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Overview

For 31 years, America’s Health Rankings® has created widespread awareness of where states and the Nation stand on important public health measures. Amid a global pandemic, the Annual Report underscores the United Health Foundation’s longstanding commitment to public health and dedication to providing data-driven insights that can help build healthier communities nationwide.
Using an updated model, this year’s Annual Report examines the impact that social, economic and environmental factors have on overall health. The report highlights 74 measures of population health, covering social and economic factors, physical environment, clinical care, behaviors and health outcomes data, drawing from 20 publicly available data sources.
The 2020 America’s Health Rankings Annual Report finds measured progress on key health markers, including the prevalence of multiple chronic conditions driven by improvements in the prevalence of cardiovascular disease. However, obesity rates continue to increase, reaching a new national high. Multiple chronic conditions, cardiovascular disease and obesity have all been identified by the Centers for Disease Control and Prevention (CDC) as risk factors for more severe COVID-19 illness. Additionally, more Americans are receiving some recommended vaccinations at higher rates but far below public health targets. Finally, the supply of mental health providers increased in each state — while at the same time, a growing number of Americans are facing mental health challenges.
The 2020 Annual Report provides one of the most comprehensive assessments of the Nation’s health on a state-by-state basis prior to the onset of the COVID-19 pandemic. This year’s data raise concerns about the ongoing challenges that Americans face when it comes to their health — which is compounded further by the current COVID-19 pandemic that will impact several health and socioeconomic factors. In recognition of current public health challenges, America’s Health Rankings has curated measures from across the platform that are classified as COVID-19 risk factors, including several health measures that the CDC has identified as risk factors for severe COVID-19 illness.
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 United Health Foundation’s focus on improving health and health care in communities across the country 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 generate 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.
As we head into the next decade, America’s Health Rankings will continue to provide an evolving state and national snapshot to inform discussions and stimulate action to build healthier communities.

Key Findings

Measured Progress on Key Health Markers

This year’s report finds measured progress on key health measures, including the prevalence of multiple chronic conditions, driven largely by improvements in cardiovascular disease.
The percentage of adults suffering from multiple chronic conditions — defined as having three or more of the following: arthritis, asthma, chronic kidney disease, chronic obstructive pulmonary disease, cardiovascular disease, cancer, depression and diabetes — declined from 10.3% to 9.5% in 2019, though troubling disparities remain. Multiple chronic conditions are a medical outcome that may involve or cause a person’s immune system to not function properly (medically referred to as immunocompromised). People of all ages who are immunocompromised may be at higher risk of severe illness from COVID-19. Additionally, those living with multiple chronic conditions represent one of the highest-need segments of the population with greater health vulnerabilities and increased use of health care services and treatments.
This decline is apparent among adults ages 65+, who have seen a 5% improvement since 2018. However, the prevalence of multiple chronic conditions is 6.5 times higher among American Indian/Alaska Native adults (18.1%) than among Asian adults (2.8%), and 4.3 times higher among adults ages 25 and older with a household income less than $25,000 (20.5%) than those with a household income of $75,000 or more (4.8%).
The report highlights promising progress on cardiovascular disease. The prevalence of adults with this chronic condition has decreased 7% from 9.0% to 8.4% between 2018 and 2019, although it still affects nearly 21.2 million adults. However, large racial and ethnic disparities exist, as cardiovascular disease prevalence is 3.1 times higher among American Indian/ Alaska Native adults (14.4%) than Asian adults (4.7%).

Obesity Rates Continue to Increase — Reaching a New National High

This year’s report found that between 2011 and 2019, obesity rates increased 15% nationally from 27.8% to 31.9% of adults, affecting nearly 70.4 million adults — a new high for a measure that has long been a challenge for Americans. Obesity has increased among all subpopulation groups during this same time period, including gender, age, education, income as well as race and ethnicity. Across the Nation, Colorado and the District of Columbia have the lowest prevalence of obesity, each at 23.8%, and Mississippi has the highest, at 40.8%.

Recent Improvements in Key Vaccination Rates

More American adults and adolescents are receiving their recommended flu and HPV vaccinations — although rates remain far below the U.S. Department of Health and Human Services’ Healthy People 2030 targets.
Between 2018 and 2019, flu vaccinations increased significantly in 46 states, and flu vaccinations increased 25% nationally from 35.0% to 43.7% of adults. However, this remains far below the 70% target for Healthy People 2030.
Flu vaccinations also increased 27% and 30% among men and women, respectively. Moreover, flu vaccinations also increased among all age groups. In particular, vaccination rates increased 41% among ages 18–44, 27% among ages 45–64 and 18% among ages 65+.
In addition to the flu vaccine, the HPV vaccination rate also increased between 2018 and 2019. The HPV vaccination rate increased 6% nationally from 51.1% to 54.2%, progressing toward the Healthy People 2030 target of 80% of adolescents ages 13–15. Notably, HPV vaccinations were also up 8% among white teens (51.6%), who have lower rates than Hispanic (58.1%) and American Indian/Alaska Native (57.5%) teens.

Mental Health Challenges Continue to Impact Americans

Americans are facing growing mental health challenges, including increased rates of frequent mental distress and suicide. However, the nationwide growth in the supply of mental health providers is encouraging.
Between 2018 and 2019, the prevalence of frequent mental distress — the percentage of adults who reported their mental health was not good 14 or more days in the past 30 days — increased 11% nationally, from 12.4% to 13.8% of adults, an increase of nearly 1.3 million adults. This rate has increased 25% since 2014, up from 11.0% of adults. The prevalence of frequent mental distress increased significantly in Iowa (21% increase), Utah (16%) and Washington (13%) between 2018 and 2019.
In addition to the increased prevalence of frequent mental distress, the suicide rate also increased 2% nationally between 2017 and 2018 (from 14.5 to 14.8 deaths per 100,000 population) continuing an upward trend. The suicide rate has increased 23% nationally since 2009. Notably, the suicide rate has increased 28% among females and 21% among males since 2009.
Moreover, the suicide rate has increased among all races and ethnicities since 2009, increasing the most among the American Indian/Alaska Native population (41%) and Black population (36%).
The number of mental health providers per 100,000 population increased 9% between 2019 and 2020 (247.4 to 268.6 per 100,000 population), and 23% since the measure was added to the report in 2017 (218.0 to 268.6 per 100,000 population). The number of mental health providers increased in every state; highlights include major gains in Alaska, which added 93.9 providers per 100,000 population, Oregon (up 48.7 per 100,000) and Washington (up 40.5 per 100,000).

Sparking Action to Build Healthier Communities Beyond the COVID-19 Pandemic

The America’s Health Rankings Annual Report paints a picture of the Nation’s ongoing public health successes and challenges, but also provides a deeper understanding of the health of the Nation at the outset of the global COVID-19 pandemic.
The United Health Foundation and the American Public Health Association hope this report not only sparks meaningful conversations among policy-makers, health officials and community leaders about the challenges Americans face when it comes to their health, but also inspires proactive solutions about effective ways to improve the health of everyone in our communities.
As we head into the next decade, we encourage communities to engage with one another in meaningful dialogue about the findings of this report, especially by exploring local solutions to community challenges. We also hope public health leaders and experts will leverage the data included in this report to enhance and broaden the understanding of the current state of health in the Country as we navigate the evolving pandemic.

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