Executive Summary

Executive Summary IntroductionFindingsState Rankings Successes Challenges Health Equity International ComparisonCore MeasuresBehaviors Community & Environment Policy Clinical Care OutcomesSupplemental MeasuresBehaviors Community & Environment Policy Clinical Care OutcomesState Summaries

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US SummaryAppendixCore Measures Table Supplemental Measures Table The Team

2018 Annual Report 2018 Annual Report - Executive Summary

Overview
America’s Health Rankings® presents its 29th Annual Report, continuing the United Health Foundation’s dedication to providing data that can help build healthier communities nationwide. The longest-running annual assessment of the nation’s health on a state-by-state basis provides updated data to serve as a benchmark for states and spark data-driven discussions on opportunities to promote the health and well-being of our country.
The Annual Report follows the America’s Health Rankings model, recognizing that determinants of health directly influence health outcomes. Thirty-five markers of health are evaluated this year, covering behaviors, community and environment, policy, clinical care and outcomes data.
This year, the report finds increases in mortality and chronic disease such as obesity that continue to impact the nation’s health. While the country’s ability to address treatment of chronic conditions may improve with increasing numbers of key health providers, interventions and policies at the individual, community, state and national levels are needed to curb these troubling trends. Also notable, the nation’s child poverty rate — a key indicator of socioeconomic status and health throughout the lifespan — has declined nationally. This encouraging development signals there may be a reduction in future adverse health outcomes associated with child poverty, however, stark differences by state show unequal progress.
Policy-makers, public health officials and community leaders are encouraged to leverage this report and resources across the America’s Health Rankings platform to better understand the progress and challenges within their states and across the nation.


Adjust My Rank: A new web tool available from America’s Health Rankings, allows users to explore how progress and challenges across key health measures can impact a state’s overall rank. 
Obesity and Chronic Diseases Continue to Negatively Impact Health and Mortality
The nation’s obesity rate rose 5 percent in the past year, with one in three adults now experiencing obesity. Subpopulation data show that adults aged 25 and older with a college degree have a lower prevalence of obesity than all other education levels. Obesity continues to be a leading cause of cardiovascular disease and cancer — chronic diseases that are contributing to premature death rates.
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The cardiovascular death rate has been rising for the past three years, with 112,403 more deaths reported in 2018 than in 2015. Despite a decline in the national cancer death rate since 1990, more than 30 states have experienced increases or have not seen their cancer death rates improve significantly. Only 19 states have seen significant decreases in cancer deaths during this time.
Note: Rates are age adjusted to mid-year population estimates. Depending upon the method of population adjustment, the change over time in cancer death rates may differ.
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Deaths from these chronic diseases and others contribute to the nation’s premature death rate — the number of years lost before an individual reaches age 75. This rate increased for the fourth straight year, driven by suicide and  drug deaths with 7,432 years lost per 100,000 people this year. Drug deaths and occupational fatalities have also increased recently, with drug deaths jumping 25 percent and occupational fatalities increasing by 19 percent in the past three years. Notably, while transportation incidents make up the largest portion of occupational fatalities, the greatest increase in the past year has been workplace violence.
A Rising Suicide Rate and Frequent Mental Distress Highlight Mental Health Concerns
This year’s report finds concerning mental health challenges impacting the nation, including an increase in the suicide rate and frequent mental distress. Suicide, measured as the number of deaths due to intentional self-harm per 100,000 deaths recorded on death certificates, increased 16 percent since 2012. 
More Americans are also reporting poor mental health for 14 or more days out of the last month, with frequent mental distress now impacting nearly one in eight adults. In fact, self-reported mental distress measured by the Behavioral Risk Factor Surveillance System (BRFSS) increased 7 percent over the past two years. 
American adults are also experiencing poorer physical health, as the percentage reporting frequent physical distress increased 5 percent over the past two years.
Increased Availability of Health Care Providers Tempered by Geographic Variation
The country’s ability to address the pressing challenges identified by the report may be improving with increased rates of mental health and primary care providers. In the past year, mental health providers increased 8 percent and primary care physicians increased 5 percent nationwide.
Despite these increases on a national level, geographic variation continues to persist when it comes to the rate of mental health providers and primary care physicians. The number of mental health providers per 100,000 people is more than six times greater in Massachusetts, the healthiest state for this measure, compared to Alabama, the state with the lowest concentration of mental health providers. Similar disparities are found in primary care,  as the number of primary care physicians per 100,000 people is three times greater in Rhode Island, the healthiest state for this measure, compared to Idaho, the state with the lowest concentration.
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Fewer Children are in Poverty, but Progress is Uneven Across States
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Child poverty is a key indicator of socioeconomic status and overall health for a population. Nationwide, the report finds that the country is making progress on this measure, as the rate decreased 6 percent in the past year and decreased by nearly one-fifth in the past five years. Exposure to chronic stress associated with financial hardship — including unreliable access to food, health care and stable housing — may impair childhood development and a ect health into adulthood.
The reduction in child poverty, however, was not equal across states and wide geographic variation exists for this measure. For example, Louisiana’s rate (28.0 percent in poverty) is nearly three times higher than New Hampshire’s rate (10.3 percent in poverty).
2018 State Rankings
Hawaii re-claims its top rank as the healthiest state this year, followed by Massachusetts, which held the position as last year’s healthiest state. Connecticut (No. 3), Vermont (No. 4) and Utah (No. 5) all remain in the top five states for overall health.
Louisiana has the greatest opportunity for improvement in overall health this year. Mississippi (No. 49), Alabama (No. 48), Oklahoma (No. 47) and Arkansas (No. 46) round out the states with greatest opportunities for improvement.
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Maine experienced the greatest improvement over the past year, jumping seven places to No. 16, while California and North Dakota both climbed five places to No. 12 and No. 13, respectively. Maine made the most progress across markers of health behaviors and community & environmental measures, notably improving nine ranks in smoking and 27 ranks in children in poverty.
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Oklahoma experienced the largest rank decline, falling four places in the rankings to No. 47 in the country. The state’s drop in rank was driven mostly by changes in health behaviors in the past year, including an 11 percent increase  in the prevalence of obesity and 14 percent increase in the physical inactivity rate.
Working Together to Address Concerning Trends in the Health of Our Nation
A record-breaking prevalence of obesity and rising mortality rates present significant health challenges for the country. In addition, wide geographic variation and inequities caused by economic and social obstacles temper the progress made in reducing child poverty and increasing the number of health care providers. While these findings paint a concerning picture of America’s health this year, United Health Foundation recognizes that federal, local and state leaders are working to move the needle on these markers and is encouraged by the improvements being made in communities across the country. These leaders, as well as policy-makers and public health officials, can use the 29th America’s Health Rankings Annual Report, the new Adjust My Rank web tool and the broader suite of resources as catalysts to spark dialogue and take action at the national and state levels to implement solutions that improve the health of our nation.