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The Health of Women and Children Across States

The U.S. map in Figure 2 displays the 2019 rankings shaded by quintile. The healthiest states for women, infants and children are in the Northeast, West and Midwest. The states with the most health challenges are concentrated in the South, with the exception of Nevada.
  • The top five states are Northeastern states.
  • Four of the bottom five states are Southern states.
The states are ranked according to a calculated score (see Methodology) with the U.S. score set at zero.
Figure 3 displays the states in order of rank. The green bars represent states scoring healthier than the U.S. average (above zero), while gold bars represent states scoring unhealthier than the U.S. average (below zero). The distance between bars indicate the difference between state scores. For example, California (No. 7) and Minnesota (No. 6) have a large difference in score, making it difficult for California to move up in the rankings. There is also a large gap in score between Ohio (No. 32) and the next higher state, Alaska (No. 31).
Highest ranked states: #1 Rhode Island #2 Massachusetts #3 New Hampshire #4 Vermont #5 Connecticut
Lowest ranked states: #46 Nevada #47 Louisiana #48 Oklahoma #49 Arkansas #50 Mississippi

Adjust My Rank is a tool that illustrates the changes in health needed to improve a state’s rank. Users can adjust up to eight measures to achieve the desired change in rank. The tool assumes all other state and national values remain constant. Adjust My Rank demonstrates that improving population health at the state level requires a multi-pronged approach. Focusing on one measure alone likely does not improve health enough to change a state’s rank. Adjust My Rank can be used to prioritize public health goals and interventions as well as to spark dialogue on how to improve state health.

Rhode Island moves into the top spot

Rhode Island is the healthiest state in this year’s report. The state’s top rank is driven by No. 1 rankings in the policy and clinical care categories (Table 1). Rhode Island also ranks in the top five across all three populations of women, infants and children. Baby-friendly facilities, uninsured women, prenatal care before the third trimester and well-baby checks have the greatest positive impact on the state’s rank. Supportive neighborhoods, infant child care cost, substance use disorder among youth and drug deaths among women have the most negative impact on Rhode Island’s rank. Strengths:
  • Low percentage of uninsured women ages 19-44 at 5.7 percent, compared with 12.4 percent nationally
  • High percentage of prenatal care before the third trimester at 98.0 percent of live births, compared with 93.7 percent nationally
  • Lowest child mortality rate at 16.3 deaths per 100,000, compared with 25.7 deaths per 100,000 nationally
Challenges:
  • High drug death rate among females ages 15-44 at 21.3 deaths per 100,000, compared with 16.3 deaths per 100,000 nationally
  • High cost of infant child care at 13.3 percent of a married couple’s median household income, compared with 12.3 percent nationally
  • Low prevalence of supportive neighborhoods at 51.0 percent of children ages 0-17, compared with 55.4 percent nationally

Mississippi remains No. 50

Mississippi is No. 50, for the second year in a row. The state ranks last in the behaviors and community & environment categories (Table 2). Improvements were made in policy, clinical care and outcomes categories in the past year, yet declines were seen in behaviors. All-in-all, Mississippi ranks in the bottom 10 states across all five model categories. The state also ranks in the bottom five for all three populations of women, infants and children. Infant child care cost, excessive drinking among women ages 18-44 and cervical cancer screening have the most positive impact on Mississippi’s rank. Breastfed infants, household smoke, uninsured women and household food insecurity are the measures with the most negative impact on Mississippi’s rank. Strengths:
  • Low prevalence of excessive drinking among women ages 18-44 at 12.4 percent, compared with 19.6 percent nationally
  • Low cost of infant child care at 7.3 percent of a married couple’s median household income, compared with 12.3 nationally
  • High prevalence of children with health insurance at 95.3 percent, compared with 93.9 percent nationally
Challenges:
  • High percentage of uninsured women ages 19-44 at 19.1 percent, compared with 12.4 percent nationally
  • Lowest percentage of infants breastfed exclusively for six months at 13.0 percent, compared with 24.9 percent nationally
  • Highest prevalence of overweight or obesity among youth at 39.2 percent, compared with 31.0 percent nationally

States with the largest changes in rank in the past year

New York and Maine made the most progress in the rankings since 2018, improving six and five ranks, respectively (Table 3). New York’s improvement was driven by progress in infants' health measures (+11 ranks from No. 28 to No. 17) and gains in the policy (+8 ranks) and clinical care (+7 ranks) categories. Maine’s rank increase was driven by progress in women’s health measures (+7 ranks from No. 27 to No. 20) and in the behaviors (+14 ranks) category.
Nebraska and Washington experienced the largest declines in the rankings since 2018, both dropping six ranks (Table 4). Nebraska's drop in rank was driven by declines in infants' health measures (-17 ranks from No. 24 to No. 41) and declines in the community & environment (-11 ranks) category. Washington's drop in rank was driven by declines in children’s health measures (-6 ranks from No. 18 to No. 24) and in the behaviors and clinical care categories (-4 ranks).




The health of women, infants and children within states

When examining women, infants and children separately, variations emerge in the rankings within many states. Table 5 displays the overall and individual ranks for women, infants and children shaded by quintile of rank. For example, New Hampshire (No. 3) ranks in the top five for infants and children, but ranks No. 11 for women. Arkansas (No. 49) ranks in the bottom five for women and infants, but ranks No. 38 for children. The largest variations in rank among the three populations occur in Oregon (No. 20), South Dakota (No. 23), Montana (No. 27), Alaska (No. 31) and New Mexico (No. 34). In all five states, the rank for children’s health is dramatically lower than the ranks for infants’ and women’s health. Meanwhile, there is little variation among the ranks of the three populations in Rhode Island (No. 1), New York (No. 13), Nevada (No. 46) and Mississippi (No. 50).
A line graph displayed in the state summaries demonstrates how each state compares with the average U.S. score in each population group (women, infants, and children) and in each model category (behaviors, community & environment, policy, clinical care and outcomes) as well as overall.

Figures 4 to 6 show the geographic distribution of rankings across states for each population group. The top ranking states for women’s health are spread throughout the West, Midwest and Northeast, while the bottom ranking states are in the South, with the exception of Nevada and Indiana. For infants' health, the top ranking states are in the West and Northeast as well as Minnesota, while the lowest ranking states are clustered in the South, as well as Nevada, Nebraska and Ohio. The top ranking states for children’s health are spread in the Northeast as well as Minnesota, Iowa, Virginia and Maryland, while the lowest ranking states are in the West and South.



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