What's the State of Your State's Health?

Minnesota, New Hampshire Rated Healthiest, Mississippi Ranks at Bottom

From the WebMD Archives

Nov. 17, 2003 -- Minnesota and New Hampshire residents can take solace this winter in the fact that the snowy states topped the list of America's healthiest states in 2003. But sun worshippers in the South may get cold comfort from the fact that their states ranked at the bottom of the list.

Minnesota and New Hampshire tied for first place this year in the annual American's Health: State Health Rankings announced today at the American Public Health Association's conference in San Francisco. South Carolina, Louisiana, and Mississippi rounded out the bottom of the list.

Each state was assigned a health score based on many different criteria.

2003 Overall Health Score Rankings:

Rank   State Score
1 Minnesota 24.3
1 New Hampshire   24.3
3 Utah 19.5
4 Vermont 19.0
5 Massachusetts 16.3
6 Connecticut 14.7
7 Iowa 14.6
8 Maine 13.8
9 Colorado 13.7
10 Hawaii 13.4
11 Washington 12.9
12 North Dakota 12.5
13 Rhode Island 12.1
14 Wisconsin 11.7
15 South Dakota 11.5
16 Nebraska 10.1
17 Idaho 9.0
18 New Jersey 8.9
19 Oregon 8.8
20 Kansas 8.3
21 Virginia 6.9
22 California 5.7
23 Wyoming 5.2
24 Pennsylvania 4.1
25 Montana 2.8
26 Ohio 2.2
27 Indiana 1.9
28 Michigan 1.8
29 Maryland 0.8
30 Illinois 0.4
31 New York -0.5
32 Arizona -2.1
33 Missouri -2.7
34 Delaware -3.4
35 Texas -3.8
36 Nevada -4.6
36 North Carolina -4.6
38 Alaska -5.5
39 Kentucky -7.0
40 New Mexico -7.5
41 Georgia -7.6
42 Florida -10.8
43 Alabama -11.1
44 West Virginia -11.3
45 Oklahoma -12.1
46 Tennessee -13.2
47 Arkansas -14.2
48 South Carolina -15.5
49 Louisiana -19.5
50 Mississippi -22.0

*Scores presented in this table indicate the percentage a state is above or below the national norm.


Overall, the report shows that Americans are 17% healthier now than they were 13 years ago thanks to major improvements in reducing the number of motor vehicle deaths, combating infectious diseases, and reducing infant deaths.

But the report also highlights some disturbing trends that might soon offset those gains, such as an alarming increase in the number of Americans without health insurance, which rose from 41 million to near 44 million from 2002-2003.

"This does not bode well for the health for millions of Americans," says Reed Tuckson, MD, vice president of the UnitedHealth Foundation, which sponsored the report. "I think the pressures that this is going to put on the public health infrastructure will be significant at a time when it is already challenged by the fiscal crisis affecting most states and by the necessary preparedness for bioterrorism and new disease outbreaks like SARS."

Health, State by State

Little has changed among the top and the bottom of the list in recent years with the top two and two worst performing states simply exchanging places. Last year, New Hampshire was in the top spot, followed by Minnesota. Louisiana ranked 50th last year, but moved up to 49th in 2003, followed by Mississippi in 50th, which ranked 49th last year.

But don't pack your bags yet, researchers say there was improvement in at least some areas among even the lowest ranked stated.

"Although they rank states, the purpose of this report was not to say this or that state is a better place to live," says Georges C. Benjamin, MD, executive director of the American Public Health Association. "The important point is to look at how states did over time, and even states in the lower tier all have done better over time."

States that experienced the greatest overall health score improvement from 2002-2003 included states at both the top and bottom of the overall rankings: Louisiana (+3.1), Vermont (+2.9), and Minnesota (+2.5). The major reasons for improvement included falling smoking rates in both Louisiana and Vermont, increased access to prenatal care in Vermont, and a falling violent crime rate in Minnesota.

Those states that saw the greatest decline in their overall health scores included: Alaska (-6.1), Massachusetts (-2.3), West Virginia (-2.1), and Virginia (-2.1). The principal reasons for decline in these states were a rise in the number of uninsured residents in all four states, increases in smoking rates in Alaska and Virginia, decreased support for public health care in Massachusetts, and an increase in motor vehicle deaths in West Virginia.


What Your State Says about Your Health

Experts say these rankings are important tools for public health and government officials, but people shouldn't take these rankings personally as a reflection of their own personal health.

"People shouldn't take a report like this to heart to say, 'What does this mean to me as a person?'" says Joseph G. Grzywacz, PhD, assistant professor in family and community medicine at Wake Forest University School of Medicine in Winston-Salem, N.C. "That's not what the tool was designed to do. It was designed to look at populations as a whole for informing policy and how systems can change, not necessarily individuals."

Grzywacz says this report actually has very little meaning for any given person in an individual state.

"Clearly, people can change their behaviors, and that will help them. And in the process that will change their state's rankings if enough people collectively change their behaviors," says Grzywacz. "If anything this is a measure of the health promotive capacity of a state. What resources are in place and what are the things they are doing for people to enable to realize better health."

Tuckson agrees and says that while this population-based information is interesting and an important tool for officials, it really probably doesn't mean very much to the realities of the individual person living in a particular community in a particular state.

"Healthiness is local. People need to control the risk factors that they can control," Tuckson tells WebMD. "That means not smoking, appropriate use of alcohol, using a seatbelt when you get into an automobile, exercise, and paying attention to your diet."

How the Rankings Were Determined

The rankings were based on a state-by-state analysis of several public health statistics supplied by the federal government and other sources. Those factors included risk factors that are indicators of behaviors and activities that are related to the healthiness of a population, including:

  • Prevalence of smoking
  • Motor vehicle deaths
  • Violent crime
  • Risk for heart disease
  • High school graduation
  • Children in poverty
  • Adequacy of prenatal care
  • Lack of health insurance
  • Financial support for public health care

The analysis also included measures of death and disease, such as:

  • Occupational fatalities
  • Limited activity days
  • Heart-related deaths
  • Cancer deaths
  • Infectious disease cases
  • Total deaths per 100,000 population
  • Infant mortality
  • Premature death
WebMD Health News Reviewed by Michael W. Smith, MD on November 14, 2003


SOURCES: America's Health: State Health Rankings, presented at American Public Health Association 131st Annual Meeting and Exposition, San Francisco, Nov. 15-19, 2003. Georges C. Benjamin, MD, executive director, American Public Health Association. Joseph G. Grzywacz, PhD, assistant professor in family and community medicine, Wake Forest University School of Medicine, Winston-Salem, N.C. Reed Tuckson, MD, vice president, UnitedHealth Foundation.

© 2003 WebMD, Inc. All rights reserved.