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Since the beginning of 2020, the public health community has been working overtime to track, analyze and respond to the COVID-19 pandemic on a day-by-day basis. While that crucial work continues, the America’s Health Rankings 2021 Annual Report marks the beginning of a new phase; we now can begin to analyze and understand the bigger picture of COVID-19, the impact of this public health emergency on the health of the nation overall and where we go from here.
At the American Public Health Association, our mission is to improve the health of the public and achieve equity in health status. We believe we have the opportunity to make the United States the healthiest it has ever been in one generation. So, the imperative question is: How has the pandemic changed our course so far? How do we move forward given this set back and where do we go from here?
As I look at the America’s Health Rankings data I see a complex picture, including reversals in trends and underlying disparities. For example, the percentage of Americans who reported having multiple chronic conditions decreased by 4% between 2019 and 2020, reaching its lowest point since 2015. Cancer was a big part of the improvement, with a 7% decrease in prevalence. While this appears to be a victory, we also know that many people missed regular cancer screening appointments due to the pandemic – and it is unclear whether the decrease in multiple chronic conditions reflects a tangible improvement in our nation’s health. Add to that the wide disparities we see by race — the rate of multiple chronic conditions was approximately 5 times higher among American Indian/Alaska Native (13.8%) and multiracial (13.1%) adults than Asian adults (2.5%).
Similarly, frequent mental distress dropped 4% nationally between 2019 and 2020, after increasing year over year since 2014. This improvement runs counter to what some expected amidst the disruption and isolation brought on by the pandemic. Not all groups experienced a decrease in frequent mental distress. During the same timeframe, there was a notable increase in frequent mental distress among adults with the highest income level – from 7.5% to 8.9% as well as the highest education level – 8.3% to 9.4%. In addition, wide racial disparities persisted. For example, frequent mental distress was 2.9 times higher among multiracial adults at 21.1% than Asian adults at 7.4%.
In response to the pandemic, public health funding grew from $87 per person in 2017-2018 to $116 per person in 2019-2020. While this is an important finding, there remain enormous geographic differences: public health funding was highest in the District of Columbia at $874 per person in 2019-2020 and just $72 per person in Nevada and Wisconsin. And public health departments are now more short-staffed than ever while facing constantly evolving challenges.
This report is an important step in understanding the early effects of the COVID-19 pandemic. We must leverage this data to know where we stand, evaluate the driving factors and better target our work to meet the health needs of all Americans so we can become the healthiest nation in one generation.

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