Do you live in the unhealthiest state in the US?

By John Murphy, MDLinx
Published January 20, 2020

Key Takeaways

Across the United States, the health of Americans is actually getting better in more ways than it’s getting worse. That’s according to a recent report by America’s Health Rankings, which rated the healthiest and unhealthiest states in the nation. 

In America today, for instance: 

  • The percentage of children living in poverty has declined 20% since 2013

  • Air pollution has decreased by 36% since 2003

  • Infant mortality has been reduced by 43% since 1990

  • Smoking among adults has dropped 45% since 1990

  • Violent crime has fallen 50% since 1993

But, it’s not all good news: 

  • Suicide has risen 4% since 2018 

  • Chlamydia is back, increasing by 5% since 2018

  • The incidence of low infant birth weight has increased 19% since 1993

  • Diabetes has shot up 148% among US adults since 1996

  • Obesity among adults has skyrocketed 166% since 1990

Also, problems that had decreased over time are on the upswing again, like cardiovascular death (up 4% since 2015) and premature death (up 7% since 2014). 

These measures differ among states, with some performing much better and some much worse. To that end, America’s Health Rankings rated all 50 states based on scores derived from 35 measures across five categories of health: behaviors, community and environment, policy, clinical care, and outcomes. This year marks the 30th anniversary of this annual report. 

“For three decades, America’s Health Rankings has provided an analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socioeconomic data to determine national health benchmarks and state rankings,” the organization explains. 

States were ranked in order from #1 to #50 for a variety of categories, including prevalence of diabetes, cancer death rate, percentage of uninsured individuals, prevalence of excessive drinking, air pollution, infant mortality rate, and many more. The rankings for these categories were then combined for the final ranking of “healthiest” state. 

Here are the three healthiest and three unhealthiest states, according to the new report. 

Three healthiest states

#1 Vermont

Vermont was the healthiest state in 2019, moving up three spots in 1 year. The state’s top rank was driven by substantial gains in several categories, but particularly for “disparity in health status”—which is the difference between the percentage of adults (ages 25 and older) with at least a high school education compared with those without, who reported their health as very good or excellent. Vermont’s disparity in health status decreased from 33.8% to 17.4%, rising 44 spots in the rankings for this metric. 

The Green Mountain State also has a low incidence of chlamydia (ranking #2 of all states), a low violent crime rate (#2), and a low percentage of uninsured individuals (#3). On the downside, it has one of the highest incidence rates of pertussis (#49), a high occupational fatality rate (#28), and a high cancer death rate (#33).

#2 Massachusetts

Massachusetts is the state with the lowest infant mortality rate at 3.8 deaths per 1,000 live births, on par with Denmark. The Bay State also has a low prevalence of obesity (#4). Additionally, it has the highest rates of mental health providers (#1) and dentists (#1). It also ranks as the #1 state for both the lowest percentage of uninsured individuals and the highest percentage of immunized children. 

But Massachusetts is not without challenges, including a high prevalence of excessive drinking (#46) and a large disparity in health status by high school education (#39). What’s more, the state’s drug death rate increased 87% in the past 3 years, from 15.7 to 29.3 deaths per 100,000 population (ranking #43 of all states). 

#3 Hawaii

Hawaii dropped from #1 in 2018 to #3 in the current rankings. But the Aloha State still has a lot going for it. It’s the state with the highest life expectancy at 82.5 years (the same as Sweden). It also has a low cancer death rate (#2), a low prevalence of obesity (#2), and a low percentage of uninsured people (#2). 

But Hawaii is riding some major waves, and we’re not talking surfing. The state has a high prevalence of excessive drinking (#43), a low percentage of high school graduates (#34), and a low rate of Tdap vaccination among adolescents (#42). 

