America’s Health Rankings Indicates Overall Healthiness Slightly Improved, but Obesity, Children in Poverty, and Diabetes Worrisome for States’ Health

December 07, 2010
  • Overall U.S. health improved in the past year, slightly faster than the past decade, but at a slower rate than in the 1990s
  • Tobacco use decreased to 21-year low, but still unacceptably high
  • Increase in obesity and diabetes will continue to exact health consequences
  • Vermont #1 again; Mississippi #50

Welcome improvements in many areas of America’s health status are offset by continuing declines in others, according to the 2010 America’s Heath Rankings®. The nation’s overall health improved one percentage point last year, but reductions in smoking, preventable hospitalizations and infectious disease were offset by continued increases in obesity, children in poverty, and lack of health insurance. The report also shows a 19 percent increase since the 2005 Edition in the percentage of adults who had been diagnosed with diabetes. In response to these trends, United Health Foundation is establishing a program to address local health challenges.

While last year’s one percent improvement in health is better than the previous decade, it falls short of the gains seen in the 1990s. From 2000-2009, health improved just 0.5 percent per year, but in the 1990s, overall health improved 1.5 percent per year, suggesting that the nation is capable of achieving better health more rapidly than it currently is. Given the sharp escalation in health costs, the economic consequences of larger burdens of preventable chronic illness should sound an alarm for urgent action by states and local communities.

“The rate of gain, while positive, is wholly inadequate for us as a nation. We know with certainty that many people will suffer consequences of preventable disease unless we strengthen individual healthiness, community by community across America,” said Reed Tuckson, M.D., United Health Foundation board member and executive vice president and chief of medical affairs, UnitedHealth Group. “The persistent year after year increase in obesity, physical inactivity, diabetes, and other risk factors combined with a still unacceptably high use of tobacco means an increased burden of chronic illness, including diabetes, with medical care costs that will be unaffordable for any state, private employer, or individual in the days to come. States are showing that we can successfully deal with health issues, but only by tackling those issues head on.”

America’s Health Rankings is an annual comprehensive assessment of the nation’s health on a state-by-state basis. It is published jointly by United Health Foundation, the American Public Health Association (APHA) and Partnership for Prevention.

The data in the report come from well-recognized outside sources, such as the Centers for Disease Control and Prevention (CDC), American Medical Association, U.S. Department of Education, and the Census Bureau. The report is reviewed and overseen by a Scientific Advisory Committee, with members from leading academic institutions, government agencies and the private sector.

State Rankings: Vermont Remains on Top; Mississippi Stays on Bottom
Every state has its successes and every state has its challenges. Vermont tops the list of healthiest states for the last four years of published reports. Vermont has had a steady climb in the Rankings for the last twelve years from a ranking of 17th in the 1997 and 1998 Editions. Massachusetts is ranked second, an improvement from third last year. Massachusetts has ranked in the top ten for almost 20 years. New Hampshire is ranked third, followed by Connecticut and Hawaii.

Mississippi is ranked 50th, with Louisiana, Arkansas, Nevada and Oklahoma rounding out the bottom five.

Georgia has improved the most in the past year from 43rd to 36th, and Idaho (14th to 9th), Nebraska (16th to 11th) and South Carolina (46th to 41st) all improved by five rank positions. Alabama also has climbed the ladder from 48th to 45th.

“Every state can create effective solutions to many of the health challenges they face,” said Tuckson. “States can use America’s Health Rankings to identify their state’s and other states’ strengths and use those examples to address areas that need attention in their own state. The key is action. We must continue to work toward impacting change in unhealthy behaviors and other factors that negatively impact a state.”

United Health Foundation Providing Help
The United Health Foundation believes that these health challenges can best be addressed through public-private partnerships at the state and local level. The United Health Foundation is partnering with the National Business Coalition on Health (NBCH) to convene business, public health, community leaders, and elected and public officials in selected communities across the U.S. to initiate data-driven health promotion and disease prevention planning. Grants will be awarded to help each community create an action plan for policy and program interventions that draw upon individual accountability, community resources and private sector expertise.

“We are energized and encouraged by United Health Foundation’s recognition and support of the important role the private sector community can play in collaborating with states to identify and address priority health problems,” said Andrew Webber, president and CEO of the National Business Coalition on Health.

United Health Foundation will also collaborate with Partnership for Prevention to identify and disseminate scientific-based public policies that can be useful for states to consider as they address their particular population health challenges.

The website,, has been enhanced to better serve as a research tool and rich database for use by individuals, political leaders, health professionals and policy analysts.

Alarming Signs of the Times
Even though smoking prevalence has reached a 21-year low, continued progress against smoking and obesity is a critical step in successfully tackling many of the nation’s health challenges. An increase in the number of children in poverty and lack of health insurance for many Americans are also serious threats to improved health in the future.

Obesity has increased 132 percent from 11.6 percent of the population in the 1990 Edition to 26.9 percent in the 2010 Edition; meaning today, more than one in four Americans are considered obese. Obesity continues to be one of the fastest growing health issues in our nation and America is spending billions in direct health care costs associated with poor diet and physical inactivity.

