Surveillance System, 2015 Frequent Physical Distress Percentage of adults who reported their physical health was not good 14 or more days in the past 30 days CDC, Behavioral Risk Factor Surveillance System, 2015 Infant Mortality Number of infant deaths (before age 1 year) per 1,000 live births CDC, National Vital Statistics System, 2013-2014 Premature Death Number of years of potential life lost before age 75 years per 100,000 population CDC, National Vital Statistics System, 2014 A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L RE P ORT 147 Appendix TABLE 6 Supplemental Measures Binge Drinking Percentage of adults who reported having four or more (women) or five or more (men) drinks on one occasion in the past month Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System, 2015 Chronic Drinking Percentage of adults who reported having eight or more (women) or 15 or more (men) drinks per week CDC, Behavioral Risk Factor Surveillance System, 2015 Fruits Mean number of fruits consumed per day by adults CDC, Behavioral Risk Factor Surveillance System, 2015 Insufficient Sleep* Percentage of adults who reported sleeping less than seven hours in a 24-hour period on average CDC, Behavioral Risk Factor Surveillance System, 2014 Seat Belt Use Percentage of adults who reported always using a seat belt when driving or riding in a car CDC, Behavioral Risk Factor Surveillance System, 2015 Vegetables Mean number of vegetables consumed per day by adults Measure Description Source, Data Year(s) Income Disparity A coefficient representing income distribution; zero indicates total income equality and one indicates complete income inequality (Gini coefficient) US Census Bureau, American Community Survey, 2015 Median Household Income Dollar amount that divides the household income distribution into two equal groups US Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2015 Personal Income Per capita personal income in dollars US Bureau of Economic Analysis, 2015 Underemployment Rate Percentage of the civilian labor force that is unemployed, plus all marginally attached workers, plus the total employed part-time for economic reasons (U-6 definition) US Bureau of Labor Statistics, 2015 Policy m Em ES ba T, rg De oe ce d U m nt be il r1 5, 20 1 6 Source, Data Year(s) 12 :0 Community & Environment Description CDC, Behavioral Risk Factor Surveillance System, 2015 1a Behaviors Measure Unemployment Rate Percentage of the civilian labor force that is unemployed (U-3 definition) US Bureau of Labor Statistics, 2015 Measure Description Source, Data Year(s) Water Fluoridation Percentage of population served by community water systems who receive fluoridated water CDC, Water Fluoridation Reporting System, 2014 *The data appearing in this edition are the same that appeared in the 2015 edition. An update was not available at the time of this publication. 148 w w w. a m e r i c a s h e a lth ra n kin g s.o r g Description Source, Data Year(s) Cholesterol Check Percentage of adults who reported having their blood cholesterol checked within the past five years Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System, 2015 Colorectal Cancer Screening Percentage of adults aged 50 to 75 years who reported receiving one or more of the recommended colorectal cancer screening tests within the recommended time interval (fecal occult blood test (FOBT) within the past year, colonoscopy within the past 10 years, or a sigmoidoscopy within the past five years and a home FOBT within the past three years) CDC, Behavioral Risk Factor Surveillance System, 2014 Dental Visit, Annual* Percentage of adults who reported visiting the dentist or dental clinic within the past year for any reason CDC, Behavioral Risk Factor Surveillance System, 2014 Measure Description Heart Attack Percentage of adults who reported being told by a health professional that they had a heart attack (myocardial infarction) CDC, Behavioral Risk Factor Surveillance System, 2015 Heart Disease Percentage of adults who reported being told by a health professional that they have angina or coronary heart disease CDC, Behavioral Risk Factor Surveillance System, 2015 High Blood Pressure Percentage of adults who reported being told by a health professional that they have high blood pressure CDC, Behavioral Risk Factor Surveillance System, 2015 High Cholesterol Percentage of adults who reported having their cholesterol checked and were told by a health professional that it was high CDC, Behavioral Risk Factor Surveillance System, 2015 High Health Status Percentage of adults who reported that their health is very good or excellent