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SOCIAL AND ECONOMIC FACTORS

Community and Family Safety

Occupational Fatalities
Number of fatal occupational injuries in construction, manufacturing, trade, transportation, utilities as well as professional and business services per 100,000 workers
Census of Fatal Occupational Injuries, 2017-2019
Public Health Funding
State dollars dedicated to public health and federal dollars directed to states per person by the Centers for Disease Control and Prevention and the Health Resources & Services Administration
CDC, HRSA and Trust for America’s Health, 2019-2020
Violent Crime‡
Number of murders, rapes, robberies and aggravated assaults per 100,000 population
Uniform Crime Reporting Program, 2019

Economic Resources

Economic Hardship Index‡ **
Comparison of state economic conditions based on crowded housing, dependency, education, income, poverty and unemployment; normalized index scores are 0 to 100, with a higher score indicating worse economic conditions
American Community Survey, 2019
Food Insecurity
Percentage of households unable to provide adequate food for one or more household members due to lack of resources
USDA, Household Food Security in the United States Report, 2018-2020
Homeownership*
Percentage of housing units owned by the occupant
American Community Survey, 2019
Homeownership Racial Disparity*
Difference in the homeownership rate between the non-Hispanic white population and the racial/ethnic population with the lowest rate (varies by state)
American Community Survey, 2019
Income Inequality‡
Ratio of median household income at the 80th percentile to median household income at the 20th percentile
American Community Survey, 2019

Education

Fourth Grade Reading Proficiency*
Percentage of fourth grade public school students who scored proficient or above on the National Assessment of Educational Progress assessment in reading comprehension
U.S. Department of Education, National Assessment of Educational Progress, 2019
High School Graduation
Percentage of high school students graduating with a regular high school diploma within four years of starting ninth grade
U.S. Department of Education, Common Core of Data, 2019
High School Graduation Racial Disparity
Difference in the high school graduation rate between non-Hispanic white students and the racial/ethnic group with the lowest rate (varies by state)
U.S. Department of Education, Common Core of Data, 2019

Social Support and Engagement

Adverse Childhood Experiences
Percentage of children ages 0-17 who experienced two or more of the following: parental divorce or separation; living with someone who had an alcohol or a drug problem; neighborhood violence victim or witness; living with someone who was mentally ill, suicidal or severely depressed; domestic violence witness; parent served jail time; being treated or judged unfairly due to race/ethnicity; or death of a parent
National Survey of Children's Health, 2019-2020
High-speed Internet
Percentage of households with a broadband internet subscription and a computer, smartphone or tablet
American Community Survey, 2019
Residential Segregation
Index of dissimilarity with higher values indicating greater segregation between Black and white residents, ranging from zero (complete integration) to 100 (complete segregation)
American Community Survey, 2015-2019
Volunteerism
Percentage of population ages 16 and older who reported volunteering in the past 12 months
CPS, Volunteering and Civic Life Supplement, 2019
Voter Participation
Average of the percentage of U.S. citizens ages 18 and older who voted in the last presidential and the last midterm national elections
CPS, Voting and Registration Supplement, 2018/2020

PHYSICAL ENVIRONMENT

Air and Water Quality

Air Pollution
Average exposure of the general public to particulate matter of 2.5 microns or less measured in micrograms per cubic meter
EPA, 2018-2020
Drinking Water Violations
Percentage of population served by community water systems with a serious drinking water violation during the year
EPA, Safe Drinking Water Information System, 2021
Non-smoking Regulation*
Percentage of population covered by 100% smokefree laws for restaurants, bars and non-hospitality workplaces
American Nonsmokers' Rights Foundation, 2021
Risk-screening Environmental Indicator Score
Estimated human health-related risk from exposure to toxic chemicals based on emission data of more than 600 chemicals, with higher scores denoting elevated risk
EPA, Toxic Release Inventory, 2019
Water Fluoridation‡
Percentage of population served by community water systems that have fluoridated water
Water Fluoridation Reporting System, 2018

Climate Change

Climate Change Policies*
Number of the following state policies in place: legally binding electricity portfolio standards, carbon pricing policies, climate change action plans and economy-wide greenhouse gas emission targets
Center for Climate and Energy Solutions, 2020
Transportation Energy Use*
Amount of energy consumed by the transportation of people and goods per 100,000 population
State Energy Data System, 2019

Housing and Transit

Drive Alone to Work‡
Percentage of workers ages 16 and older who drove alone to work
American Community Survey, 2019
Housing With Lead Risk‡
Percentage of housing stock with potential elevated lead risk due to age of housing
American Community Survey, 2019
Severe Housing Problems
Percentage of occupied housing units with at least one of the following problems: lack of complete kitchen facilities, lack of plumbing facilities, overcrowding or severely cost-burdened occupants
Comprehensive Housing Affordability Strategy, 2014-2018

