America’s Health: 2001 State Health Rankings
Each year United Health Foundation publishes a very important report that ranks the 50 United States in 16 different health-related categories, including overall health. This report provides useful information for fitness professionals who aspire to justify and create health promotion and fitness programs for a variety of populations within a state. The data can also serve to rank which health promotion activities may be of greatest benefit within a state population—for example, physical activity, weight control and so on. Below are some general comments on the report, plus tables showing the latest rankings for overall health, risk of heart disease and prevalence of smoking.
The full text (63 pages) of this year’s report, titled America’s Health: UnitedHealth Foundation State Health Rankings, 2001 Edition, can be viewed online at www.unitedhealthfoundation.org. You may order a hard copy from this Web site or from the UnitedHealth Foundation, 9900 Bren Rd. E., Minnetonka, MN 55343.
Healthiness for individuals, families and communities is a composite of at least three essential elements: (1) the personal behaviors and decisions individuals and families make that affect their health status; (2) the decisions community policy leaders make regarding the availability of social resources devoted to the promotion and protection of a community’s health; and (3) the community environment that shapes the possibilities for healthiness.
To compile the UnitedHealth Foundation State Health Rankings, a panel of leading public health scholars assessed these elements, employing a unique methodology. The panel assigned different weights to 17 components of healthiness. These components included smoking, motor vehicle deaths, high-school graduation rates, unemployment, access to care, disabilities, incidence of preventable disease and others. Panel members gleaned their data from the Departments of Health, Commerce, Education and Labor; the National Safety Council; and the American Cancer Society.
While not perfect, the measures selected were believed to be the best available indicators of the various components of healthiness at this time and were consistent with past rankings. Based on input from the panel of experts, each component was assigned a weight that determined its percentage of the overall health score. The panel clustered the components into five categories: Lifestyle; Access to Health Care; Occupational Safety and Disability; Disease; and Mortality. For example, “Lifestyle” included five components: prevalence of smoking, motor vehicle deaths, violent crime, risk of heart disease and high-school graduation. Based on the 2001 results, Vermont, Utah, Minnesota and North Dakota currently have the highest lifestyle ratings (i.e., healthiest lifestyles), whereas South Carolina, Louisiana, Florida and Tennessee have the lowest lifestyle ratings.
The UnitedHealth Foundation’s report includes numerous tables ranking the states on different components of health. In the tables, a state’s score indicates the percentage the state is above or below the national norm. For example, a state with a score of 20 is 20 percent above the national average for that component. A negative score means the state is below the national average. When comparing states from year to year, differences in score are more important than changes in ranking.
Three of the tables are presented here:
- Table 1, “2001 Overall State Ranking,” on page 20 shows how the states compare when all 17 components of healthiness are taken into account.
- Table 2, “Risk for Heart Disease,” on page 22 ranks the states on three conditions that contribute to the risk of heart disease: hypertension, sedentary lifestyle and obesity. The values attributed to these conditions indicate how prevalent they are within a state. Each value is measured as a percentage of the state’s population. The values given in Table 2 were collected by the Centers for Disease Control and Prevention (CDC) as part of its Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS uses telephone interviews of sample populations from each state to estimate current behaviors.
- Table 3, “Prevalence of Smoking,” on page 23 reflects the percentage of each state’s population over age 18 that regularly smokes tobacco products. This information also came from the CDC’s BRFSS. A smoker was someone who had smoked at least 100 cigarettes and currently smoked regularly. The table displays the 2001 ranks, based on 2000 data. According to these data, the proportion of the population that smokes varies from a low of 12.9 percent in Utah to more than 30 percent in Kentucky. The national average is 23.2 percent of the population, an increase of 0.5 percent from last year. In the same time frame, the prevalence of smoking decreased by 2.5 percent or more in Connecticut, Delaware, Colorado and Nevada. It increased by over 2.5 percent in New Hampshire and Florida.
Since the states were ranked in 1990, the prevalence of smoking has decreased in the United States by only 6.3 percent. In Virginia, Rhode Island and Arizona, it has fallen 10 percent or more. Every state has experienced a decrease since the 1990 rankings. Missouri has had the smallest decrease—only 0.5 percent (from 27.7% to 27.2% of the population). Due to the limits of the BRFSS, caution must be used in comparing changes in prevalence in states with small populations.