ANNUAL REPORT - America's Health Rankings

ANNUAL REPORT

EXECUTIVE SUMMARY

DECEMBER 2017

The full report is available at

EXECUTIVE SUMMARY

OVERVIEW America's Health Rankings? presents its 28th Annual Report, providing new insights to the longest-running assessment of the nation's health on a state-by-state basis.

The 2017 report looks at 35 measures covering behaviors, community and environment, policy, clinical care and outcomes data. The report also serves as a benchmark for states ? and the nation ? to measure progress, identify emerging trends and drive action for improving public health. This year, the report reveals that the nation is facing serious public health challenges, including rising rates of premature death and an uneven concentration of key health care providers. United Health Foundation, through America's Health Rankings platform, helps policy-makers, public health officials, researchers and communities improve the health, well-being and health care at the local, state and national level.

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The 2017 America's Health Rankings Annual Report inds

THE

NthATeIOnNatFiAoCnESisCeOxNpCeErRiNeInNcGinTRgEcNoDnScINeMrnOinRTgAtLrITeYndTashloeinnpgrewmmithoatiruntrcearedlaietsayetsh.

rate has incre in rates of car

Across the U.S., the premature death rate (the number of years

PREMATURE DEATHS

+3% of potenTtiahlelifpe rloesmt baeftourereagdee7a5t)hinrcaretaesehdafsorinthcertehiardsed for the third straight year,

straight yaealor,nregacwhiitnhg i7n,2c14reyeaasrselsosint breafotreesaogef c75aprderio10v0a,0s0c0ular and drug deaths.

population. This recent rise is concerning, particularly after the

Since 2015

premature death rate declined dramatically by 20 percent from 1990 to 201P5R. EMATURE DEATHS

DRUG DEATHS

+3% 2017 also saw increases in the rates of cardiovascular and drug

deaths nationwide. Cardiovascular deaths increased in the

U.S. for the seconSdinccoen2se0c15utive year. The rate among blacks is significantly higher than the rate among whites, Hispanics, Asians

and American DInRdUiaGnsD/AElaAsTkHaSNatives. Drug deaths continued on an upward trend, increasing by 7 percent to the highest level

+7% recorded by America's Health Rankings (15.0 deaths per 100,000

population) and were particularly high among whites.

+7% In the past year

CARDIOVASCULAR DEATHS

+2% Since 2015

In the past year

MORTALITY RATES ARE INCREASING IN MANY STATES, EVEN THOSE REAvNenKsEoDme of the nation

HIGHLCYAFRODIROOVAVSECRUALLALRHDEEAATLHTHS

are experiencing increases i

The report finds that over the past five years, even some of the nation's healthiest states by overall

+2% rank have experienced notable increases in key measures of mortality. Three northeastern states

that regularly rank toward the top in overall health have experienced large increases in dMrAuSgSdAeCaHtUhSsE. TTS is

ranked the healthiest

+69% ? New Hampshire'Ss irnacteein2c0r1e5ased by 118 percent (additional 13.2 deaths per 100,000 populationst)a. te, but has experienced a large ? Massachusetts' rate increased by 69 percent (additional 8.1 deaths per 100,000 population). increase in the drug ? Rhode Island's rate increased by 56 percent (additional 8.9 deaths per 100,0000 population). death rate since 2012.

Even some of the nation's healthiest states This trend is alsoatrreueefxorpcearrdieionvacsicnuglarindceartehas.sAeltshoinugmh orarntkaelditays,tfhoerfoeuxrtahmhepallteh:iest state this

year, Utah experienced one of the largest increases in the rate of cardiovascular dOevaetrhsth(eadpdaisttionivael years, the c

21.9 deaths per 100,000 population) from 2012 to 2017.

has varied among sta

+69%

MASSACHUSETTS is ranked the healthiest state, but has experienced a large increase in the drug death rate since 2012.

UTAH is ranked the

foCuArtRhDIhOeVaAlSthCUieLsAtRstate,

+10% but hDaEsAoTHnSeHoAfVtEhe INCREASED Flroamr2g71e.9stot28i5n.0cdreaethas ses in tpher e100c,00a0rpdopiuolatviona. scular

death rate since 2012.

NEVADA

While key mortality rates have increased nationally, the burden has not been felt evenly by all

states. For example:

CANCER

DEATHS HAVE

? Nevada's rate of cOanvceerrdtehaethspdaesctlineivd,ebuyteitasrrast,etohfecacrdhioavnasgcuelairndemathosritnaclrietaysDeErdCaRstiEenAcsSeE2D012 (from 191.3

to 189.7 deaths per 100,000hpaopsuvlaatiorineadnda2m71.o9ntog28s5t.a0tdeesa,thfsoprere1x0a0m,00p0lepo:Fproumpela1r91t10.i30o,t0on01,089rp.e7opdsueplaattehioscn.tively).

