IntroductionExecutive SummaryFindingsOverviewState RankingsSuccessesChallengesVariations in Mortality MeasuresVariations in the Number of Health Care Providers Between and Within StatesHealth EquityComparison with Organization for Economic Cooperation and Development NationsCore MeasuresBehaviorsCommunity & EnvironmentPolicyClinical CareOutcomesSupplemental MeasuresBehaviorsCommunity & EnvironmentPolicyClinical CareOutcomesState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS SummaryAppendixData Sources and MeasuresMethodology2017 Model DevelopmentScientific Advisory CommitteeThe TeamConclusion
Figure 1 lists the 2017 state scores sorted by rank and depicts how much a state is above or below the national average. Table 1 shows the 2017 rankings in alphabetical order and Figure 2 displays the rankings on a U.S. map.
Massachusetts ranks No. 1 this year, up from No. 2 in 2016. This is the first time Massachusetts attained top ranking, thus ending Hawaii’s five-year reign as the healthiest state. Massachusetts has steadily progressed from No. 11 in 1990 to No. 4 in 2012. The other top-five states in 2017 are Hawaii (No. 2), Vermont (No. 3), Utah (No. 4) and Connecticut (No. 5). Utah replaces Minnesota (No. 6) in the top five this year.
Massachusetts’ strengths include the lowest percentage of uninsured at 2.7 percent of the population, a low prevalence of obesity and a high number of mental health providers. The state is challenged by a high preventable hospitalization rate, high drug death rate and large disparities in health status by educational attainment. Massachusetts has reduced smoking prevalence 25 percent in the past five years, from 18.2 percent in 2012 to 13.6 percent of adults in 2017. In the past two years, the percentage of children in poverty in the state decreased 38 percent from 17.6 percent to 11.0 percent of children.
Most Challenged States
The bottom-five states in 2017 are Mississippi (No. 50), Louisiana (No. 49), Arkansas (No. 48), Alabama (No. 47) and West Virginia (No. 46). West Virginia replaced Oklahoma (No. 43) in the bottom five. Mississippi and Louisiana have major health challenges, including a high prevalence of smoking, obesity and children in poverty. These challenges contribute heavily to poor rankings and make it difficult for those two states to rise above No. 49 and No. 50. Figure 1 shows the large difference between the bottom two states and No. 48 Arkansas.
Largest Changes in Ranking Since 2016
In the past year, Florida (No. 32) and Utah (No. 4) made the most improvement in rank, with each state rising four places (Table 2). Florida’s rankings in children in poverty, disparity in health status and frequent mental distress improved. Utah’s rankings in air pollution, immunizations among children and disparity in health status improved. North Dakota fell seven places. North Dakota’s rankings for smoking, Salmonella and immunizations among children dropped.
Largest Changes in Ranking Since 2012
New York made the largest gain, moving from No. 18 in 2012 to No. 10 this year. Montana rose six places from No. 28 in 2012 to No. 22 this year. North Dakota lost the most ground, moving from No. 10 to No. 18. Maine (No. 15 to No. 23) and Wisconsin (No. 13 to No. 21) each dropped eight places.
Largest Changes in Ranking Since 1990
It is noteworthy that since the inception of the rankings in 1990, New York has rose 30 places (No. 40 in 1990 to No. 10 this year). Vermont improved 17 places (No. 20 to No. 3), and Maryland moved up 15 places (No. 31 to No. 16). North Dakota fell 17 places since 1990 (No. 1 to No. 18), and Missouri slipped 16 places (No. 24 to No. 40).
Model of Health Category Rankings
America’s Health Rankings are built upon the World Health Organization definition of health:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
The model used for the rankings reflects that determinants of health — shown in Figure 3 — directly influence health outcomes.
Not all states perform equally well in these five categories of health, as reflected in Table 3. The five shades of blue identify how the model categories of health vary within a state. The lightest shade indicates a ranking in the top 10 states, and the darkest shade indicates a ranking in the bottom 10 states. For example, West Virginia ranks No. 46 and is in the bottom 10 states for Behaviors, Clinical Care and Outcomes measures; but West Virginia ranks much stronger in Policy measures at No. 12. In contrast, Utah ranks high overall at No. 4 but only ranks No. 35 in policy measures.