The State of the States' Health

From the WebMD Archives

Nov. 16, 2000 -- Maybe it's the spectacular fall foliage, the maple syrup, or the lobsters: Five of the six New England states -- all but Rhode Island -- were ranked among the top 10 in an annual survey of the relative healthiness of the populations of all 50 states.

Or could it be the mahi-mahi, poi, and sunshine in Hawaii, the fifth healthiest state? Or the fresh, bracing cold air and scenery in Minnesota, Utah, and Colorado (numbers two, three, and seven, respectively)?

On the other hand, Southern charm, warmth, and hospitality can't mask the fact that the health of the citizenry in South Carolina, Louisiana, and Mississippi (numbers 48, 49, and 50, in that order) could use significant improvement.

Results of the survey, conducted each year since 1990, were released this week in Boston at the annual meeting of the American Public Health Association. Taken as a whole, they give a snapshot of the overall health of the American people at the turn of the new century and provide blueprints for public health experts, legislators, and consumers as to what works, what doesn't, and how health care can be improved in the future.

"All of our states are working hard to improve the health of their residents. Some states are working against much more complex obstacles than others are, and we recognize that no ranking system is perfect, and there is always room for improvement in interpretation," says Reed Tuckson, MD, senior vice president of consumer health and medical care advancement for UnitedHealth Group, the company that commissioned and published the survey.

Because public health is concerned with the physical, mental, and social well-being of communities and the people who live in them, the rankings focus attention on five key elements that affect the comprehensive health of a state and its residents, Tuckson tells WebMD. The elements and the factors that were weighed state-by-state in each category are:

  • Lifestyle -- number of smokers, motor vehicle deaths per million miles traveled, violent crime rates, heart disease risk factors (obesity, high blood pressure, lack of exercise), and high school graduation rates, which is seen as a measure of whether residents are educated about health care;
  • Access to care -- unemployment rates, adequacy of care for pregnant women, number of people without health insurance, and financial support for health care from state and local agencies;
  • Occupational safety and disability -- workplace deaths and days lost at work from illness;
  • Disease -- number of cancer cases and infectious diseases; and
  • Mortality -- death rates for all residents, infant deaths, and premature deaths.


Coming out on top of the heap was New Hampshire, which has consistently remained among the top finishers over the last decade. It earned top honors for being lowest in violent crimes and infant death and highest for adequacy of care for pregnant women and support for public health. The state's lowest mark was for cancer incidence, with the 21st highest rate. In all, the state ranked in the top 10 on 10 of 17 measures.

"We're very proud, obviously," William Kassler, MD, MPH, medical director for the Granite State, tells WebMD. "It reflects a lot of hard work on the part of the health department, but we can't be complacent, and we have to continue to remain focused on what still remains to be done. The data and the rankings look at the aggregate, and behind that aggregate are still tremendous pockets of need in New Hampshire."

In contrast, Mississippi ranked last among all states, due to its high number of motor vehicle deaths, high risk for heart disease, low high school graduation rate, high number of uninsured, low state and local support for public health care, high workplace-related deaths, and high overall death rates. The Magnolia State fared best in the categories of low violent crime (22nd) and care for pregnant women (26th).

"I think this very important report reveals a number of challenges," says Jonathan E. Fielding, MD, MPH, director of public health and health officer for California's Los Angeles County Department of Health Services. "The most important is that we already have the scientific knowledge to make continued improvements in health. ... If we just did all the things we know now to be effective, we could greatly improve the health of the American people."

"We all know that as a country, we can do better at improving and protecting the health of the American people, and we have a ways to go," Tuckson agrees. He notes, for example, that during the 1990s, a time of unparalleled prosperity and economic growth in the U.S., there was a 3% increase in the proportion of the population without health insurance and an overall decline in high school graduation rates.


Some of the key changes in the state of the country's health over the last decade include:

  • an almost 7% decrease in the overall percentage of smokers
  • a 40% decrease in motor vehicle deaths
  • lower national unemployment due to the strongest and longest period of economic growth in the nation's history
  • a more than 7% increase in care for pregnant women
  • increased support for public health
  • a reduction in heart disease rates
  • lower infant and premature death rates

Mohammed Ahkter, MD, MPH, executive director of the American Public Health Association, notes that the report tells us more about our health as a society than it does about the health of individuals within specific states. "Disease knows no boundaries," he says. "Mosquitoes don't wait to ask the county commissioner whether they can go on to the next state or not."

The data used in the report to rank the states were drawn from the American Cancer Society, National Safety Council, and the U.S. Departments of Health, Commerce, Education, and Labor. The report can be found at

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