Executive HighlightsIntroductionKey FindingsSocial and Economic FactorsPhysical EnvironmentClinical CareBehaviorsHealth OutcomesInternational ComparisonState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS SummaryAppendixMeasures TableData Source DescriptionsThe Team
Before the COVID-19 pandemic, food insecurity and unemployment decreased, while per capita income rose.
Definition: Percentage of households unable to provide adequate food for one or more household members due to lack of resources.
Food insecurity has broad effects on health due to the related mental and physical stress. The health-related costs attributed to hunger were conservatively estimated at $160 billion in 2014. A Centers for Disease Control and Prevention (CDC) study found that food-insecure adults had, on average, annual health care expenditures $1,834 higher than food-secure adults.
The percentage of households that were food insecure decreased 20% between 2011-2013 and 2016-2018, from 14.6% to 11.7% of households (Figure 2). During this time, food insecurity among households declined significantly in 12 states, led by Hawaii (12.9% to 8.0%), Colorado (13.9% to 9.1%) and Idaho (15.1% to 9.8%) (Figure 3).
Economic hardship index
Definition: Compares the economic condition of one state relative to another based on crowded housing, dependency, education, income, poverty and unemployment; normalized index scores range from 0 to 100, with a higher score indicating worse economic conditions.
Combining the six population-level social and economic measures provides a more complete picture of the difficulties faced in a community than a single measure could provide. A higher score on the economic hardship index is associated with lower life expectancy. Low income causes chronic stress that contributes to poor health through decreased life expectancy, educational attainment and social mobility as well as increased mental illness, obesity, infant mortality, teenage births, homicides and imprisonment.
To view the economic hardship index measures by state, go to Explore Health Topics.
Per capita income
Definition: Per capita income in the past 12 months, in inflation-adjusted dollars to data year.
Income impacts a household’s ability to support a healthy lifestyle with quality food, housing, education, preventive medicine and curative care. Individuals with a low household income tend to have a higher prevalence of diseases and die earlier compared with people with higher household incomes. There is increased stress associated with being in the lower end of the income spectrum, which is associated with unhealthy behaviors and outcomes.
Between 2017 and 2019, per capita income, one of the six components of the new economic hardship index measure, increased 10% from $32,397 to $35,672 (Figure 4). During this time, it also increased 13% among Hispanic ($19,537 to $22,002), 11% among Black ($22,175 to $24,509) and 10% among white residents ($38,437 to $42,106) (Figure 5). Between 2018 and 2019, significant increases occurred in 39 states and the District of Columbia (Figure 6). Delaware had the largest increase of 9% from $33,745 to $36,858.
Per capita income varies across states and by race and ethnicity. In 2019, per capita income was highest in Massachusetts ($46,241), followed by Connecticut ($45,359) and New Jersey ($44,888). It was lowest in Mississippi at $25,301, followed by Arkansas ($27,274) and West Virginia ($27,446). White residents had the highest per capita income at $42,106, followed by Black residents ($24,509) and Hispanic residents ($22,002).
Definition: Percentage of civilian population ages 16-64 that are unemployed.
There is a strong relationship between employment status and mental and physical health. A stable, safe and well-paying job makes it easier for people to live in healthier neighborhoods, provide quality child care and education for their families, afford nutritious food and access medical care — all critical factors to maintaining good health. Unemployment is associated with a higher risk of all-cause mortality, especially among adults ages 18-24.
Unemployment, another component of the new economic hardship index measure, declined 15% between 2017 and 2019, from 5.4% to 4.6% (Figure 7). During the same timeframe, it decreased 18% among Black (9.6% to 7.9%), 16% among Hispanic (6.1% to 5.1%) and 12% among white (4.3% to 3.8%) civilians (Figure 8).
Unemployment varies across states and by race and ethnicity. In 2019, the unemployment rate was highest in Mississippi (6.8%), West Virginia (6.2%) and Alaska (5.8%), and lowest in North Dakota (2.8%) and New Hampshire (3.0%). The unemployment rate was highest among Black (7.9%) and Hispanic (5.1%) civilians. White civilians had the lowest rate at 3.8%.
