America's Health Rankings, United Health Foundation Logo


Smoking is the US’s leading cause of preventable death, contributing to 480,000 deaths annually. Secondhand smoke causes 41,000 deaths yearly, and 10.9 million suffer from a smoking-related illness. Approximately 14 million major medical conditions are attributed to smoking, which damages nearly every body organ and causes respiratory disease, heart disease, stroke, cancer, preterm birth, low birthweight, and premature death. Smoking shortens lifespan an average of 10 years. The US annual smoking cost: $170 billion in direct medical expenses and $156 billion in lost productivity. When smokers quit, heart attack risk drops sharply after just 1 year.

Data source: Behavioral Risk Factor Surveillance System, 2014 For details:

Core Measures: SMOKING, 2015 Annual Report
Measure: Smoking, 2015 Annual Report

Why does this matter?

Smoking cigarettes has an adverse impact on health. As the leading cause of preventable death and disease in the United States, cigarette smoking is responsible for more than 480,000 deaths every year. Smokers live 10 years less than non-smokers, on average. Currently, more than 16 million Americans live with a disease caused by smoking. 

Smoking damages nearly every organ and is associated with:

  • Heart disease.
  • Stroke.
  • Respiratory diseases such as chronic obstructive pulmonary disease.
  • Diabetes.
  • Multiple types of cancer.

Smoking can affect non-smokers as well. Exposure to secondhand smoke is responsible for 41,000 deaths among U.S. adults every year. The annual cost of smoking to the United States is around $132.5-$175.9 billion in medical expenses and $151 billion in lost productivity due to premature death. 

In recent years, there has been an increase in popularity of e-cigarettes, especially among youth. E-cigarettes often contain nicotine and other cancer-causing chemicals, and have been linked to lung injuries, hospitalizations and death. In October of 2021, the U.S. Food and Drug Administration (FDA) authorized the marketing of certain electronic nicotine delivery system devices as a tool to help addicted adults smoke less cigarettes.

  • CDC, Behavioral Risk Factor Surveillance System, 2014

Excessive Drinking

Excessive alcohol use includes binge drinking and chronic drinking; it can lead to fetal damage, liver diseases, hypertension, cardiovascular diseases, and other major health problems. An annual average of 87,798 alcohol-attributable deaths, 2.5 million years of potential life lost, and an average of 12,460 motor vehicle traffic crashes were due to excessive drinking from 2006 to 2010. Excessive alcohol use cost states a median of $3.5 billion in 2010, or $2.05 per state per alcoholic beverage consumed. Costs were from workplace-productivity losses, increased health care and criminal justice expenses, motor vehicle crashes, and property damage.

Data source: Behavioral Risk Factor Surveillance System, 2014 For

Measure: Excessive Drinking, 2015 Annual Report
Measure: Excessive Drinking, 2015 Annual Report

Why does this matter?

Excessive drinking comes with short- and long-term risks. Short-term risks include:

Long-term risks include:

Death rates from excessive drinking increased significantly between 2000 and 2019. An estimated 95,000 people die every year from alcohol-attributable causes, making it the third-leading preventable cause of death in the United States, behind tobacco and poor diet/physical inactivity. Excessive drinking is responsible for an average of 261 deaths per day, which is equal to 2.8 million years of potential life lost per year. Excessive alcohol use cost the United States a total of $249 billion in 2010.

  • CDC, Behavioral Risk Factor Surveillance System, 2014

Drug Deaths

Drug overdose deaths—the nation’s leading cause of injury death—rose over the past 2 decades. An estimated 24.6 million Americans over age 12 in 2013 used an illicit drug in the last month including marijuana, cocaine, heroin, and misused prescription drugs. Total estimated cost of illicit drug use in the US economy is $193 billion. After marijuana, prescription drugs are the second-most abused substance. Painkillers prescribed and overdose deaths quadrupled from 1999 to 2013. Annual prescription opioid abuse costs reached upwards of $55 billion in 2007 due to work-productivity losses, health care costs, drug treatment, and criminal justice expenses.

Data source: National Vital Statistics System, 2011 to 2013 For

Measure: Drug Deaths, 2015 Annual Report
Measure: Drug Deaths, 2015 Annual Report

Why does this matter?

The United States is in the midst of a drug crisis with fatal consequences. Drug overdoses have become the leading cause of injury death and have more than tripled between 1999 and 2017. There were more than 70,000 confirmed drug overdose deaths in 2017, and of those, more than 47,000 involved an opioid. A 2017 report from the Council of Economic Advisers estimated the total cost of the opioid epidemic in the United States to have been between $293.9 billion and $622.1 billion in 2015.


Heavy drug use and overdoses burden individuals, families, their communities, the health care system and the economy. The effects of substance misuse contribute to significant public health problems including crime, homicide and suicide, teenage pregnancy, sexually transmitted infections, HIV/AIDS, domestic violence, child abuse and motor vehicle accidents.

