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Lack of Health Insurance

Individuals without health insurance have more difficulty accessing the health care system, are often unable to participate in preventive care programs, and have more unmet health needs than those with health insurance. Unmet health needs may develop into more serious conditions requiring more costly treatments. Lack of health insurance often leads to emergency department visits that can be 10 times more costly than treatment in a clinic. The unmet health needs of the uninsured contribute to a 25% greater risk of mortality compared with those who have health insurance; this accounts for an estimated 18,000 excess deaths annually.

Data source: American Community Survey, 2013 to 2014 For details: www.americashealthrankings.org/ALL/HealthInsurance


Measure: Uninsured, 2015 Annual Report
Measure: Uninsured, 2015 Annual Report

Why does this matter?

Health insurance is critical in helping people receive the preventive and medical care they need to achieve and maintain good health. The nation’s uninsurance rate dropped significantly after the Affordable Care Act was enacted, yet nearly 29.6 million people were still uninsured in 2019. In 2016, an analysis found that 74% of uninsured adults reported that they were uninsured because they could not afford health insurance.

Compared with insured adults, uninsured adults have more health disadvantages, including: 

One study estimated that after Medicaid expansion, three states experienced a 6% decline in all-cause mortality in adults ages 20 to 64 compared with adults living in demographically and economically similar states that did not expand Medicaid. This decline was largely from medical conditions that respond well to medical management such as HIV, heart disease and diabetes.

Source:
  • U.S. Census Bureau, Health Insurance Coverage in the United States, 2013-2014


Public Health Funding

Public health funding allows states to proactively implement preventive and education programs that improve health. Public health program spending represents only a small fraction of all health care spending, yet its impact can be substantial. Increased spending on public health programs is associated with a decrease in mortality from preventable causes of death. Research shows investing $10 per person per year in community-based programs proven to increase physical activity, improve nutrition, and prevent smoking or other tobacco use could save the country more than $16 billion annually within 5 years. This is a return of $5.60 for every $1 invested.

Data source: Trust For America’s Health, 2013 to 2014 For details: www.americashealthrankings.org/ALL/PH_Spending


Measure: Public Health Funding, 2015 Annual Report
Source:
  • Trust for America's Health, 2013-2014


Immunizations—Children

Early childhood immunization is a safe and cost-effective means of controlling diseases. Infants receiving recommended immunizations by age 2 are protected from 14 diseases. Routine childhood immunizations save an estimated $10 billion in direct medical costs. Health insurance plans are required to cover immunizations, and for those without insurance, there are programs that provide free vaccines for eligible children. Vaccinations have led to a 95% decrease in vaccine-preventable diseases in the last 50 years. The CDC included vaccines in the 10 greatest public health achievements of the 20th century.

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/Immunize


Measure: Immunizations - Children, 2015 Annual Report
Measure: Immunizations - Children, 2015 Annual Report

Why does this matter?

Early childhood immunization is a safe and cost-effective way of protecting infants and children from potentially life-threatening preventable diseases early in life when they are most vulnerable. Infants receiving recommended immunizations by age 2 are protected from 14 diseases. Vaccinations have led to a 95% decrease in vaccine-preventable diseases in the past 50 years, leading the Centers for Disease Control and Prevention (CDC) to call vaccines one of the 10 greatest public health achievements of the 20th century.

After implementation of the Vaccines For Children Program in 1994, modeling estimated that among all children born between 1994 and 2013, childhood vaccinations would prevent 322 million cases of disease and 21 million hospitalizations over their lifetimes, and prevent 732,000 premature deaths due to vaccine preventable diseases. These estimates translate to net savings of $295 billion in direct costs and $1.38 trillion in total societal costs.

Source:
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Immunizations—Adolescents


As children age, protection from some childhood vaccines begins to diminish, putting school-aged children at risk for diseases like pertussis. A TDaP booster at age 11 or 12 is needed to maintain protection against tetanus, diphtheria, and pertussis. The booster also protects those who come in contact with school-aged children, most importantly infants and the elderly. Additional vaccines protect against new diseases older children may come in contact with as children or as adults. This includes meningococcal conjugate vaccine (MCV4) that protects against meningococcal disease and HPV vaccination that protects against cervical, genital, and oropharyngeal cancers.