High school graduation and racial gap
High school graduation rates improved and progress was made in reducing the racial gap.
High school graduation: Percentage of high school students who graduated with a regular high school diploma within four years of starting ninth grade.
High school graduation racial gap: Difference in the high school graduation rate between white students and the racial/ethnic group with the lowest rate (varies by state).
Educational attainment is a strong predictor of future health outcomes according to Healthy People. The connection between education and health is well documented, with lower educational attainment among adults having a high correlation with poorer health. Higher educational attainment is associated with better jobs, higher earnings, increased health knowledge, better self-reported health and fewer chronic conditions. Individuals with lower educational attainment are at a greater risk of adverse health outcomes such as obesity, cardiovascular disease, lung disease, mental health problems and premature death.
Between 2011 and 2018, high school graduation increased 8%, from 79.0% to 85.3% (Figure 9). Over this time period, four states improved 20% or more (Figure 10): Nevada (34% from 62.0% to 83.2%), Alabama (25% from 72.0% to 90.0%), Florida (22% from 71.0% to 86.3%) and Georgia (22% from 67.0% to 81.6%). Between 2012 and 2018, high school graduation increased among all racial and ethnic groups (Figure 11). It increased most among Black (14% from 69.0% to 79.0%), Hispanic (11% from 73.0% to 81.0%) and American Indian/Alaska Native (10% from 67.0% to 73.5%) students.
High school graduation varies across states and by race and ethnicity. In 2018, the graduation rate was highest in Iowa (91.4%), New Jersey (90.9%) and Kentucky (90.3%), and lowest in New Mexico (73.9%) and Alaska (78.5%). Also, in 2018 Asian/Pacific Islander (92.2%) students had the highest rate of high school graduation, followed by white (89.1%), Hispanic (81.0%), Black (79.0%) and American Indian/Alaska Native (73.5%) students.
In 2018, the high school graduation racial gap — the difference in graduation rates between American Indian/Alaska Native students and white students — was 15.6 percentage points, a 4% decline since 2017, from 16.2 percentage points. The racial gap was 10.2 times higher in South Dakota at 39.9 percentage points between American Indian/Alaska Native (50.0%) and white (89.9%) students than in Alabama at 3.9 percentage points between Black (87.7%) and white (91.5%) students (Figure 12).
Households with high-speed internet rose, essential for work and school engagement during the COVID-19 pandemic.
Definition: Percentage of households that have a broadband internet subscription and a computer, smartphone or tablet.
High-speed internet is an important resource for work, education and effective communication. Access to the internet is a basic human right according to the United Nations, citing its value for social and economic development. It is especially crucial during the COVID-19 pandemic as many employers and educators transition to remote work and learning. Moreover, according to the CDC, having high-speed internet is vital for receiving health care via telehealth, which is becoming increasingly common during the COVID-19 pandemic.
The percentage of households that report having high-speed internet and a computer, smartphone or tablet increased 14% between 2013 and 2018, from 77.7% to 88.3% of households (Figure 13). Since 2017, households with high-speed internet increased significantly nationally by 1% and in 31 states and the District of Columbia (Figure 14). The largest improvements occurred in Arkansas (77.1% to 80.8%) and the District of Columbia (84.1% to 88.3%), both improving 5% between 2017 and 2018.
High-speed internet varies across states and by race and ethnicity. In 2018, the percentage of households with high-speed internet was highest in Utah (92.9%), Washington (92.6%) and New Hampshire (92.4%), and lowest in New Mexico (79.4%), Mississippi (80.6%) and Arkansas (80.8%). In the same year, Asian households had the highest prevalence at 94.3%, significantly higher than all other racial and ethnic groups (Figure 15). American/Indian Alaska Native households had the lowest percentage at 76.0%.