CDC, Behavioral Risk Factor Surveillance System, 2015 Injury Deaths Number of deaths due to injury per 100,000 population CDC, National Vital Statistics System, 2012-2014 Poor Mental Health Days Number of days in the past 30 days adults reported their mental health was not good CDC, Behavioral Risk Factor Surveillance System, 2015 Poor Physical Health Days Number of days in the past 30 days adults reported their physical health was not good CDC, Behavioral Risk Factor Surveillance System, 2015 Stroke Percentage of adults who reported being told by a health professional that they had a stroke CDC, Behavioral Risk Factor Surveillance System, 2015 Suicide Number of deaths due to intentional self-harm per 100,000 population CDC, National Vital Statistics System, 2014 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1a 12 :0 Health Outcomes 20 1 6 Clinical Care Measure Source, Data Year(s) * The data appearing in this edition are the same that appeared in the 2015 edition. An update was not available at the time of this publication. A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L RE P ORT 149 Appendix Methodology Score = State value – national value Standard deviation of all state values m Em ES ba T, rg De oe ce d U m nt be il r1 5, This “z score” indicates the number of standard deviations a state value is above or below the national value. A 0.00 indicates a state has the Behaviors Community & Environment Public & Health Policies Clinical Care Health Outcomes 2. Normalize state values for each measure using US value (calculate z score) 12 :0 1a 1. Gather data same value as the nation. States with higher values than the national value have a positive score; states below the national value have a negative score. To prevent an extreme score from exerting excessive influence, the maximum score for a measure is capped at +/- 2.00. If a US value is not available from the original data source for a measure, the mean of all state values is used with the exception of measures from the Behavioral Risk Factor Surveillance System (BRFSS). For BRFSS measures, the median of the state values is used for the US value to conform to the Centers for Disease Control and Prevention methodology. Overall score is calculated by adding the scores of each measure multiplied by its assigned weight (the percentage of the total overall ranking). Each of the five major categories of the America’s Health Rankings model of health (behaviors, community & environment, policy, clinical care, and outcomes) are assigned different weights (Table 7). Measure weights can be found at http://www.americashealthrankings. org/AR16/about. 6 For each measure, the raw state-level data are obtained from secondary sources (Table 5) and presented as a “value.” The most current data available as of October 2016 were included in the analysis. The score for each state is based on the following formula: 20 1 Rankings Calculation –2σ –1σ μ 1σ 2σ 3. Eliminate outliers 4. Multiply by weights Σ 5. Sum weighted scores 6. Rank states by sum of all measure scores 150 w w w. a m e r i c a s h e a lth ra n kin g s.o r g TABLE 7 Weights by Model Category 6 Weight Behaviors 0.250 Community & Environment 0.225 Policy 0.125 Clinical Care 0.150 Outcomes 0.250 20 1 older were calculated for each edition year from 2012 to 2016. State and national prevalence estimates of smoking and obesity among adults aged 25 years and older were also calculated for each of four self-reported education levels (less than high school education, high school graduate, some college, and college graduate). Statistically significant differences between groups were determined by non-overlapping 95% confidence intervals. Because of changes in BRFSS methodology prior to 2011 (2012 edition), data was limited to 2011 to 2015 (2012 to 2016 editions) to allow comparability. Average rate of change per year (slope of a least-squares fitted line) in prevalence over the five-year period (2012 to 2016) was calculated for the analysis. The average prevalence over the same five-year period was calculated for comparison with average annual rate of change by state and education level. Using rate of change per year better accounts for expected year-to-year variation in the measures compared with reporting relative or absolute differences between editions 2012 and 2016. 