The U.S. map in Figure 7 displays the 2018 senior health rankings shaded by quintile of rank. The healthiest states are centralized in the Northeast, with a few states in the West and Midwest. States ranking at the bottom for senior health are clustered in the South. State scores (see Methodology) are used to calculate the senior health state rankings. Figure 8 shows the 2018 senior health state rankings along with each state’s score. The difference between the highest and lowest scores is larger today than it was in 2017, potentially indicating wider disparities between the top and bottom states. Table 3 shows the 2018 senior health state rankings.


*Weighted standard deviation relative to U.S. value. A score of 0.000 is equal to the U.S. value.

Healthiest States

Utah is the new healthiest state for U.S. seniors, ousting Minnesota from the top spot and moving up from No. 2 in 2017. The state has improved steadily since ranking No. 10 in the first America’s Health Rankings Senior Report in 2013.
Utah’s strengths include:
  • Lowest prevalence of excessive drinking (2.6 percent of adults aged 65 and older)
  • Lowest prevalence of smoking (3.7 percent of adults aged 65 and older)
  • High percentage of volunteerism (45.9 percent of adults aged 65 and older)
  • Low rate of preventable hospitalizations (27.9 discharges per 1,000 Medicare enrollees aged 65 and older)
  • Low percentage of hospital readmissions (12.3 percent of Medicare enrollees aged 65 and older)
  • Low prevalence of full-mouth teeth extractions (9.9 percent of adults aged 65 and older)
Despite ranking first, Utah seniors face the following challenges:
  • High geriatrician shortfall (77.5 percent of geriatricians needed)
  • Low SNAP enrollment (46.6 per 100 eligible adults aged 60 and older in poverty)
  • Low flu vaccination coverage (54.9 percent of adults aged 65 and older)
  • Low percentage of dedicated health care providers (91.9 percent of adults aged 65 and older)
  • Low number of home health care workers (82.6 workers per 1,000 adults aged 75 and older)
Other states in the top five are Hawaii (No. 2), New Hampshire (No. 3), Minnesota (No. 4) and Colorado (No. 5). These states ranked in the top five in 2017.

Most Challenged States

Louisiana ranks No. 50 this year, a three-rank drop from 2017. Louisiana’s challenges include:
  • High prevalence of obesity (35.3 percent of adults aged 65 and older)
  • Highest percentage of seniors living in poverty (13.0 percent)
  • High prevalence of food insecurity (23.4 percent of adults aged 60 and older)
  • Lowest nursing home quality (31.6 percent of four- and five-star beds)
  • High percentage of frequent mental distress (10.0 percent of adults aged 65 and older)
Louisiana’s successes include:
  • High number of home health care workers (154.3 workers per 1,000 adults aged 75 and older)
  • Low prevalence of excessive drinking (6.8 percent of adults aged 65 and older)
Oklahoma (No. 46), Arkansas (No. 47), Kentucky (No. 48) and Mississippi (No. 49) round out the bottom five.

Largest Ranking Changes

Since 2017

Several states moved up or down five or more ranks this year (Table 4). Iowa and Pennsylvania made the most progress, improving nine spots. Arizona and Washington experienced the largest declines, dropping eight and seven ranks, respectively.
Iowa made progress in both behaviors and outcomes measures. The state’s behaviors rank improved from No. 38 to No. 20 and it’s outcomes rank went from No. 17 to No. 11.
Pennsylvania’s change was driven by improvements in behaviors and clinical care measures. The state’s behaviors rank went from No. 50 last year to No. 21 this year, and its clinical care rank improved from No. 15 to No. 8.
Arizona dropped from No. 23 to No. 31 this year, with large declines in behaviors (from No. 8 to No. 27) and outcomes (from No. 22 to No. 30).
Washington fell seven spots in the rankings. Its behaviors rank changed from No. 5 to No. 15. It also lost ground in clinical care, dropping from No. 18 to No. 20.

Since 2013

Since the first edition of America’s Health Rankings Senior Report in 2013, some states have made major strides in senior health while others have made little progress or have declined (Table 5). Rhode Island made the biggest improvement, from No. 33 in 2013 to No. 8 this year, while Arizona and Vermont’s ranks dropped the most since 2013.
Rhode Island made progress in behaviors (from No. 21 to No. 7), community & environment (from No. 37 to No. 30) and policy (from No. 16 to No. 10) measures.
Alaska improved from No. 39 in 2013 to No. 22 this year. The state moved from No. 50 to No. 35 in behaviors, No. 18 to No. 2 in community & environment, No. 43 to No. 25 in policy and No. 32 to No. 22 in health outcomes.
Utah, the No. 1 state for senior health, ranked No. 10 in the first edition. Wisconsin and Montana made long-term improvements despite short-term setbacks. Wisconsin progressed from No. 19 in 2013 to No. 12 this year, and Montana improved from No. 35 to No. 28. Nevada climbed six ranks since 2013.
Arizona and Vermont dropped by more than 10 ranks since 2013. Arizona’s behaviors rank changed from No. 12 to No. 27, policy went from No. 20 to No. 39 and outcomes dropped from No. 20 to No. 30. Vermont fell from No. 6 to No. 19 in behaviors, No. 8 to No. 20 in policy, and No. 1 to No. 34 in clinical care.
Kansas and Nebraska dropped nine ranks since 2013, although Kansas has improved in the short-term. Idaho and Indiana each declined six ranks since 2013.

Model of Health Category Rankings

America’s Health Rankings is built on the World Health Organization’s 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 of health (Figure 9) used in this and the other America’s Health Rankings reports has four categories of health determinants. The behaviors, community & environment, policy and clinical care categories reflect the personal, social and environmental factors that influence the fifth category, health outcomes. Table 6 shows that states don’t always perform equally across these five categories. For example, Utah, the healthiest-ranking state for seniors, ranks among the top 10 states in all categories except policy, where it ranks No. 23. Illinois and Mississippi are the only states to rank in the same quintile across all five model categories.

Figure 9. America’s Health Rankings model of health



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