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Executive Highlights

This year marks the 30th edition of America’s Health Rankings. First published in 1990, America’s Health Rankings Annual Report has grown from ranking states across 16 measures of health to 35 measures in 2019. Over the last 30 years, the model and measures used in the report have advanced as our understanding of public health has evolved. Today, measures cover health behaviors, community and environment, policy, clinical care and outcomes data, drawing from 19 publicly available data sources. The current model reflects a greater understanding of how broader determinants, such as education, air pollution and the supply of mental health providers, impact our overall health.
America’s Health Rankings provides the longest running state-by-state analysis of the nation’s health. For three decades, policy-makers, public health officials and community leaders have used the Annual Report as a roadmap to better understand the strengths and challenges in their own states and at the national level. Findings from America’s Health Rankings reports have been included in legislative testimonies, academic articles, newspaper and television stories, and public health planning materials.
This year, the Annual Report also looks back at key successes and challenges the country has experienced over the past three decades, highlighting public health issues that have significantly impacted our communities.
This year’s report was developed in partnership with the American Public Health Association (APHA). The United Health Foundation is pleased to partner with APHA as a champion for the health of all people and all communities. The mission of the United Health Foundation — to enhance the well-being of our communities — closely aligns with APHA’s mission to improve the health of the public and achieve equity in health status.
The United Health Foundation and APHA are pleased to offer America’s Health Rankings as a resource to help create awareness of how states and the nation are faring across a wide range of health measures. The findings are meant to spark meaningful dialogue that will lead to actionable steps to help create healthier communities for all Americans.

Recent Improvements Show Promise for Healthier Communities


This year’s Annual Report finds improvements have been made in lowering rates of smoking, infant mortality, children in poverty and increasing the supply of mental health providers.
Smoking rates continue to improve, decreasing 6% in the past year. Understanding that e-cigarette and vaping have become an urgent public health concern, America’s Health Rankings has added supplemental data from 36 states on adult e-cigarette use this year. Of those states, e-cigarette use among adults varies from 4.3% in Maryland to 7.5% in Colorado.
Decreases in infant mortality, a two-year estimate, have resulted in nearly 1,200 fewer infant deaths. Children in poverty continues to improve, decreasing 2% in the past year (from 18.4% to 18.0%) and 20% since the most recent peak in 2013. The number of mental health providers increased 5% in the past year from 234.7 to 247.4 per 100,000.

Premature Death, Drug Deaths and Suicide Continue to Increase

Over the past year, the nation continued to experience concerning increases in measures related to mortality. The report finds:
  • The premature death rate, which captures the number of years lost to people who died before age 75, increased nationally in the past year, from 7,432 to 7,447 years of potential life lost before age 75 per 100,000.
  • The drug death rate, a three-year estimate, increased 37% from 14.0 to 19.2 deaths per 100,000 – equating to more than 53,000 additional deaths over the three-year period.
  • Suicide increased 4% in the past year from 13.9 to 14.5 deaths per 100,000.
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America’s Health Rankings has called attention to increasing mortality rates across populations throughout 2019. For example, the 2019 Health of Women and Children Report found that the teen suicide rate increased 25% since 2016. The 2019 Senior Report also highlighted the higher rate of suicide among seniors ages 65-74, which has increased 16% from 2002 to 2017.

Health Challenges Vary Across the United States

America’s Health Rankings finds that health challenges vary across the United States. Differences in health and well-being are found across geography and by gender, age, race/ethnicity, education, and income groups. Examining differences among groups helps highlight challenges that national or state aggregate data may mask. It may also help policy-makers and community leaders tailor programs that help address health challenges among certain populations.
Data across race/ethnicity reveal notable disparities. For example:
  • The percentage of adults who smoke is 3.8 times higher among American Indian/Alaska Natives (29.1%) than among Asians (7.7%).
  • The prevalence of obesity among adults is more than 3 times higher among blacks (39.9%), American Indian/Alaska Natives (39.0%) and Hawaiian/Pacific Islanders (35.2%) than among Asians (11.5%).
According to the Centers for Disease Control and Prevention (CDC), educational attainment is linked to a lifetime of health benefits. Findings in the Annual Report support that, including:
  • The percentage of adults who smoke is 3.9 times higher among adults ages 25+ with less than a high school education (25.3%) than among college graduates (6.5%).
  • Diabetes prevalence increases with each decreasing education level. It is 2.5 times higher among adults ages 25+ with less than a high school education (20.0%) than among college graduates (8.0%).
Where one lives also has an important impact on health. The Annual Report finds differences across states for every measure, but some disparities are particularly noteworthy, such as:
  • The infant mortality rate is 2.3 times higher in Mississippi (8.6 deaths per 1,000 live births) than Massachusetts (3.8).
  • The rate of violent crime, which can have both an immediate and lasting impact on health and well-being, is 7.9 times higher in Alaska (885 offenses per 100,000), than in Maine (112).

