America's Health Rankings, United Health Foundation Logo

Core Measures: Community & Environment

Air Pollution, 2018 Annual Report
Measure: Air Pollution, 2018 Annual Report

Why does this matter?

Air pollution is associated with heart and lung problems and even premature death. Large pollutant particles in the air can cause irritation and discomfort, while small, fine pollutants from sources such as auto exhaust or power plants can penetrate deeply into lung tissue and enter the bloodstream. The environment is also impacted by air pollution, as particles are carried from one area to another. Examples include increasing acidification in lakes and streams and changing nutrient patterns in soil. 

Exposure to fine particle air pollution, including from wildfires, has been linked to problems with respiratory and cardiovascular functions, including:

  • Decreased lung function.
  • Asthma.
  • Irregular heartbeat.
  • Heart attack.
  • Early death in those suffering from heart disease or lung disease. 

Air pollution of fine particulate matter originating from human activity was estimated to be responsible for 107,000 premature deaths in 2011. The same study found the cost to society was an estimated $886 billion. The United States Office of Management and Budget (OMB) reports the costs and benefits of federal regulations. OMB found that regulations issued between 2004 and 2014 to limit air pollution by the Environmental Protection Agency (EPA) generated between $157 billion and $777 billion (in 2010 dollars) in benefits to the U.S. economy, mainly by reducing the health risks of exposure to fine particulate matter.

  • U.S. Environmental Protection Agency, 2015-2017

Children in Poverty, 2018 Annual Report
Measure: Children in Poverty, 2018 Annual Report

Why does this matter?

Families with income below the federal poverty level may struggle to consistently meet the basic needs of their children. Exposure to chronic stress, including unreliable access to food, health care and stable housing, may impair the development of children in poverty and can affect their health at any stage: 

  • Birth: Mothers living in low-income neighborhoods are more likely to give birth prematurely and have low birthweight babies.
  • Childhood: Obesity, asthma and emergency room visits are more common among children living in poverty compared with those not living in poverty.
  • Adolescence: Students experiencing poverty are significantly less likely to graduate high school

Living in poverty affects a child’s ability to succeed in school and may impact potential future earnings. One estimate of the cost of U.S. childhood poverty totaled $1.03 trillion annually, factoring in lost potential earnings and costs of poor health.

  • U.S. Census Bureau, American Community Survey, 2016

Infectious Disease, 2018 Annual Report
Measure: Infectious Disease, 2018 Annual Report

Why does this matter?

Beginning in the middle of the 20th century, the field of public health began to shift its focus from infectious diseases like cholera and smallpox to chronic diseases like diabetes and cancer. Innovations in sanitation, hygiene and science helped dramatically improve the health of the U.S. population. Clean water measures, immunizations, antibiotics, education and early intervention are many efforts that decreased the rates of infectious disease. However, largely preventable infectious diseases still pose a threat to our nation’s health. Rates of some infectious diseases, such as chlamydia, continue to rise despite the readily available prevention and treatment options.

Three common diseases, each with different modes of transmission, prevention strategies and treatment options are included in this composite measure:

  • Chlamydia: A sexually transmitted infection (STI), identified through screening at-risk populations and can be treated with antibiotics.
  • Pertussis: Often called whooping cough, pertussis is spread through respiratory droplets and may be prevented through vaccination.
  • Salmonella: Generally foodborne and is prevented through proper food and animal handling practices, such as hand washing.
  • America's Health Rankings composite measure, 2018

Chlamydia, 2018 Annual Report
Measure: Chlamydia, 2018 Annual Report

Why does this Matter?

Chlamydia is the most commonly reported sexually transmitted infection (STI) in the U.S. and can infect both men and women. Chlamydia is caused by the bacterium Chlamydia trachomatis. More than 1.8 million chlamydia cases were reported in 2019, though many more cases go undiagnosed and unreported.

Chlamydial infections are usually asymptomatic, but can still cause permanent damage to reproductive organs. Untreated chlamydia in men rarely causes life-threatening damage, but can cause painful testicular swelling. Among women, untreated chlamydia can lead to pelvic inflammatory disease, chronic pelvic pain, inability to get pregnant or ectopic pregnancy, a life-threatening condition in which the fertilized egg develops outside the uterus. 

