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For 31 years, America’s Health Rankings® has created widespread awareness of where states and the nation stand on important public health measures by providing the longest running state-by-state analysis of the nation’s health. 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.
Over the past three decades, the model and measures used in the report have evolved as our understanding of health and its root causes has advanced. Using an updated model (Figure 1), this year’s Annual Report examines the impact that social, economic and environmental factors have on overall health.
Changes to the model reflect the state of population health literature and ongoing review by the America’s Health Rankings Advisory Council. Changes include:
  • Addition of two new categories, social and economic factors plus physical environment.
  • Creation of disparity measures such as low birthweight racial gap and premature death racial inequality.
  • Enhanced topic, subpopulation and sub-component data.
  • Addition of a variety of new data sources.
The 2020 Annual Report finds measured progress on key health markers including the prevalence of multiple chronic conditions, driven largely by improvements in the prevalence of cardiovascular disease. However, the prevalence of obesity continues 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.
We acknowledge the devastating impact of COVID-19 in our communities. Out of the shared understanding that the country is facing significant and unprecedented health challenges due to the pandemic, America’s Health Rankings has chosen not to include a state’s overall ranking in this year’s report. Measure-specific rankings are included, as well as model-category rankings. Measure-specific rankings are still comparable over time; however, model category rankings are no longer comparable with prior editions due to the number of advancements in the 2020 edition.
Additionally, to reduce confusion about data timing given the impact of the COVID-19 pandemic, this year’s report shifted to referring to data based on the year they were collected, rather than the edition of the report that the data were published in. This change allows readers to determine which measures were collected before the COVID-19 pandemic and which measures were collected in 2020. We believe this approach will clarify what delays are present in the data to ensure that public health and community leaders have the most accurate picture of the health of their communities. We expect to start seeing the impact of the COVID-19 pandemic across numerous health measures in the 2021 report.
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 Annual Report 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.
As in previous years, the report provides a unique opportunity to track short- and long-term public health successes as well as identify current and emerging challenges at state and national levels. We recognize that every state has strengths and challenges. It is important to consider all the measures in the report, as each measure does not stand alone but rather influences and is influenced by other measures of health and everyday life.


America’s Health Rankings’ purpose is to inform and drive action to build healthier communities by offering credible, trusted data for improving health and health care. To achieve this, comprehensive data are necessary. The report uses a wealth of reputable data sources to produce key health-related measures across categories of health determinants and health outcomes. The report includes:
To improve population health, the America’s Health Rankings Annual Report:
  • Provides a benchmark for states. Each year the report presents trends, strengths, challenges and highlights of every state. With America’s Health Rankings Annual Report’s three decades of data, individuals can continue to monitor health trends over time and compare their state with neighboring states and the nation.
  • Stimulates action. The report is intended to drive change and improve health by promoting data-driven discussions among individuals, community leaders, the media, policymakers and public health officials. States can incorporate the report into their annual review of programs, and many organizations use the report as a reference when assigning goals for health-improvement plans.
  • Highlight disparities. The report shows differences in health between states and among population groups at the state and national level, including gender, age, education, income as well as race and ethnicity groups.

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