30 Years of Public Health Efforts Have Successfully Reduced Smoking and Infant Mortality

Looking back over 30 years, the nation has accomplished meaningful progress in improving the health of communities through long-term public health efforts in smoking and infant mortality.
Smoking among adults has decreased 45% since the first report in 1990. Today, 16.1% of adults report smoking tobacco, compared with 29.5% in 1990. CDC has called the decrease in smoking one of the greatest public health achievements of the early 21st century, but acknowledges the need to continue to address the impact of vaping and e-cigarettes.
The U.S. infant mortality has reached the lowest rate in America’s Health Rankings history, yet the U.S. lags behind most other developed countries. The U.S. infant mortality rate is 1.5 times higher than the average (3.8 deaths per 1,000 live births) among Organization for Economic Co-operation and Development countries.
Nationally, infant mortality has decreased 43% from 10.2 in 1990 to 5.8 deaths per 1,000 live births and decreased in all 50 states. Since 1990, the four states with the largest reduction in their infant mortality rate are South Carolina (from 13.0 to 6.7 per 1,000 live births), New York (from 10.7 to 4.5), Illinois (from 11.9 to 6.2) and Washington (from 9.7 to 4.1). Despite these improvements, the public health community continues to work toward reducing these devastating levels further.

Challenges Across Diabetes, Obesity and Mortality Grow Over Three Decades

While the country has made encouraging progress in a few key areas of public health, additional challenges have emerged that pose significant threats to the health of Americans. In particular, the nation has seen increases in levels of diabetes and obesity, and more recent challenges with rising rates of suicide and drug deaths. Premature death and cardiovascular deaths have also started to rise after years of decline.
Diabetes has reached the highest prevalence in America’s Health Rankings history and has increased 148% from 4.4% to 10.9% of adults since 1996. It now impacts approximately 30 million adults. Additionally, obesity has increased 166% over the past 30 years, from 11.6% to 30.9%.
More recently, challenges have increased across mortality measures at the national level, with premature death and cardiovascular death rates increasing after decades of decline. The report finds:
  • Since 2007, drug deaths increased 104% from 9.4 to 19.2 deaths per 100,000.
  • The suicide rate increased 17% since 2012 from 12.4 to 14.5 deaths per 100,000.
  • The premature death rate has increased for five consecutive years after generally decreasing since 1990.
  • The cardiovascular death rate has been increasing since 2015 (up 4% from 250.8 to 260.4 deaths per 100,000).

In 2019, Vermont is the Healthiest State, Mississippi has Greatest Opportunity for Improvement

Thirty-five measures contribute to this year’s rankings of the healthiest states. Vermont is the healthiest state in 2019, followed by Massachusetts (No. 2), Hawaii (No. 3), Connecticut (No. 4) and Utah (No. 5). Vermont improved three ranks in 2019 to take the top spot and the ranking is attributed partly to a low incidence of chlamydia, a low violent crime rate and a low percentage of uninsured individuals. This is the fifth time Vermont has ranked No. 1 in the past 30 years.
Mississippi ranks No. 50, while Louisiana (No. 49), Arkansas (No. 48), Alabama (No. 47) and Oklahoma (No. 46) round out the states with the greatest opportunities for improvement. Mississippi struggles with high infant mortality and cardiovascular death rates.
Since 2018, Alaska, Virginia and Wyoming experienced the largest rank improvements, with all three states improving five ranks. Maine experienced the largest rank decline, falling five places in the rankings to No. 21 in the country.
30 Years of State Rankings


The Annual Report also looked at the largest changes in state rankings over the past 30 years. New York has made the most progress since 1990, improving 29 ranks from No. 40 to No. 11. Vermont, the top-ranked state in 2019, has improved 19 places, while Maryland and New Jersey each improved 13 places.


Some states have also dropped in the health rankings over the past 30 years. Kansas has experienced the greatest decline since 1990, falling 17 places from No. 12 to No. 29. Wisconsin, Missouri, Iowa and Oklahoma also experienced large rank changes, declining 16, 15, 14 and 14 ranks, respectively.

Driving Action to Build Healthier Communities for the Next 30 Years

For 30 years, America’s Health Rankings has created widespread awareness of where states and the nation stand on important public health measures and has encouraged health improvement by promoting data-driven discussions. Advocates and policy-makers working to build healthier communities are encouraged to use the findings from the 2019 Annual Report to pursue solutions to the most pressing issues facing states and the nation today and in the coming decades.
The United Health Foundation is pleased to provide actionable insights in this report, along with the online America’s Health Rankings database of more than 160 measures. Looking forward to the future of public health, America’s Health Rankings will continue to provide an evolving state and national snapshot to inform and drive action to build healthier communities. As the country continues to make progress and different health challenges arise, the Annual Report will lead important public health discussions and spark action.

About the United Health Foundation

Through collaboration with community partners, grants and outreach efforts, the United Health Foundation works to improve our health system, build a diverse and dynamic health workforce and enhance the well-being of local communities. The United Health Foundation was established by UnitedHealth Group (NYSE: UNH) in 1999 as a not-for-profit, private foundation dedicated to improving health and health care. To date, the United Health Foundation has committed $430 million to programs and communities around the world. We invite you to learn more at www.unitedhealthgroup.com/SocialResponsibility.

About the American Public Health Association

APHA champions the health of all people and all communities. We strengthen the public health profession, promote best practices and share the latest public health research and information. We are the only organization that combines a nearly 150-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health. Learn more at www.apha.org.

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