Three unhealthiest states

#48 Arkansas

Arkansas was the third most unhealthy state in 2019, with high rates of obesity (#48), physical inactivity (#48), and smoking (#48). It has a high percentage of children in poverty (#47) and a high infant mortality rate (#48). It ranked near the top for frequent physical distress (#49), which is the percentage of adults who reported their physical health was not good 14 or more days in the past 30 days. Arkansas also has high prevalence rates of cardiovascular deaths (#47), cancer deaths (#46), and premature death (#46). 

But, not all is doom and gloom in the Natural State (so named because of its natural scenery and wildlife). Arkansas has a low prevalence of excessive drinking (#10), a high percentage of high school graduates (#14), a small disparity in health status by high school education (#10), and a relatively low rate of drug deaths (#14). 

#49 Louisiana

Among all states, Louisiana has some of the highest rates of children in poverty (#48) and low infant birth weight (#49). It also has a high prevalence of obesity (#47) and high rates of diabetes (#47) and cardiovascular deaths (#46). In the past 10 years, chlamydia has increased 65%, from 451 to 742 cases per 100,000 population, making Louisiana the state with the second-highest prevalence of chlamydia.

On the bright side, smoking in Louisiana decreased by 20% since 2012, from 25.7% to 20.5% of adults. The Pelican State also has a small disparity in health status by high school education (ranking #4 in the United States) and a low prevalence of pertussis (#7). Tdap immunization coverage among adolescents is high (#11), as is the state’s number of mental health providers (#19).

#50 Mississippi

Mississippi was ranked the most unhealthy state in 2019. It’s the state with the lowest life expectancy (74.8 years, which is on par with Latvia). It also has the highest percentage of children in poverty (#50) and infants born with low birth weight (#50). It’s the state with the highest rate of cardiovascular deaths (#50) and the second-highest rate of cancer deaths (#49). The Magnolia State also has some of the highest prevalence rates of obesity (#49), physical inactivity (#49), and diabetes (#48). 

All this bad news would be enough to drive you to drink...but not in Mississippi. It has the third-lowest rate of excessive drinking (#3). It also has one of the lowest rates of drug deaths (#7). And, it has a small discrepancy in health status by high school education (#5). 

Other noteworthy highs and lows

  • Drug-related deaths. West Virginia had the highest percentage of drug-related deaths, which increased 50% in the state in the past 3 years, from 32.2 to 48.3 deaths per 100,000 population, and 120% since 2007.

  • Cardiovascular deaths. Mississippi had the highest cardiovascular death rate (363.2 deaths per 100,000), which was 1.9 times higher than Minnesota, the state with the lowest rate (193.8 deaths per 100,000).

  • Cancer deaths. Kentucky had the highest rate of deaths from cancer, with 233 deaths per 100,000 people. Utah had the lowest rate, with 150 deaths per 100,000.

  • Chlamydia. Alaska had the highest rate of chlamydia, with 802 cases per 100,000 people. West Virginia had the lowest, with 228 cases per 100,000.

  • Obesity. Colorado had the lowest prevalence of obesity in adults at 22.9%. West Virginia and Mississippi were tied for the highest obesity prevalence at 39.5%.

  • Primary care physicians. Idaho had the lowest percentage of primary care physicians, with 97 PCPs for every 100,000 people. Little Rhode Island had the highest percentage of PCPs, with 275 of them for every 100,000 Rhode Islanders.

  • Occupational fatalities. Wyoming had the highest rate of occupational fatalities, with 10.9 deaths per 100,000 workers. The state of Washington had the lowest, with 2.7 occupational deaths per 100,000 workers.

  • Violent crime. The state with the highest violent crime rate? Alaska, with 885 offenses per 100,000 people. That’s 7.9 times higher than Maine, the state with the lowest rate, with 112 offenses per 100,000 people.

  • Excessive drinking. Wisconsin had the highest rate of excessive drinking (25% of adults) and had the lowest.

For the ranking of all 50 states, download the complete America’s Health Rankings 2019 Annual Report.

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