America’s Health Ranking report for 2015 is out. We delve into the details and investigate which regions of the US are healthiest, safest and most improved since 2014.

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For the fourth year running, Hawaii is deemed the healthiest state.

This country-wide report is the longest running of its type, published yearly since 1990. Its focus is on data, but the team also hopes to inspire change where needed.

America’s Health Rankings report comes from the combined efforts of the United Health Foundation and the American Public Health Association.

An incredible amount of data crunching, collecting and mining has created some truly eye-opening statistics.

The list of topics covered in the report is extensive, from cardiovascular disease to immunization; from the number of visits to the dentist to insufficient sleep; teen pregnancy to employment rates.

The scope is breathtaking. No stone is left unturned in this, its 26th edition.

The group uses the broad definition of “health,” as coined by the World Health Organization (WHO):

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

As one might imagine, a study of such depth and breadth unearthed a wealth of findings. Some positive, some not so positive.

Among the positive outcomes this year are a slide in smoking rates, an increase in the immunization of children and a drop in preventable hospitalizations. Other positives included fewer cardiovascular deaths and lower infant mortality.

On the other side of the coin, drug deaths, diabetes, obesity and the number of children living in poverty have all increased since 2014’s report.

Before delving into the report in more detail, below are the main findings by state as highlighted in America’s Health Rankings’ official report:

  • Hawaii: for the 4th consecutive year, Hawaii is the healthiest state
  • North Carolina: the biggest improvement, moving from 37th position to 31st, physical inactivity decreased 13%
  • Washington: improved from 13th to 9th. The general health of poorer Washingtonians increased but so did excessive drinking (up 2%)
  • Oregon: dropped from 12th place to 20th. Drug-related deaths decreased, but obesity increased
  • New Mexico: dropped from 33rd to 37th, violent crime up 10%
  • Maine: improved from 20th to 15th. Immunization rates and physical activity both up.

For the fourth year in a row, Hawaii is deemed the healthiest state. Since the report began in 1990, the state has consistently been toward the top of the charts.

Hawaii has a low rate of preventable hospitalizations, obesity and poor mental health days.

One of the challenges for Hawaii last year was their low rate of infant immunizations. In the last 12 months, they have increased the rate by 11% to 73.7%. Although this is a marked increase, they are still below the national average.

Hawaii is also above average for excessive drinking and their incidence of Salmonella.

This year, Louisiana shifted Mississippi out of the bottom slot. In fact, over the last 25 years, they have not made it out of the bottom five.

Louisiana’s most pressing challenges are high rates of smoking (almost a quarter of adults) and the prevalence of obesity (more than 1 in 3 adults). Most worrying perhaps, more than one third of Louisiana’s children are in poverty, jumping up 73% in the past 5 years.

On a positive note, preventable hospitalization has dropped 16% over the previous 2 years. Also, Louisiana only has a small disparity in health status by education level, they have low air pollution and high levels of immunization among adolescents.

As mentioned, the report is overwhelmingly thorough; below are a few points of interest from some of the many topics covered:

Positive trends

  • Smoking: dropped 5%, from 19.0% to 18.1%. America’s lowest smoking rate is found in Utah (9.7%) and the highest in West Virginia (26.7%)
  • Physical inactivity: the number of people who completed no physical activity (outside of work) in the last 30 days decreased 11%, from 25.3% to 22.6%
  • HPV vaccinations in adolescent females: increased 6%, from 37.6% to 39.7%
  • Preventable hospitalizations: decreased 8%, from 62.9 to 57.6 discharges per 1,000 Medicare beneficiaries.

Challenging areas

  • Drug deaths: increased 4.0%, from 13.0 to 13.5 deaths per 100,000 people. The lowest rate is in North Dakota – 2.7 per 100,000 population – and the highest in West Virginia, at 32.5 per 100,000
  • Children in poverty: the number of under-18s living in poverty rose 6%, from 19.9% to 21.1%.

Additional areas of interest

  • Excessive drinking: measured as the percentage of adults who binge drink, i.e., consume more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the last month, or chronic drinking, i.e., more than 8 or 15 drinks (men/women) in 1 week. The driest states were West Virginia (10.3%), Tennessee (11.6%) and Utah (12.1%). The biggest drinkers were North Dakota (25%), Wisconsin (23.3%) and Iowa (22.3%)
  • Obesity: classed as a body mass index (BMI) of 30 or more; obesity was lowest in Colorado (21.3%), Hawaii (22.1%) and Massachusetts (23.3%).The states with the highest rates were Arkansas (35.9%), West Virginia (35.5%) and Mississippi (35.5%)
  • High school graduation: the percentage of high school students who graduate with a regular high school diploma within 4 years of beginning ninth grade. Top of the class was Iowa with 89.7% and bottom was Oregon with 68.7%
  • Violent crime: this measure looks at the number of rapes, murders, robberies and aggravated assaults per 100,000 population. The best performer in this category was Vermont, with 121.1, and the worst was Alaska, with 640.4
  • Health insurance: percentage of population that does not have health insurance. Lowest levels of insurance were found in Texas, where 20.6% of people were not insured. The highest take-up was in Massachusetts, with only 3.5% uninsured residents.

As a wealthy and powerful country, one might expect a glowing comparison between the US and the rest of the world. Sadly, this is not the case.

The report states:

On nearly all indicators of mortality, survival, and life expectancy, the United States ranks at or near the bottom among high-income countries.”

For instance, America’s infant mortality rate is 5.9 deaths per 1,000 live births. The WHO rate the US as 45th globally, just below Bosnia, Serbia and the former Yugoslavian Republic of Macedonia and just above Qatar and Slovakia.

Life expectancy in the US is 79 years – 34th in the world. Almost all Western European countries, Japan, Canada, Australia, New Zealand and Singapore have a lengthier life expectancy.

A report that covers such a huge spectrum of measures is bound to throw out the good, the bad and the ugly. The authors hope that positive and negative findings will spur the nation to improve its health in an ongoing and realistic way.

They state:

This is the overarching purpose of every Annual Report – to kindle and continue to fuel dialogue that leads to action.”

Medical News Today recently covered another in-depth study that showed the injury rate has dropped globally.