Americans are living longer due to several medical advances, but unhealthy behavior and preventable illness threaten quality of life, according to United Health Foundation’s 2012 America’s Health Rankings®.
While premature, cardiovascular and cancer deaths have declined since 1990 by 18.0 percent, 34.6 percent and 7.6 percent, respectively, Americans are experiencing troubling levels of obesity (27.8 percent of the adult population), diabetes (9.5 percent of the adult population), high blood pressure (30.8 percent of the adult population) and sedentary behavior (26.2 percent of the adult population).
For the sixth year in a row, Vermont is the nation’s healthiest state. Hawaii is ranked second, followed by New Hampshire, Massachusetts and Minnesota. The five least healthy states are South Carolina (46), West Virginia (47), Arkansas (48), and Mississippi and Louisiana, which tied for the 49th slot. States that showed the most substantial improvement in rankings include: New Jersey (nine slots), Maryland (five slots), and Alabama, Colorado, Massachusetts, Nebraska, Oklahoma and Rhode Island (three slots).
To see the Rankings in full, visit: www.americashealthrankings.org.
“As a nation, we’ve made extraordinary gains in longevity over the past decades, but as individuals we are regressing in our health,” said Reed Tuckson, M.D., medical adviser, United Health Foundation, and executive vice president and chief of medical affairs, UnitedHealth Group. “We owe this progress not only to medical breakthroughs, but to public health advocates who are working tirelessly to advance wellness on the community level. But our public health heroes cannot do it alone. Longer lives need not be sicker lives, so we must all come together to do more to prevent the risk factors within our personal control.”
“The America’s Health Rankings report is a call to action for individuals – and the communities in which they live – to do something about the nation’s health crisis now,” said Georges Benjamin, M.D., executive director of the American Public Health Association.
“The detailed information in the Rankings provides a roadmap for helping America become healthier,” said Eduardo Sanchez, M.D., chairman, Partnership for Prevention. “Even the healthiest states can identify areas for improvement, while those with lower rankings can see what’s possible by looking at where they stand.”
Sedentary behavior, diabetes, obesity, hypertension weigh on health, economy
Sedentary behavior, which is defined as not doing any physical activity outside of work for the last 30 days, is at dangerous levels, affecting 26.2 percent of Americans. Rates of sedentary behavior are as high as 35.0 percent of the adult population in Mississippi, Tennessee and West Virginia. These statistics need to be understood in the context that even minimal action can produce meaningful results, as evidenced by a recent study that showed that moving from sedentary to mild activity increases life expectancy by 1.8 years (PLOS Medicine, 2012).
Obesity continues to be at epidemic levels and is one of the fastest-growing health challenges confronting our nation. The national median of obese adults is 27.8 percent; that means more than 66 million adults are obese, more than the entire population of the United Kingdom. In even the least obese state, Colorado, more than 20 percent of the population is obese. The combination of sedentary behavior and poor diet inevitably lead to increasing levels of obesity, which contributes to diabetes, cardiovascular disease, cancer and other negative health outcomes. Additionally, the economic burden of obesity is worrisome. By 2030, medical costs associated with treating preventable obesity-related diseases are estimated to increase to $66 billion per year, and the loss in economic productivity could be between $390 billion and $580 billion annually, according to F as in Fat: How Obesity Threatens America's Future 2012, a report released by Trust for America's Health and the Robert Wood Johnson Foundation.
Diabetes is also at epidemic levels. The percentage of adults with diabetes is as high as 12.0 percent in West Virginia, South Carolina and Mississippi. The national median of adults with diabetes is 9.5 percent. A 2010 report from the UnitedHealth Center for Health Reform & Modernization indicates that if these rates are not reduced, diabetes and pre-diabetes will account for about 10 percent of total health care spending by 2020, at an annual cost of almost $500 billion.
America’s Health Rankings also finds that 30.8 percent of adults nationwide say they have elevated blood pressure, which is a primary risk factor for cardiovascular disease. The prevalence of high blood pressure ranges from a low of 22.9 percent of adults in Utah to a high of 40.1 percent in Alabama. A recent study from the Centers for Disease Control and Prevention found that 39.4 percent of hypertensive adults are unaware of their high blood pressure, indicating that the actual burden of hypertension might be even higher than 30.8 percent. The same CDC study found that 53.5 percent of adults who know they have hypertension do not have their condition under control (MMWR, Sept. 12, 2012).
