Overview

• Hawaii—for the fourth consecutive year—takes the title of healthiest state in 2015.
• North Carolina shows the biggest improvement in rank over the past year, rising to 31st from 37th.
• The nation shows signs of short-term improvement with decreases in preventable hospitalizations and physical inactivity, and with increases in immunization coverage among children and adolescents. There was also continued long-term improvement in less cigarette smoking, fewer cardiovascular deaths, and lower infant mortality.
• There are troubling increases in rates of US drug deaths, diabetes, obesity, and children in poverty. In addition, premature death rates—an indicator of early death in a population—have plateaued; many early deaths are preventable through lifestyle modifications.

2015 Edition Ranks

State Rankings

Healthiest

• Hawaii: Hawaii has consistently been in the top 6 states since the America’s Health Rankings® Annual Report launched in 1990. Hawaii scores well for having a low prevalence of obesity, low rates of preventable hospitalizations, and few poor mental health days. Immunizations among children aged 19 to 35 months—identified as a key challenge for the state last year—increased 11% from 66.5% to 73.7% over the past year. Like all states, Hawaii also has areas needing improvement. It scores below the national average for immunizations among adolescents for the TDaP vaccine and above the national average for excessive drinking and the incidence of Salmonella.

Most Improved

• North Carolina: North Carolina shows the biggest improvement in rank over the past year, moving up 6 places. The state’s rise is due to an improvement in the percentage of immunizations among children and HPV immunizations among adolescent females. Also, there was a decline in physical inactivity and in the incidence of Salmonella infections.
• Notably Improved States: Maine moves from 20th last year to 15th, Washington from 13th to 9th, Kentucky from 47th to 44th, and Delaware from 35th to 32nd.

Most Challenged

• Louisiana: Louisiana ranks 50th this year, moving Mississippi out of the bottom spot to 49th. Arkansas (48), West Virginia (47), and Alabama (46) complete the bottom 5 states. Oklahoma (45) and Kentucky (44) move out of the bottom 5.

National Successes

• Preventable Hospitalizations: In the last year, preventable hospitalizations decreased 8% from 62.9 to 57.6 discharges per 1,000 Medicare beneficiaries. In the past 2 years, preventable hospitalizations decreased 11%, and since 2001 the decrease has been 30%.
• Physical Inactivity: In the last year, the prevalence of physical inactivity decreased 11% from 25.3% to 22.6% of adults.

TABLE 3 Largest Changes in Rank Since 2014 Edition (1 Year)

• Immunizations: More people are getting recommended vaccines. In the past 2 years, immunizations among children aged 19 to 35 months increased 5% from 68.5% to 71.6%. In 1996 the percentage was less than 60%. Similarly, in the last year HPV vaccinations among females aged 13 to 17 years increased 6% from 37.6% to 39.7%. The incidence of pertussis—a vaccine-preventable condition—decreased 41% from 15.5 to 9.1 cases per 100,000 population.
• Smoking: In the last year, the prevalence of smoking decreased 5% from 19.0% to 18.1% of adults. Smoking has decreased since 1990 from 29.5% to 18.1% of the adult population. However, 1 in 6 adults still smoke.
• Cardiovascular Deaths: In the past 10 years, cardiovascular deaths decreased 23% from 326.6 to 250.8 per 100,000 population.
• Infant Mortality: Since 1990 infant mortality has decreased 41% from 10.2 to 6.0 deaths per 1,000 live births.

National Challenges

• Obesity: In the past 2 years, obesity increased 7.2% from 27.6% to 29.6% of adults. In 1990 obesity was less than 12% of adults.
• Diabetes: Self-reported diabetes continues to increase—now at 10.0% of the adult population. Twenty years ago, it was 4.4% of the adult population.
• Drug Deaths: In the last year, the rate of drug deaths increased 4% from 13.0 to 13.5 deaths per 100,000 population.
• Children in Poverty: In the last year, the percent of children living in poverty increased by 6% from 19.9% to 21.1% of children under age 18 years. Since 2002 children in poverty has increased 34% from 15.8% to 21.1%.
• Premature Death: For the third year in a row the nation has not made progress in the premature death rate. Premature death is a measure of early death in a population. A variety of intervention strategies that encourage healthy lifestyles and preventive care can be effective in decreasing premature death.

TABLE 4 National Successes and Challenges — Long Term Changes

TABLE 5 National Successes Since the 2014 Edition

TABLE 6 National Challenges Since the 2014 Edition