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, The overall ranking is the ordering of each state according to the overall score. The ranking of individual measures is the ordering of each state according to the measure’s value, with the exception of immunizations—adolescents and infectious disease, which are ranked according to score. Ties in values are assigned equal ranks. Not all changes in rank are statistically significant. BRFSS data were analyzed using Stata v14.1 to account for the complex survey design. Responses of “refused”, “don’t know,” or “not sure” were excluded from the analysis, but are reflected in standard error and confidence interval estimates. For subpopulation measures, “refused”, “don’t know,” or “not sure” responses were coded as missing. For calculating subpopulation estimates, the population of interest is specified in a manner that avoids deletion of cases. This ensures an accurate variance estimation. Population estimates for measures from BRFSS were calculated using the specified survey weights and represent the non-institutionalized adult population. Discrepancies between prevalence estimates and population estimates are likely due to random sampling error and nonrandom response biases. BRFSS made two changes in 2011 to improve their survey methodology. Due to these changes, 2011 to 2015 BRFSS data is not comparable to previous years. 12 :0 Trends in Smoking and Obesity Prevalence, 2012 to 2016 Five-year trends in smoking and obesity prevalence in the United States were examined to highlight differences across states and levels of education. Using 2011 to 2015 BRFSS data, state and national prevalence estimates of smoking and obesity among adults aged 18 years and A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L RE P ORT 151 Appendix Model Development 20 1 6 includes those in general practice, family practice, obstetrics and gynecology (OB-GYN), pediatrics, geriatrics, and internal medicine. The previous definition included total physicians in general practice, family practice, OB-GYN, pediatrics, and internal medicine. The measure now aligns with County Health Rankings. Data were obtained from Redi-Data, Inc, a licensed provider of American Medical Association (AMA) data. In prior years, data were obtained from the annually printed AMA publication Physician Characteristics and Distribution in the US, which has been discontinued. • The calculation for air pollution (page 40) was amended to correct an error for estimating average emissions in counties without monitors. The previous measure overstated air pollution in each state by 0.1 to 0.2 micrograms of fine particles per cubic meter. m Em ES ba T, rg De oe ce d U m nt be il r1 5, Each year the America’s Health Rankings model is evaluated to reflect the evolving understanding of population health, to improve existing data sources, to integrate new data sources, and to adjust to changing availability of information. All proposed changes are explored using modeling to clarify the impact of any change. Final recommendations are made to the Scientific Advisory Committee in early spring. If you wish to receive this information or if you have measure or data source suggestions for America’s Health Rankings, please contact us at www. americashealthrankings.org/about/page/ submit-an-inquiry. In addition to the proposed changes, we continue to explore other indicators that reflect health, with special attention to climate change, built environment, diet, health equity, and socioeconomic status indicators. Changes Implemented in 2016 The following core measures were replaced or amended: 12 :0 1a • The outcome measures poor mental health days and poor physical health days were replaced by frequent mental distress (page 68) and frequent physical distress (page 70), respectively. The new measures capture the percentage of adults with severe and/or chronic mental and physical health issues and align with County Health Rankings. The frequent distress measures gauge the percentage of adults in frequent poor health (14 or more days in the past 30 days), whereas the poor health days measures reflect the average number of poor health days in the past 30 days. Poor mental health days and poor physical health days have been shifted to supplemental measures to provide continuity of data. • The definition of primary care physicians (page 59) has been amended. The new definition is limited to active physicians, and 152 w w w. a m e r i c a s h e a lth ra n kin g s.o r g These substitutions and adjustments do not have an appreciable effect on a state’s score or rank. The following supplemental measures were added: • Colorectal Cancer Screening (page 82). Colorectal cancer is the third most commonly diagnosed cancer and the third-leading cause of cancer mortality in the United States. Colorectal cancer is easier to treat when detected early through screening. Screening also allows for removal of colorectal polyps before they become cancerous. Colorectal cancer screening is an indicator of preventive care and is an important part of clinical care targeted at early diagnosis and treatment of disease. • Seat Belt Use (page 78). Seat belt use reduces the severity of injuries from motor vehicle accidents and reduces motor vehicle deaths. Young adults, adults living in rural areas, and men are less likely to wear seat belts. Seat belt use varies greatly by state. 