  • CDC WONDER, Multiple Cause of Death Files, 2011-2013

“Since 1999, the amount of prescription painkillers prescribed and sold in the US has nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report.” - CENTERS FOR DISEASE CONTROL AND PREVENTION


Almost one-third of US adults are obese. Obesity contributes to an estimated 200,000 deaths yearly and is a leading factor in such preventable conditions as heart disease, type 2 diabetes, stroke, cancer, hypertension, liver disease, kidney disease, Alzheimer’s disease, dementia, respiratory conditions, and osteoarthritis. An estimated $190.2 billion is spent on obesity-related health issues each year, representing 21% of annual medical spending. Obese adults spend on average 42% more on health care than healthy-weight adults. Obesity, smoking, and excessive alcohol consumption contribute similarly to chronic conditions and overall poor health.

Data source: Behavioral Risk Factor Surveillance System, 2014 For details:

Measure: Obesity, 2015 Annual Report
Measure: Obesity, 2015 Annual Report

Why does this matter?

Obesity is a complex health condition with biological, economic, environmental, individual and societal causes. Known contributing factors to obesity include social and physical environment, genetics, prenatal and early life influences, and behaviors such as poor diet and physical inactivity.

Adults who have obesity, when compared with adults at a healthy weight, are more likely to have a decreased quality of life and an increased risk of developing serious health conditions, including hypertension, Type 2 diabetes, heart disease and stroke, sleep apnea and breathing problems, some cancers and mental illnesses such as depression and anxiety. Weight stigma, or discrimination and stereotyping based on an individual’s weight, may also negatively influence psychological and physical health. 

The costs associated with obesity and obesity-related health problems are staggering. One study estimated the medical costs of obesity to be $342.2 billion (in 2013 dollars). Beyond direct medical costs, the indirect costs of decreased productivity tied to obesity are estimated at $8.65 billion per year among American workers.

  • CDC, Behavioral Risk Factor Surveillance System, 2014

Physical Inactivity

Physical inactivity is responsible for 1 in 10 deaths yearly and increases risk of coronary heart disease, diabetes, hypertension, obesity, certain cancers, and premature death. Only 21% of adults meet the US Department of Health and Human Services recommendation of at least 150 minutes of physical activity weekly. Adults with higher education or those with higher incomes are more likely to be physically active than those with low education or low income. Non-Hispanic white adults report more aerobic and muscle-strengthening physical activity than non-Hispanic black and Hispanic adults. Increasing—especially starting—physical activity can prevent and help manage chronic diseases.

Data source: Behavioral Risk Factor Surveillance System, 2014 For details:

Measure: Physical Inactivity, 2015 Annual Report
Measure: Physical Inactivity, 2015 Annual Report

Why does this matter?

Many adults spend a large portion of their time being sedentary (prolonged sitting) despite the benefits of regular physical activity. A study by the Centers for Disease Control and Prevention (CDC) found that 8.3% of deaths of non-disabled adults ages 25 and older were attributed to physical inactivity. Being physically active and reducing sedentary behavior benefits health. Regular physical activity (at least 150 minutes a week) is associated with reduced risk of:

  • Cardiovascular diseases, such as heart disease and stroke.
  • Hypertension.
  • Type 2 diabetes.
  • Certain cancers, including bladder, breast and colon cancer.
  • Dementia.
  • Anxiety and depression.

Costs associated with physical inactivity account for more than 11% of total health care expenditures and are estimated at $117 billion annually.

  • CDC, Behavioral Risk Factor Surveillance System, 2014

High School Graduation

Studies show if the health of less-educated Americans equaled that of college-educated Americans, health improvements would result in more than $1 trillion in savings annually. College graduates’ life expectancy is 5 years longer than those who did not complete high school. For those without a high school education, life expectancy has decreased since the 1990s. Individuals with more education are less likely to smoke, drink heavily, or be overweight or obese; they are more likely to have a higher earning potential and better employment opportunities, which allow for access to healthier food, health insurance, medical care, and safe neighborhoods.

Data source: National Center for Education Statistics, 2012 to 2013 (ACGR) For Details:
Measure: High School Graduation, 2015 Annual Report
  • U.S. Department of Education, National Center for Education Statistics, Common Core of Data, 2012-2013 School Year

“Many, if not most of the obstacles to school completion (teen pregnancy, school violence, hunger, homelessness, unmet physical and mental health needs) are the same obstacles to vibrant health and well-being.” - American Public Health Association - The Center for School, Health and Education

Please tell us a little more about you

We appreciate you taking the time to help America’s Health Rankings better understand our audiences. Your feedback will allow us to optimize our website and provide you with additional resources in the future. Thank you.

Please select one option which best describes your profession or field of expertise

Journalist or media professional
Health Policy Professional
Public health professional (state, local, or community level)
Health care provider or administrator
Member of an advocacy group or trade organization
Academic, student, or researcher
Government administrator, legislator, or staffer
Concerned citizen
Don't show me this again
Please take a quick survey.