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Executive BriefIntroductionNational HighlightsFindingsHealth OutcomesSocial and Economic FactorsPhysical EnvironmentClinical CareState RankingsInternational ComparisonAppendixMeasures TableData Source DescriptionsMethodologyState Summaries
US Summary
Alabama
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US SummaryAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingThe America’s Health Rankings® 2023 Annual Report, released in partnership with the American Public Health Association, continues to provide a comprehensive look at health across the nation.
This report highlights the record-high and rising prevalence of chronic conditions, as well as stark disparities by geography and nearly every demographic group.
The Annual Report, first published in 1990, is the longest-running state-by-state analysis of the nation’s health. This edition examines 87 measures of health from 28 data sources. The report, released in partnership with the American Public Health Association, is supplemented with new data related to chronic condition management and insights from the Texas Association of Community Health Centers, as well as an analysis of Organization for Economic Co-operation and Development (OECD) international health data.
In 2022, more than 29 million adults reported having three or more chronic conditions. The prevalence of all eight chronic conditions measured — arthritis, asthma, chronic kidney disease, chronic obstructive pulmonary disease, cardiovascular disease, cancer, depression and diabetes — reached its highest level recorded since America’s Health Rankings added these measures. There were striking disparities in each chronic condition by nearly every demographic group, particularly among the new subpopulations in this year’s report: disability status, veteran status and sexual orientation.
The premature death rate increased for a second consecutive year, reaching its highest rate in America's Health Rankings history. Chronic conditions played a significant role in driving this rate, contributing to six of the top 10 leading causes of death before age 75. Other measures of mortality also worsened, with increases in drug deaths, firearm deaths and homicide.
Recent improvement continued in the increasing supply of mental health providers, but frequent mental distress also continued to increase. Other improvements include a decline in occupational fatality and unemployment rates and increases in per capita income. The uninsured rate and the supply of dental care providers improved, while the prevalence of avoiding care due to cost increased and the supply of primary care providers decreased.
Additionally, many measures that appeared to be pandemic-era successes have returned to 2019 levels. For example, between 2021 and 2022 excessive drinking increased 6% from 17.3% to 18.4% of adults (compared with 18.6% in 2019), and frequent physical distress increased 14% from 10.9% to 12.4% (compared with 12.5% in 2019). Between 2020 and 2021, suicide increased 4% from 14.0 deaths per 100,000 population back to the 2019 rate of 14.5. Air pollution also worsened in 2020-2022 and exceeded pre-pandemic levels.
Finally, three new physical environment measures were added to the report this year: climate risks, transportation health risks and renewable energy. Improvements were made in renewable energy generation, while approximately 115.3 million people lived in areas of high climate risks, and 78.0 million people lived in areas of high transportation health risks.
Objective
America’s Health Rankings aims to inform and drive action to build healthier communities by offering credible, trusted data that can guide efforts to improve population health and health care. To achieve this, America’s Health Rankings continues to collaborate with an advisory group to determine the selection of a comprehensive set of measures. The 2023 Annual Report is based on:
- Eighty-seven measures. These include 49 ranking and 38 additional measures (not included in overall rank). Seven new measures are introduced this year, including breast cancer screening, cancer screenings, climate risks, homicide, housing cost burden, renewable energy and transportation health risks. For a full list of measures, definitions and source details, see the Measures Table.
- Five categories of health. These include health outcomes and four other categories that are determinants of health: social and economic factors, physical environment, behaviors and clinical care.
- Twenty-eight sources. Data are from many sources, including the Centers for Disease Control and Prevention’s (CDC’s) Behavioral Risk Factor Surveillance System, the Council on Environmental Quality’s Climate and Economic Justice Screening Tool Index and the U.S. Census Bureau’s American Community Survey.
- International comparison. This report features a look at the health of the United States compared with other OECD countries in three measures: infant mortality, life expectancy and total health spending.
The America’s Health Rankings Annual Report aims to improve population health by:
- Presenting a holistic view of health. This report goes beyond measures of clinical care and health behaviors by considering social, economic and physical environment measures, reflecting the impact of social determinants of health.
- Providing a benchmark for states. Each year, the report presents strengths, challenges and highlights for every state and the District of Columbia. Public health advocates can monitor health trends over time and compare their state with other states and the nation. State Summaries containing data on all 49 ranking measures are available on the website as a separate download.
- Highlighting disparities. The report shows differences in health between states and among demographic groups at state and national levels, with groupings based on race/ethnicity, gender, age, educational attainment, income level and metropolitan status. New demographic groups added to this year’s report include disability status, sexual orientation and veteran status. These analyses often reveal differences among groups that national or state aggregate data may mask.
- Stimulating action. The report aims to drive change and improve health by promoting data-driven discussions among individuals, community leaders, public health workers, policymakers and the media. States can incorporate the report into their annual review of programs, and many organizations use it as a reference when assigning goals for health improvement plans.
For details on demographic subpopulation group definitions and limitations, including the new disability status, sexual orientation and veteran status stratification groups, please refer to methodology.
Model for Measuring America’s Health
America’s Health Rankings is built upon the World Health Organization’s definition of health: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The model was developed under the guidance of the America’s Health Rankings Advisory Council and committees, with insights from other rankings and health models, particularly County Health Rankings & Roadmaps and Healthy People. The model serves as a framework across all America’s Health Rankings reports for identifying and quantifying the drivers and outcomes that impact state and national population health.
"Efforts like America’s Health Rankings and Healthy People underscore the importance of having high-quality demographic population data for benchmarking, as well as for tracking where we are and where we need to go." - Dr. David Huang, PhD, MPH, CPH, Chief of Health Promotion Statistics Branch at National Center for Health Statistics, CDC