Chlamydia consistently accounts for the majority of medical costs from nonviral STIs. Chlamydia cost the U.S. over $700 million in 2018, due less to its cost per case than to its extremely high incidence rate.

  • CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas, 2016

Pertussis, 2018 Annual Report
Measure: Pertussis, 2018 Annual Report

Why does this matter?

Pertussis, commonly known as “whooping cough,” is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Pertussis can be a serious and potentially life-threatening illness, especially among infants, and is spread through the air by spending time with an infected person who is coughing and sneezing. Symptoms typically develop within five to 10 days of exposure but can take up to three weeks. The disease is often mistaken for a cold until the onset of rapid, intense coughing fits, generally one to two weeks into the disease.

In 2017, there were 18,975 reported cases of pertussis, though many cases go undiagnosed and unreported. Reported cases of pertussis reached an all time low of 1,010 reported cases in 1976 and has gradually increased over the past 40 years, in part due to increased surveillance and better diagnostics. From 2004 to 2012 the number of cases was notably high. In 2012 there were 48,277 cases of pertussis reported by states, representing the highest number of pertussis cases reported in the United States since 1955. The rise in new cases may be associated with increased use of student vaccine exemptions in schools, as well as waning effectiveness of the pertussis vaccine over time leaving older children and adults susceptible to pertussis.

  • CDC, National Notifiable Diseases Surveillance System, 2016

Salmonella, 2018 Annual Report
Measure: Salmonella, 2018 Annual Report

Why does this matter?

Salmonellosis is a gastrointestinal illness caused by several species of Salmonella bacteria. The bacteria typically live in the intestines of humans and animals and are commonly transmitted through the consumption of food contaminated with animal feces. Salmonella symptoms usually appear 12 to 72 hours after exposure and include diarrhea, fever and abdominal cramps.

According to the Centers for Disease Control and Prevention (CDC), non-typhoidal Salmonella causes an estimated 1.2 million illnesses and 450 deaths in the United States annually, with 1 million of the illnesses resulting from contaminated food. Salmonella is responsible for the most hospitalizations and deaths per year of any germ found in food. Although many cases are mild and are not diagnosed or reported, 27% of diagnosed cases result in hospitalization and 0.4% of diagnosed cases result in death. Around $365 million in medical costs are attributed to Salmonella infections annually.

  • CDC, National Notifiable Diseases Surveillance System, 2016

Occupational Fatalities, 2018 Annual Report
Measure: Occupational Fatalities, 2018 Annual Report

Why does this matter?

Occupational fatalities, also known as workplace fatalities, represent unsafe working conditions and personal risks faced by workers. In 2019, there were 5,333 fatal workplace injuries — a 2% increase since 2018. Transportation incidents accounted for the majority of fatalities at 39.8%, followed by falls, slips and trips which accounted for 16.5% of fatalities. In 2019, fishing and hunting occupations had the highest rate of fatal workplace fatalities followed by logging occupations and then aircraft flight engineer occupations.

Costs related to workplace injury and death were estimated at $171.0 billion in 2019. Costs include workers' compensation, administrative expenses, wage and productivity losses, medical fees and damages to company property.

  • U.S. Bureau of Labor Statistics, Census of Fatal Occupational Injuries, 2014-2016

Violent Crime, 2018 Annual Report
Measure: Violent Crime, 2018 Annual Report

Why does this matter?

Families, neighborhoods and communities are all affected when violent crime occurs. Violent crimes cause physical harm as well as social and emotional distress including injury, disability, premature death, depression, anxiety and post-traumatic stress disorder. Violent crime can lead to less physical activity. When personal safety is threatened, individuals are less likely to choose to walk or bike to their destination, regardless of neighborhood income levels.

Violent crimes place a financial burden on hospitals and health care systems. Costs — including violence preparedness, prevention, as well as security and safety within health care facilities — were estimated at $2.7 billion in 2016. The overall estimated economic burden of violent crime was $65 billion in lost productivity and $6 billion in direct medical costs in 2007. Researchers estimate the following per-offense total costs: $9 million per homicide, $241,000 per rape/sexual assault, $107,000 per aggravated assault and $42,000 per robbery (2008 dollars).

  • Federal Bureau of Investigation, Uniform Crime Reporting Program, 2017

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.