2017 Exploration • Distracted Driving. An emerging issue in public health is the role distracted and/or inattentive driving has on mortality and morbidity. A measure in this area would help describe the role distracted driving has on population health and highlight interventions aimed at reducing the amount of distracted or inattentive driving in a state. 6 • Exercise. Currently this is measured in the model with physical inactivity and it only captures lack of physical activity outside of work. The objective of a measure in this area would be to better capture exercise or the lack thereof across different populations. This could include physical activity outside of work, job-related physical activity, prolonged sitting, and/or screen time. This exploration will look at factors including job-related physical activity, screen time, and strenuous exercise. m Em ES ba T, rg De oe ce d U m nt be il r1 5, See Tables 5 and 6 for the full definitions, data sources, and data years. allow a broader assessment of the utilization of these services to improve health. 20 1 • Water Fluoridation (page 81). Community water fluoridation is an effective way of preventing dental caries—an infectious disease in which bacteria dissolve tooth enamel. Water fluoridation is considered a top 10 achievement in public health in the last century.1 The percentage of the population served by community water systems who receive fluoridated water from the Centers for Disease Control and Prevention Water Fluoridation System has been added as an indicator for implementation of proven public health policy. The following areas are being explored and will be discussed at the spring Scientific Advisory Committee meeting: • Premature Death Excluding Infant Deaths. Currently, the model includes infant mortality in the premature death rate. The exclusion of infant deaths from premature death will reduce the double counting of deaths for those younger than 1 year. 12 :0 1a • Injury Deaths. Injury deaths is currently a supplemental measure. Expanding this measure to include injury from specific causes would shed light on many causes of death, especially among those younger than 65 years. Drug deaths is currently included in the model as one specific cause of injury death, and suicide is included as a supplemental measure. • Preventive Clinical Care. Developing a composite measure that includes multiple aspects of preventive care, as recommended by the US Preventive Services Task Force (USPSTF), will • Mental Health Providers. Professional care for mental health is vital. Currently the model contains measures for primary care physicians and dentists, but it lacks an indicator of capacity or availability of mental health providers. • Environment. Our home, work, and community environments affect our health. Exploring other environmental measures, such as water quality in recreational lakes, rivers, and/or streams, will provide more depth to the rankings. • Dental Health. Extraction of teeth due to disease is both an indicator of adverse current health and a potential determinant of continued adverse health in the future. Full extraction, limited extraction (six or more teeth), and extractions occurring before 65 years will be considered as indicators of oral health. 1 Ten great public health achievements in the 20th century. Centers for Disease Control and Prevention website. http://www. cdc.gov/about/history/tengpha.htm Accessed October 21, 2016. A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L RE P ORT 153 Appendix Scientific Advisory Committee Anna Schenck, PhD, MSPH, Chair Director, Public Health Leadership Program UNC Gillings School of Global Public Health University of North Carolina at Chapel Hill 1a Dennis P Andrulis, PhD, MPH Senior Research Scientist Texas Health Institute 12 :0 Jamie Bartram, PhD Director The Water Institute at UNC UNC Gillings School of Global Public Health University of North Carolina at Chapel Hill Bridget Booske Catlin, PhD, MHSA Senior Scientist and MATCH Group Director University of Wisconsin Population Health Institute Director, County