National Changes

The 22-year perspective provided by this report allows us to view health over time. During the past 22 years, this report has tracked our nation’s 21.2 percent improvement in overall health (Graph 1). This national success stems from improvements in the reduction of infant mortality, infectious disease, prevalence of smoking, cardiovascular deaths and violent crime, among others (see table). However, success has eluded us in several very significant measures — the rapid increase in the prevalences of obesity and diabetes and the persistently high rate of uninsured population. A dramatic increase in the percentage of children in poverty during the last five years has also suppressed faster improvement in health.

Graph 1 illustrates that the rate of improvement experienced in the health of the United States’ population occurred in two phases. During the 1990s, improvement in national health averaged 1.6 percent per year. During this decade, the annual improvement in health has averaged 0.5 percent. Special concern surrounds the decline in health determinants, as those measures point to the future health of the population.

National Successes and Challenges

The United States has the potential to return to the rates of improvement typical in the 1990s.  However, to do so, it must address the drivers of health directly by focusing on reducing important risk factors. For example, the prevalence of smoking was stagnant for many years and now is showing improvement, declining from 23.2 percent in the 2003 Edition to 17.3 percent in the 2011 Edition, the lowest level in 22 years. Utah has reduced its smoking rate to less than 10 percent, lower than the 12 percent goal for the nation set forth in Healthy People 2020.  Seven states (California, Connecticut, Arizona, Massachusetts, New Jersey, Hawaii and Minnesota) have driven their smoking rates to less than 15 percent, approaching the Healthy People 2020 goal. Only West Virginia has a smoking rate greater than 25 percent of the population, and 13 states have rates that exceed 20 percent of the adult population.

Potentially preventable hospitalizations (hospital admissions that may be preventable with high quality primary and preventive care) have declined over the last ten years from 82.5 to 68.2 admissions per 1,000 Medicare enrollees. Potentially preventable hospitalizations are a significant issue with regard to both quality and cost. The Agency for Healthcare Research and Quality (AHRQ) reports that in the year 2000, nearly five million admissions to U.S. hospitals involved treatment for one or more potentially preventable conditions, with a resulting cost of more than $26.5 billion. Furthermore, AHRQ states that “While some hospitalizations were likely inevitable, many might have been prevented if individuals had received high quality primary and preventive care. Identifying and reducing such avoidable hospitalizations could help alleviate the economic burden placed on the U.S. health care system. Assuming an average cost of $5,300 per admission, even a 5 percent decrease in the rate of potentially avoidable hospitalizations could result in a cost savings of more than $1.3 billion.”¹

Preventable hospitalizations are also a window into the disparities that exist in the healthcare delivery system. In a study of 2003 data by Russo, C. Allison et. al ²., racial and ethnic disparities existed in the rates of preventable hospitalizations, with blacks generally having the highest rates and Hispanics the second highest rates. In particular, disparities were greatest for hospitalizations related to chronic health conditions such as diabetes, hypertension, and asthma. Compared with non-Hispanic whites, rates of admission for these conditions were about three to five times greater among blacks, and approximately two to three times greater among Hispanics.

Unprecedented and still unchecked growth in the prevalence of obesity dramatically affects the overall health of the United States. The prevalence of obesity has increased 137 percent, from 11.6 percent of the population in the 1990 Edition to 27.5 percent of the population in the 2011 Edition. Now, more than one in four people in the U.S. is considered obese – a category that the Centers for Disease Control and Prevention reserves for those who are significantly over the suggested body weight given their height. This alarming rate of increase shows little evidence of slowing or abating (Graph 4 ).

Because this data relies on self-reported height and weight, actual obesity rates, as measured by health professionals, may be almost 10 percent higher, meaning that over one-third of the population is likely to be obese.³   In fact,  the National Health and Nutritional Examination Survey (NHANES) study, which physically measures height and weight, indicates that the national obesity level is 33.8 percent of adults.⁴

Obesity is known to contribute to a variety of diseases, including heart disease, diabetes and general poor health.
 

The current economic climate also increases the challenge of maintaining a healthy population. Graph 5 depicts the continuing increase in the percentage of children in poverty, increasing from 17.4 percent of children in the 2007 Edition to 21.5 percent of children in the 2011 Edition. In the 2002 Edition, the child poverty rate was at a historic low of 15.8 percent of persons under age 18.

Children in Poverty is an indication of the lack of access to health care, including preventive care, for this vulnerable population.

Lack of health insurance coverage increased from 13.9 percent in the 2001 Edition to 16.2 percent of the population in the 2011 Edition. Lack of health insurance not only inhibits people from getting the proper care when needed but also reduces access to necessary preventive care to curtail or minimize future illnesses.  

Massachusetts, with the lack of health insurance at 5.0 percent of the population, is substantially better than all other states and less than one third of the national average. Texas has a rate five times that of Massachusetts. Changes in national health care laws have the potential to dramatically affect this metric over the next few years.

In addition, high school graduation, binge drinking, poor mental health days and poor physical health days have shown minimal improvement in the last decade and impede more significant improvements in general population health.