? Meanwhile, Louisiana's rate of drug deaths increased from 13.7 to 17.7 deaths per 100,000 population over

the past five years, but cancer and cardiovascular deaths declined during the same period (by 1.0 deaths

per 100,000 population and 2.3 deaths per 100,000 population, respectively).

CARDIOVASCULAR DEATHS HAVE

DRUG

DEATHS HAVE

3

INCREASED

INCREASED

From 13.7 to 17.7 deaths

The concentration of key health care providers WIDE VARTIAhTeIOcNoAnvCcaRerOinSeStsrTawHtEidoCenOlUyoNfaTkcRerYyoINshsTeHtahElteChOccNoaCurEneNtTprRyrA.oTvIOidNeOrFsHEALTH CARE PROTVhIDeERcSonvcaerinetsrawtidoenloyfakceryoshsetahltehccoaurnetpryro. viders This year's report also exvamairnieed sthewcoidnceenltyrataiocnroof kseyshtehalteh ccaroe uprnovtidreyrs., including mental

health pNroavtiidoenrws, ipdreim, atrhyecacroenpchyesnictiraantsioanndodfemntiestnst,aalndhefoaulnthd wpirdoevvidareiartsiovnaarcierossswthideecloyu, ntry. NsixattiiomnewNNsidaathetwtwiei,ootiinhtntnuhehwwmcssiiobddoopneeemmrcr,,oeoeettnvfhhtmissreedatteteaaccinotrttooneaesnnlsosphccfheheeemaaarnnletvvt1thnrr0iitaanpna0ttrlggoiih,oo0vsesnnida0iixxleoot0hrttffsiippmmproeoeerevpn1inssdu0ttetlt0aaarhh,lsl0teeihhv0oaenen0nraaiuueptllmsmtothhhpmabbunppoleeasrrotrtoroiotwvovohniiiffddedtmemhreelayrrseen,sstwnnaovvittttaaheaahrersllisire.ehhosssmeteawaweatellsiitstddt.hhaeetellyys,,having

with sopmroevisdtaetressphearv1i0n0g,0si0x0tipmoepsutlahteionnutmhabneor tohfemr setnateasl .health

providers per 100,000 population than other states.

555444777...333

Massachusetts has

888555...000

Alabama has

the hMigahsseascthcuosnecttesnhtarastion

the lowAelasbt camonacheanstration

othf emhMeingatshaselashctehcauolstnehcttpesrnhotavrasidtieorns o(t5hf4em7.h3einpgetharel1s0ht0ec,a0ol0tn0hcppeornpotuvraliadttiieoornns) o(5f4m7.3enptear l10h0e,a0l0th0 pporopvuliadtieorns)

otfhme elonwtAaellashbteacamolntahchepanrsotrvaitdieorns ot(8fh5me.0leopnwetrae1ls0ht0ec,0aol0nt0hceppnorptoruvaliatdtiioeonnrs) o(f8m5.0enpetar l10h0e,a0l0th0 pporopuvliadtieorns)

The distribu(5ti4on7.3ofpperirm10ar0y,0ca0re0pphoypsiucliaatnios na)nd dentists(8al5s.o0vpaerires10ac0r,o0s0s0thpeocpouulnattriyonb)y

approximately twTohteo odniset. rRibhoudteioIsnlaonfd,pMriamssaacryhucsaetrtes,pNhewysYicoriak nansdaCnodnndeecntitciusttshave more than

200 primary cavreaTphrhieeyssdicaisiactnrrsiobpsuestri1to0hn0e,o0cf0o0purpnimotprauyrlaybtiocynaa,rcpeoppmrhpoyaxrseiimcdiwanittehslfayenwtdewrodthetanont1oi0snt0sep.hysicians per

100,000 in UtahvTaanhrdieeIdsdaiahscotr.riSobisumstiilaotrhnlye,oMcfaopsusrainmcthrauyrsyebtctysaaarnepdppNrheoywxsiJmcerisaaentyeshlayvntedwmdooertenotthoisantnse8.0 dentists per

100,000 populavtaiorni,ewshailecrAorksasnstahse, Mciossuisnsitprpyi, bAlyabaapmparaonxdiDmealatwealrye thwavoe tfeowoernteh.an 45 dentists