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/Immunize_teens


Measure: Immunizations - Adolescents, 2015 Annual Report
Source:
  • America's Health Rankings composite measure, 2015


Immunizations, HPV Female—Adolescents

This vaccine targets the HPV types that most commonly cause cervical cancer and can cause anal, oropharyngeal, vulvar, and penile cancers.



Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ ALL/Immunize_teens



Measure: Immunization HPV Females, 2015 Annual Report
Source:
  • CDC, National Immunization Survey-Teen, 2014

Immunizations, HPV Male—Adolescents

This vaccine targets the HPV types that most commonly cause cervical cancer and can cause anal, oropharyngeal, vulvar, and penile cancers.

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/Immunize_teens



Measure: Immunization HPV Males, 2015 Annual Report
Source:
  • CDC, National Immunization Survey-Teen, 2014


Immunizations, MCV4—Adolescents

The meningococcal vaccine protects against the most common forms of meningococcal disease and its complications.

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/Immunize_teens


Measure: Meningococcal Immunizations, 2015 Annual Report
Measure: Meningococcal Immunizations, 2015 Annual Report

Why does this matter?

Meningococcal disease is a potentially life-threatening illness caused by the bacterium Neisseria meningitidis. It is a leading cause of bacterial meningitis in the United States. At any given time, about 10 percent of the U.S. population are carriers of N. meningitidis, meaning the bacteria are living in the nose and throat without causing disease. The bacteria can spread when people have close or lengthy contact with another person’s respiratory secretions, such as through kissing, coughing or living in the same household.

Five serogroups (A, B, C, W and Y) cause most meningococcal disease cases in the United States. Preventing the disease remains a priority because of the potentially serious outcomes and risk of outbreaks. There were around 350 cases reported in 2017, with the highest incidence occurring among infants.

The Centers for Disease Control and Prevention recommends that all preteens ages 11 and 12 get the meningococcal conjugate vaccine (covers the A, C, W and Y serogroups), with a booster at age 16. Teens may also get the optional serogroup B meningococcal disease for further protection. An analysis of the effectiveness of adolescent meningococcal vaccination found that getting one dose of the vaccine at age 11 and a booster at age 16 was cost-effective and prevented the most numbers of disease cases and deaths.

Source:
  • CDC, National Immunization Survey-Teen, 2014


Immunizations, TDaP—Adolescents

Since US TDaP vaccination began, reported tetanus and diphtheria cases dropped 99%, and reported pertussis cases dropped 80%.

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/Immunize_teens


Measure: Tdap Immunizations, 2015 Annual Report
Measure: Tdap Immunizations, 2015 Annual Report

Why does this matter?

Tetanus, diphtheria and pertussis are serious illnesses that are caused by bacteria. Vaccination is the most effective defense against illness and death from these diseases.

  • Tetanus (lockjaw) causes painful muscle tightening, stiffness and difficulty breathing.
  • Diphtheria can cause a thick coating to form in the throat, making it hard to breathe and swallow. It can also cause heart failure, paralysis and death
  • Pertussis (whooping cough) is an acute respiratory infection causing severe and prolonged coughing, potentially progressing to pneumonia or even death

Diphtheria and pertussis are spread through person-to-person contact, mainly via respiratory and throat secretions. Tetanus is non-communicable and enters the body through cuts, scratches and wounds.

The childhood vaccine for these diseases is called DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) and the booster vaccine for adolescents and adults is called Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine). The Tdap vaccine is recommended for:

  • Adolescents ages 11-18 (preferably at age 11 or 12) who have completed the recommended childhood DTaP series
  • Adults aged 19 and older who have not previously received a dose of Tdap 
  • Anyone who has close contact with infants or has not previously received Tdap
  • Pregnant women, in order to protect newborns from pertussis — infants are most at risk for severe, life-threatening illness from pertussis

Since vaccination began in the United States, reported tetanus and diphtheria cases have dropped 99 percent, and reported pertussis cases dropped 80 percent. In 2017, there were 18,975 reported cases of pertussis in the United States.

A recent literature review found that pertussis vaccination among adolescents is cost-effective. Tdap vaccination during pregnancy has also been found to be a highly cost-effective intervention that provides infants with protection against pertussis.

Source:
  • CDC, National Immunization Survey-Teen, 2014

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