Health Rankings & Roadmaps Andrew Coburn, PhD Professor and Associate Dean Muskie School of Public Service University of Southern Maine 154 w w w. a m e r i c a s h e a lth ra n kin g s.o r g Leah Devlin, DDS, MPH Professor of the Practice, Health Policy and Management UNC Gillings School of Global Public Health University of North Carolina at Chapel Hill Marisa Domino, PhD Professor, Health Policy and Management UNC Gillings School of Global Public Health University of North Carolina at Chapel Hill 20 1 Tom Eckstein, MBA Principal Arundel Metrics, Inc 6 John Dreyzehner, MD, MPH, FACOEM Commissioner of Health Tennessee Department of Health m Em ES ba T, rg De oe ce d U m nt be il r1 5, The Scientific Advisory Committee, led by Anna Schenck, PhD, MSPH, at the University of North Carolina Gillings School of Global Public Health, meets annually to review America’s Health Rankings. The committee assesses the report for potential improvements that maintain the value of the comparative, longitudinal information; uses new or improved health measures as they become available; and incorporates new methods when feasible. The committee reflects the evolving role and science of public health, and it emphasizes the importance of America’s Health Rankings as a vehicle to promote and improve the general discussion of public health. Finally, the committee encourages balance among public health efforts to benefit the entire community. The Scientific Advisory Committee represents a variety of stakeholders including representatives from local health departments, members of the Association of State and Territorial Health Officials, and the American Public Health Association, as well as experts from many academic disciplines. Scientific Advisory Committee members include: Jonathan E Fielding, MD, MPH, MBA, MA Professor of Health Services and Pediatrics UCLA School of Public Health Former Director of Public Health and Health Officer, Los Angeles County Department of Public Health Marthe Gold, MD Logan Professor and Chair Department of Community Health CUNY Medical School Glen P Mays, PhD, MPH F Douglas Scutchfield Endowed Professor Health Services and Systems Research University of Kentucky College of Public Health Matthew T McKenna, MD, MPH Medical Director Fulton County Department of Health and Wellness Anne-Marie Meyer, PhD Faculty Director Integrated Cancer Information and Surveillance System UNC Lineberger Comprehensive Cancer Center Sarah Milder, MPH Principal and Epidemiologist Arundel Metrics, Inc The Team Thomas C Ricketts, PhD, MPH Professor of Health Policy and Administration and Social Medicine UNC Gillings School of Global Public Health University of North Carolina at Chapel Hill Mary C Selecky Washington State Secretary of Health (retired) Arundel Metrics, Inc. Melanie Buhl Tom Eckstein Dr Mary Ann Honors Laura Houghtaling Jamie Kenealy Alexia Malaga Sarah Milder Kristin Shaw m Em ES ba T, rg De oe ce d U m nt be il r1 5, Katie Sellers, DrPH Chief Program Officer, Science and Strategy Association of State and Territorial Health Officials Aldrich Design Emily Aldrich Jenna Brouse Andrea Egbert 6 Patrick Remington, MD, MPH Associate Dean for Public Health University of Wisconsin School of Medicine and Public Health America’s Health Rankings is a team effort in which all contribute a vital part to the creation and dissemination of this report. Members of this team, listed alphabetically by organization, follow: 20 1 Rhonda Randall, DO Chief Medical Officer UnitedHealthcare Retiree Solutions Leiyu Shi, PhD Professor Department of Health Policy and Management Co-Director, Primary Care Policy Center for the Underserved Johns Hopkins University School of Public Health 12 :0 1a Steven Teutsch, MD, MPH Chief Science Officer Los Angeles County Department of Public Health Director and Health Officer The Glover Park Group Kate Ackerman Jane Beilenson Sara Bonn Tulani Elisa Irene Moskowitz Craig James Lee Jenkins Amanda Keating Rachel Millard Andy Oare Reservoir Communications Group Christine Harrison David Lumbert Grace Montgomery Robert Schooling Tuckson Health Connections Dr Reed Tuckson United Health Foundation Scott Adams Michael Birnbaum Alyssa Erickson Jane Pennington LD Platt Dr Rhonda Randall Kara Smith Tina Stow Jodie Tierney Danielle Varallo Anne Yau Angela Zirkelbach A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L RE P ORT 155 Appendix The 2016 edition of America’s Health Rankings Annual Report is available in its entirety at www.americashealthrankings.org. Visit the site to request or download the report. America’s Health Rankings Annual Report is a joint effort of United Health Foundation (www.unitedhealthfoundation.org) and the American Public Health Association (www.apha.org). It is funded by United Health Foundation, a 501(c)(3) organization. 