“Obesity and tobacco use are top contributors to a variety of diseases, including heart disease, cancer, stroke, diabetes and other leading causes of premature death and disability,” said Georges C. Benjamin, M.D., executive director of the American Public Health Association. “We cannot avoid these critical public and personal health battles. We must work with multiple stakeholders and our public health partners to develop with comprehensive solutions to solve this problem.”

Smoking has been one of the biggest health battles for decades. In the past year, the prevalence of smoking decreased from 18.3 percent to 17.9 percent of the adult population, the lowest in 21 years (from a high of 29.5 percent in the 1990 Edition). But tobacco use is still estimated to be responsible for one out of five deaths annually (approximately 443,000 deaths per year). Four states – Utah, California, Massachusetts and Washington – have driven their smoking rates to less than 15 percent, a goal for all states.

“As the name of our organization suggests, we work with others on prevention solutions. If states implement programs based on the best scientific evidence and individuals exercise their individual accountability, together we can prevent illness and death,” said Robert J. Gould, Ph.D., president and CEO of Partnership for Prevention.

Children in Poverty
The current economic climate also hinders the ability to maintain a healthy population. Children living in poverty are challenged by lack of access to health care, limited availability of healthy foods, constrained choices for physical activity, limited access to appropriate educational opportunities and stressful living conditions. The number of children in poverty has increased for the last four years and is now equal to the rate in the 1990 Edition. A steady increase has occurred, from 17.4 percent of children reported in the 2007 Edition to 20.7 percent of children in the 2010 Edition.

Lack of Health Insurance
According to the U.S. Census Bureau, there are an estimated 51 million uninsured Americans. Lack of health insurance coverage increased slightly from 15.3 percent in the 2009 Edition to 16.0 percent in the 2010 Edition, and has increased more than two full percentage points since the 2001 Edition (13.9 percent to 16.0 percent).

According to the report, 8.3 percent of American adults have been told by a physician that they have diabetes, which is significantly higher than it was five years ago. A recent report from the CDC estimates that the number of Americans with diabetes will range from 1 in 3 to 1 in 5 by 2050. This means a large number of people are either at risk for diabetes or are unaware they have the disease and are not being medically managed.

A recent report from the UnitedHealth Center for Health Reform & Modernization states that more than 50 percent of Americans could have diabetes and/or pre-diabetes by 2020 at a cost of $3.35 trillion over the next decade if current trends continue. New estimates show diabetes and pre-diabetes will account for an estimated 10 percent of total health care spending by the end of the decade at an annual cost of almost $500 billion – up from an estimated $194 billion this year.

Two Decades of Success
Examples of state success stories since the first edition in 1990:

  • Maryland decreased the prevalence of smoking from 29.7 percent to 15.1 percent of the population.
  • Louisiana decreased the percentage of children in poverty from 38.5 to 19.5 percent of persons under age 18.
  • Washington decreased infant mortality from 9.7 to 4.8 deaths per 1,000 live births.
  • Vermont decreased cardiovascular deaths from 401.7 to 241.1 per 100,000 population.

These successes indicate that change is possible for all states when there is a united front to make progress on health outcomes.

U.S. Lags Behind Other Nations on Many Health Measures
Despite spending more than any other country on health care, the United States falls behind other countries in a number of health outcome measures. The United States:

  • Falls behind 30 other countries in terms of a healthy life expectancy with an average of 70 years. Japan leads all countries with an expectancy of age 76.
  • Has the highest mortality rate from treatable conditions when compared to 19 other industrialized countries.
  • Is third to last in the rate of infant mortality among 37 developed nations. In 2008, the United States had seven deaths per 1,000 live births, compared to three deaths or fewer in Italy, Japan, Finland, France and Greece, among others.
  • Ranks 29th in homicide rates when compared to 31 other industrialized countries.

Join a live webcast of the event, America’s Health Rankings 2010: All Health is Local – How States Can Make a Healthier Nation, by visiting on Dec. 7 from 12:00 p.m. – 1:30 p.m. EST.

About America’s Health Rankings®
America’s Health Rankings® is the longest running report of its kind. For 21 years, the Rankings has provided an analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socio-economic data to determine national health benchmarks and state rankings. The Rankings employs a unique methodology, developed and annually reviewed by a Scientific Advisory Committee of leading public health scholars. For more information, visit

About the United Health Foundation
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. Since established by UnitedHealth Group [NYSE: UNH] in 1999 as a not-for-profit, private foundation, the Foundation has committed more than $176 million to improve health and health care. For more information, visit

About the American Public Health Association
The American Public Health Association is the oldest and most diverse organization of public health professionals in the world and has been working to improve public health since 1872. The Association aims to protect all Americans, their families and their communities from preventable, serious health threats and strives to assure community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States. APHA represents a broad array of health professionals and others who care about their own health and the health of their communities. More information is available at

About Partnership for Prevention
Partnership is a national non-profit membership organization comprised of leaders in the business community, non-profit organizations and local and state government advancing evidence-based prevention in policies and practices. The organization seeks to create a “prevention culture” in America, where the prevention of disease and the promotion of health, based on the best scientific evidence, is the first priority for policy makers, decision-makers and healthcare practitioners who can make a difference in this area. 

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