per 100,0M00aspsoapcuhlautisoent.ts, Connecticut,

Utah and Idaho

MNaeswsaYcohruksaenttds,RChondneeIcsltaicnudt,

hUatvaeh faenwdeIrdtahhaon

MNaeswsaYchoharuvkseaemnttdso,RrCehotohndaneneIcstlaicnudt,

hUatvaeh faenwdeIrdtahhaon

New YhoarkveanmdoRrehothdaenIsland have more than

22 00 00 PRIMARY CARE 2 0 0 PPHRIYMSAICRIYANCAS RPEER

1PP0RH0IYM,S0AI0CR0IYAPCNOASPRPUEELRAT I O N P1 0H0Y,S0I0C0I APNOSPPUELRAT I O N

have fewer than

11 00 00 PRIMARY CARE 1 0 0 PPHRIYMSAICRIYANCAS RPEER

1PP0RH0IYM,S0AI0CR0IYAPCNOASPRPUEELRAT I O N P1 0H0Y,S0I0C0I APNOSPPUELRAT I O N

100,000 POPULATION

100,000 POPULATION

Similarly, Massachusetts and SNimewilaJrelyr,sMeyahssaavcehmusoertetsthaannd SNimewilaJrelyr,sMeyashsaavcehmusoertetsthaannd New Jersey have more than

88 00 DENTISTS PER 8 0 1D0E0N,T0I0S0TSPOPEPRULATION

D1 0E0N,T0I0S0T SPPOEPRU L AT I O N 100,000 POPULATION

Arkansas, Mississippi, Alabama AanrkdanDsealas,wMariseshisasvipepfie,wAelarbtahmana AarnkdanDsealsa,wMairsesihsasvipepfie, wAelarbtahmana and Delaware have fewer than

44 55 DENTISTS PER 4 5 1D0E0N,T0I0S0TSPOPEPRULATION

D1 0E0N,T0I0S0T SPPOEPRU L AT I O N 100,000 POPULATION

4

22001177 AANNNNUUAALL RREEPPOORRTT RRAANNKKIINNGGSS 2017 ANNUAL REPORT RANKINGS

2017 STATE RANKINGS

WWAA

OORRWA IIDD

OR

ID

NNVV CCAA NV

UUTT

CA

UT

AAZZ

AAKK

AZ

MMTT

MT WWYY

WY CCOO

CO NNMM

NM

AK

HHII HI

VVTT NNHH

NNDD

VT NH

NSSDD NSNDEE NEKKSS

MMNN WWII

MNIIAA WI

IAMMOO

IILL IL

KSOOKK

OK TTXX

MAAORR ALLAAR MMSS

MS

MMII

IINNMI OOHH IN KKYOY H TTNNKY

TAANLL GGAA

NNYY PPAANY

VPVAAA NNVCCA SSNCCC SC

AL GA

LA TX

FFLL

FL

MMEE ME MMAA

MRRAII CRCTIT CNNTJJ DNDEJE MMDDED MDDDCC WDWCVV

WV

RRAANNKK::

1 to 10 1 to 10

11 to 20 11 to 20

21 to 30 21 to 30

31 to 40 31 to 40

41 to 50 41 to 50

Not Ranked Not Ranked

RANK: 1 to 10

11 to 20

21 to 30

31 to 40

41 to 50

Not Ranked

This year, Massachusetts ranks as the healthiest state, while Hawaii -- which has held the top spot for

the past five years -- drops to secondTT. hVheeermHHoeenaat l(lNtthho.iiee3)ss,ttUSStatthaa(ttNeeoss. 4) and Connecticut (No. 5) round out the top five states for overall health. The Healthiest States

11

MMAASSSSAACCHHUUSSEETTTTSS

22

HHAAWWAAIIII

33

VVEERRMMOONNTT

44 UUTTAAHH

55

CCOONNNNEECCTTIICCUUTT

MASSACHUSETTS

HAWAII

VERMONT

UTAH

CONNECTICUT

For the second year in a row, Mississippi (No. 50) has the greatest opportunity for improvement in

overall health. from last year,

LwohuiliesiaWneas(tTNTVohhir.eeg4i9nSS)iat,taaAfetrtkleelatssnhsrWWeaseiit(tpNhhlaoctt. heh4s8ee)(NBBaonii.gdg4ggA6lee)atsbsoattrmCoCauhhn(aNadlololl.eeu4tnn7tg)ghmeeeasfsiivnetasitnaetdesthweitirhrtahnekimngosst

significant areas of opporTtuhneitySftoar timepsrWoveitmhetnht ien BheiagltgheasntdCwhelal-blleeinngg. es

5500 4499 4488

MMIISSSSIISSSSIIPPPPII

LLOOUUIISSIIAANNAA

AARRKKAANNSSAASS

MISSISSIPPI

LOUISIANA

ARKANSAS

TThhee SSttaatteess TThhaatt MMaaddee tthhee BBiiggTggheessStttIIammteppsrrooTvvheeammt MeennattdiienntRRhaaennkk Biggest Improvement in Rank

4477 AALLAABBAAMMAA

4466

WWEESSTTVVIIRRGGIINNIIAA

ALABAMA

WEST VIRGINIA

TThhee SSttaattee WWiitthh tthhee

LLaaTrrhggeeeSssttaRRtaaennWkkiDDtheectchlliiennee

5

Largest Rank Decline

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