“High prevalence of sedentary behavior, obesity, diabetes and hypertension means that a freight train of preventable chronic illnesses is going to crash into our health care system unless we take action now,” said Dr. Tuckson. “This trend is already affecting individuals’ lives and the system as a whole, but it will be devastating if left unchecked. We – as citizens, public health advocates, employers, employees, and family members – need to address unhealthy behaviors today if we want to save our children from a lifetime of needless pain and expense. As important as access to quality medical care is to our health, the way too many people are living today is actually the biggest risk to their health.”
Where you live matters: Least healthy states face significant challenges
This year’s Rankings saw stark differences between the five healthiest states (Vermont, Hawaii, New Hampshire, Massachusetts and Minnesota) and the five least healthy states (Mississippi, Louisiana, Arkansas, West Virginia and South Carolina). In comparing the top five and bottom five states, it is evident that the least healthy states face formidable challenges related to behavioral determinants of health and to socioeconomic factors that influence health.
While smoking rates in the five healthiest states range from 16.8 percent to 19.4 percent of the adult population, smoking rates are between 23.1 percent and 28.6 percent in the five least healthy states. Likewise, 27.2 percent to 36.0 percent of the population leads sedentary lives in the five least healthy states, compared to between 21.0 percent and 23.5 percent of the population in the five healthiest states.
“We are encouraged that several states in or near the bottom have been able to make progress,” said Dr. Tuckson. “Alabama and Oklahoma were among the states that made important gains. Additionally, we are very encouraged by the intense efforts to enhance health in Louisiana and Mississippi.”
The 2012 Rankings also illustrates the impact of a state’s economic climate on its residents’ health. The five highest-ranked states report a higher median household income ($51,862 to $65,880) than the five lowest-ranked states ($37,881 to $43,939). Rates of children in poverty, which range between 8.6 percent and 16.4 percent of residents in the five healthiest states, are between 24.4 percent and 30.5 percent in Mississippi, Louisiana, Arkansas, West Virginia and South Carolina. Per-capita income and poverty affect the ability of households to afford aspects of a healthy lifestyle.
Healthier states also report a healthier job climate. Unemployment rates range between 5.4 percent and 7.3 percent of the population in the top five ranked states, compared with between 7.8 to 10.5 percent of residents in the bottom five ranked states.
United Health Foundation calls for communities to act, provides tools to help people make the right choices
United Health Foundation is launching the funding of a new learning collaborative with the Association of State and Territorial Health Officials that will identify states that have improved in key measures in the Rankings and study best practices that contribute to their successes. These lessons will then be shared with others in a continuous quality-improvement feedback loop among the states.
In addition, United Health Foundation is providing funding to the National Business Coalition on Health (NBCH) to operate private sector-led health engagement activities with multiple stakeholders and is continuing funding for the Department of Health and Human Services' Million Hearts initiative.
“We are extremely encouraged by the Million Hearts initiative, which is engaging partners from communities, health systems, nonprofit organizations, federal agencies and the private-sector,” said Kate Rubin, president, United Health Foundation. “Not only is its goal of preventing one million strokes and heart attacks in five years laudable, but it also represents a model of collaboration that should be reproduced as often as possible.”
Because individuals must be empowered and supported in making personally appropriate and accountable health and wellness decisions, the United Health Foundation has continued to enhance its website, americashealthrankings.org, with a variety of tools aimed at empowering people to become advocates for improved public health:
About America’s Health Rankings®
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, American Public Health Association and Partnership for Prevention.
The data in the report come from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and 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. A key America’s Health Rankings data source – a telephone survey by the U.S. Centers for Disease Control and Prevention that accounts for seven of the 24 measures in the index – was changed this year to include cell phone-only households, as well as a household-weighting process that better reflects increasing diversity within states. As a result of the new techniques, the rates for the following seven measures cannot be compared to previous years: smoking, obesity, binge drinking, sedentary lifestyle, diabetes, poor physical health days and poor mental health days.
America’s Health Rankings® is the longest-running report of its kind. For 23 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 socioeconomic 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 www.americashealthrankings.org.
About 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. After its establishment by UnitedHealth Group [NYSE: UNH] in 1999 as a not-for-profit, private foundation, the Foundation has committed more than $200 million to improve health and health care. For additional information, please visit www.unitedhealthfoundation.org.