State Rankings

Thirty-four measures are used to calculate the senior state health rankings1. The U.S. map in Figure 6 displays the 2019 rankings shaded by quintile. The healthiest states are spread throughout the West, Midwest and New England, and the states with the most challenges are concentrated in the South.

Healthiest States

This year, Hawaii remains the healthiest state for seniors. Last year, Hawaii and Utah were No. 1. Hawaii’s top rank in 2019 is driven by ranking No. 1 in behaviors, No. 2 in health outcomes and No. 3 in policy (Table 1).
Hawaii’s strengths include:
  • Lowest prevalence of obesity at 19.8 percent of adults aged 65 and older, compared with 28.5 percent nationally
  • Highest prevalence of arthritis management (those with arthritis who report arthritis does not limit usual activities) at 60.0 percent of adults aged 65 and older, compared with 52.9 percent nationally
  • Highest percentage of four- and five-star nursing home beds at 67.9 percent, compared with 47.3 percent nationally
  • Lowest death rate among 65- to 74-year-olds at 1,415 deaths per 100,000, compared with 1,791 deaths nationally
Despite Hawaii’s many strengths, the state faces challenges as well:
  • High prevalence of excessive drinking at 10.1 percent of adults aged 65 and older, compared with 7.4 percent nationally
  • Low percentage of volunteerism at 20.5 percent of adults aged 65 and older, compared with 28.0 percent nationally
  • High percentage of hospital deaths at 24.1 percent of chronically ill Medicare decedents aged 65 and older, compared with 20.8 percent nationally
Other states in the top five are Utah (No. 2), Connecticut (No. 3), Minnesota (No. 4) and Colorado (No. 5). These same states ranked in the top five in 2018, except for Connecticut, which replaced New Hampshire (No. 3 in 2018; No. 6 this year).

Most Challenged States

Mississippi dropped to No. 50 this year (No. 49 in 2018), replacing Louisiana at the bottom. Mississippi faces many health challenges that contribute to its poor health ranking. It ranks No. 50 in community & environment and health outcomes, No. 49 in clinical care, No. 48 in behaviors and No. 41 in policy (Table 1).
Mississippi’s challenges include:
  • Lowest community support expenditures (used by states for funding personal care, congregate meals, transportation and nutrition-education programs for seniors) at $184 dollars per adult aged 60 and older in poverty, compared with the average of $571 dollars for all states
  • Highest prevalence of seniors living in poverty at 13.7 percent, compared with 9.3 percent nationally
  • Highest early death rate at 2,483 deaths per 100,000 adults aged 65 to 74, compared with 1,791 deaths nationally
Mississippi’s bright spots are:
  • Low prevalence of excessive drinking at 4.1 percent among adults aged 65 and older, compared with 7.4 percent nationally
  • Low percentage of ICU use at 12.3 percent of Medicare decedents aged 65 and older, compared with 14.2 percent nationally
  • High percentage of hospice care use at 54.8 percent of Medicare decedents aged 65 and older, compared with 54.4 percent nationally
Other states in the bottom five are Kentucky (No. 49), Louisiana (No. 48), Oklahoma (No. 47) and West Virginia (No. 46). West Virginia fell from its 2018 rank of No. 45, while Arkansas moved out of the bottom five to No. 45 this year.
Table 1 shows that the healthiest states generally rank in the top 10 in the behaviors and outcomes category rankings, while the most challenged states perform poorly in these two model categories. States don’t always perform equally well across these five categories. For example, North Dakota ranks No. 18 overall, No. 38 in behaviors, No. 1 in community and environment, No. 31 in policy, No. 46 in clinical care and No. 5 in health outcomes.
Table 2 lists the 2019 senior health rankings alphabetically for all 50 states.
*Weighted standard deviation relative to U.S. value. A score of 0 is equal to the U.S. value.
In Figure 7 green bars represent states scoring above the U.S., while yellow bars represent states scoring below the U.S. Washington (No. 14) and Delaware (No. 15) have the largest difference in score, making it difficult for Delaware to move up in the rankings. There is also a large gap in score between Mississippi (No. 50) and the next state, Kentucky (No. 49).
This year, the America’s Health Rankings website launched Adjust My Rank, a new tool that illustrates the changes in health needed to alter a state's ranking. Users adjust up to eight individual measures to achieve the desired change in rank. The tool assumes all other states remain at their current level. The goal of Adjust My Rank is to spark dialogue on how to improve health, prioritize public health interventions and involve a wide variety of people in improving state health.
For a deeper dive into a state’s current ranking, users can view the Core Measures Impact Graph in the State Summary Explore section. The graph displays the impact each measure has on a state’s overall score and ranking, allowing users to identify at-a-glance which measures have the greatest impact on their state’s overall ranking.

Largest Changes in Rank

Since 2018 Table 3 shows Illinois and Vermont improved seven and six ranks, respectively. The Illinois policy rank improved from No. 31 to No. 16, and its behaviors rank improved from No. 39 to No. 29. Vermont’s change was mainly driven by its behaviors rank, which improved from No. 19 last year to No. 10 this year.
Table 4 shows Alaska experienced the largest decline, dropping from No. 21 to No. 33 this year. It had large declines in policy (from No. 24 to No. 40) and behaviors (from No. 35 to No. 45).

Since 2013 Since the first edition of America’s Health Rankings Senior Report, Rhode Island has made the biggest improvement in senior health, from No. 30 in 2013 to No. 7 this year (Table 5). Rhode Island’s improvement was driven by progress in clinical care (No. 38 to No. 2), community & environment (No. 38 to No. 25) and behaviors (No. 21 to No. 8).
Wisconsin improved from No. 19 in 2013 to No. 10 this year, moving from No. 38 to No. 17 in behaviors, No. 41 to No. 24 in policy and No. 16 to No. 6 in health outcomes.
California and Montana improved eight ranks since 2013, while New York, Utah and Alaska improved seven ranks. Despite short-term setbacks, Alaska made long-term improvements and moved from No. 40 in 2013 to No. 33 this year.
Table 6 shows Kansas and Nebraska dropped 10 ranks since the first edition. Kansas’ clinical care rank changed from No. 12 to No. 32, and community & environment fell from No. 4 to No. 16. Nebraska dropped from No. 23 to No. 44 in policy and from No. 5 to No. 10 in community & environment.
Much of North Carolina’s nine-rank decline since 2013 is attributable to a four-rank drop since 2018. Holding spots in the top five in 2013, Iowa and Massachusetts have dropped eight and seven ranks, respectively. North Dakota and Arizona, previously No. 11 and No. 24, have dropped seven ranks.

[1] The senior state health rankings from 2013 to 2018 have been recalculated and updated on the website to account for changes in data availability and a recalculation of arthritis management in editions 2013 to 2017. For details, please see Model Development.

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