20 1 1a m Em ES ba T, rg De oe ce d U m nt be il r1 5, American Dental Association American Medical Association, special data request for information on active state licensed physicians provided by Redi-Data, Inc, Oct 24, 2016 The Dartmouth Atlas of Health Care Trust for America’s Health US Department of Commerce Census Bureau Bureau of Economic Analysis US Department of Education National Center for Education Statistics US Department of Health and Human Services Centers for Disease Control and Prevention US Department of Justice Federal Bureau of Investigation US Department of Labor Bureau of Labor Statistics US Environmental Protection Agency World Health Organization 6 Data within this report were obtained from and used with permission of: 12 :0 United Health Foundation and the American Public Health Association encourage the distribution of information in this publication for non-commercial and charitable, educational, or scientific purposes. Please acknowledge America’s Health Rankings Annual Report, 2016 Edition as the source and provide the following notice: ©2016 United Health Foundation. All rights reserved. Please acknowledge the original source of specific data as cited. Arundel Metrics, Inc, of Saint Paul, Minnesota, conducted this project for and in cooperation with United Health Foundation and the American Public Health Association. Design by Aldrich Design, Saint Paul, Minnesota. Please direct questions and comments on the report to United Health Foundation at unitedhealthfoundationinfo@uhg.org. Copyright ©2016 United Health Foundation. 156 w w w. a m e r i c a s h e a lth ra n kin g s.o r g America’s Health Rankings Expansion The expansion of America’s Health Rankings in 2016 was two-fold, with two new major populationlevel reports introduced to accompany America’s Health Rankings Annual Report and America’s Health Rankings Senior Report, along with two Spotlight reports. ividuals and on for ind A call to acti America’s Health Rankings provides a holistic m Em ES ba T, rg De oe ce d U m nt be il r1 5, scorecard of more than 60 measures of the health munities their com 2015 20 1 level report to be introduced. In this report, 6 America’s Health Rankings Health of Women and Children Report was the first new population- A call to acti on for ind ividuals and their com munities 2016 of women of reproductive age, infants, and children. Like America’s Health Rankings Senior Report, it focuses on behaviors, community & environment, policy, clinical care, and outcomes for each state. America’s Health Rankings Health of Those Who Have Served Report debuted in November. In partnership with Military Officers Association of Health of Women and Children Rep ort America (MOAA), America’s Health Rankings collaborated with an advisory group of leading military and veterans organizations to develop a study of the health of those who have served in the United States military compared with the health of civilians. The report analyzed 24 health measures that and income. 1a compares these two groups as a whole as well as by age, sex, race/ethnicity, Two Spotlights were also released. Spotlight: Prevention focuses 12 :0 on the variation of clinical prevention measures across the states, and Spotlight: Impact of Unhealthy Behaviors quantifies the impact of multiple unhealthy behaviors on the population’s overall health status. The amplify the information contained in the larger population reports. SPOTLIGHT: IMPACT OF UNHEALTHY BEHAVIORS Hero Images Spotlights complement, leverage, and A MER IC A’ S H EA LTH R A N K IN GS ® A N N UA L RE P ORT 157 6 20 1 m Em ES ba T, rg De oe ce d U m nt be il r1 5, 1a 12 :0 www.unitedhealthfoundation.org America’s Health Rankings® is available in its entirety at www.americashealthrankings.org. Visit the website to request or download additional copies. december 2016 Our Partner: 2016 EDITION United Health Foundation 9900 Bren Road East Minnetonka, MN 55343 A M E R I C A’ S H E A LT H R A N K I N G S ® A N N U A L R E P O R T Guided by a passion to help people live healthier lives, United Health Foundation provides helpful information to support decisions that lead to better health outcomes and healthier communities. The Foundation also supports activities that expand access to quality health care services for those in challenging circumstances and partners with others to improve the well-being of communities.