CLINICAL CARE

Access to Care

Avoided Care Due to Cost
Percentage of adults who reported a time in the past 12 months when they needed to see a doctor but could not receive it because of cost
Behavioral Risk Factor Surveillance System, 2020

Providers

Dental Care Providers
Number of general dentists and advanced practice dental therapists per 100,000 population
National Plan and Provider Enumeration System, September 2021
Mental Health Providers
Number of psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, advanced practice nurses specializing in mental health care as well as those treating alcohol and other drug abuse per 100,000 population
National Plan and Provider Enumeration System, September 2021
Primary Care Providers
Number of active primary care providers (including general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics, internal medicine, physician assistants and nurse practitioners) per 100,000 population
National Plan and Provider Enumeration System, September 2021
Uninsured‡
Percentage of population not covered by private or public health insurance
American Community Survey, 2019

Preventive Clinical Services

Colorectal Cancer Screening
Percentage of adults ages 50-75 who reported receiving one or more of the recommended colorectal cancer screening tests within the recommended time interval (blood stool test within the past year, sigmoidoscopy within the past five years, colonoscopy within the past 10 years, stool DNA test within the past three years, virtual colonoscopy within the past five years or sigmoidoscopy within the past 10 years and blood stool test in the past year)
Behavioral Risk Factor Surveillance System, 2020
Dental Visit
Percentage of adults who reported visiting a dentist or dental clinic within the past year
Behavioral Risk Factor Surveillance System, 2020

Immunizations

Childhood Immunizations
Percentage of children who received by age 35 months all recommended doses of the combined seven-vaccine series: diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine; measles, mumps and rubella (MMR) vaccine; poliovirus vaccine; Haemophilus influenzae type b (Hib) vaccine; hepatitis B (HepB) vaccine; varicella vaccine; and pneumococcal conjugate vaccine (PCV)
National Immunization Survey-Child (Birth Cohort), 2017-2018
Flu Vaccination
Percentage of adults who reported receiving a seasonal flu vaccine in the past 12 months
Behavioral Risk Factor Surveillance System, 2020
HPV Vaccination
Percentage of adolescents ages 13-17 who received all recommended doses of the human papillomavirus (HPV) vaccine
National Immunization Survey-Teen, 2020

Quality of Care

Dedicated Health Care Provider
Percentage of adults who reported having a personal doctor or health care provider
Behavioral Risk Factor Surveillance System, 2020
Preventable Hospitalizations
Discharges following hospitalization for diabetes with short- or long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease, angina without a procedure, asthma, hypertension, heart failure, dehydration, bacterial pneumonia or urinary tract infection per 100,000 Medicare beneficiaries ages 18 and older continuously enrolled in Medicare fee-for-service Part A
Mapping Medicare Disparities Tool, 2019

BEHAVIORS

Nutrition and Physical Activity

Exercise‡
Percentage of adults who met the federal physical activity guidelines (150 minutes of moderate or 75 minutes of vigorous aerobic activity and two days of muscle strengthening per week) in the past 30 days
Behavioral Risk Factor Surveillance System, 2019
Fruit and Vegetable Consumption‡
Percentage of adults who reported consuming two or more fruits and three or more vegetables daily
Behavioral Risk Factor Surveillance System, 2019
Physical Inactivity
Percentage of adults who reported doing no physical activity or exercise other than their regular job in the past 30 days
Behavioral Risk Factor Surveillance System, 2020

Sexual Health

Chlamydia
Number of new cases of chlamydia per 100,000 population
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas, 2019
High-risk HIV Behaviors
Percentage of adults who reported any of the following in the past year: injected any drug other than those prescribed for you, been treated for a sexually transmitted disease or STD, or given or received money or drugs in exchange for sex
Behavioral Risk Factor Surveillance System, 2020
Teen Births
Births per 1,000 females ages 15-19
CDC WONDER, Natality Public Use Files, 2019

Sleep Health

Insufficient Sleep
Percentage of adults who reported sleeping, on average, fewer than seven hours in a 24-hour period
Behavioral Risk Factor Surveillance System, 2020

Smoking and Tobacco Use

E-cigarette Use*
Percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days
Behavioral Risk Factor Surveillance System, 2020
Smoking
Percentage of adults who reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days
Behavioral Risk Factor Surveillance System, 2020

Behavioral Health

Depression*
Percentage of adults who reported being told by a health professional that they have a depressive disorder including depression, major depression, minor depression or dysthymia
Behavioral Risk Factor Surveillance System, 2020
Drug Deaths*
Deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 population
CDC WONDER, Multiple Cause of Death Files, 2019
Excessive Drinking
Percentage of adults who reported binge drinking (four or more [females] or five or more [males] drinks on one occasion in the past 30 days) or heavy drinking (eight or more [females] or 15 or more [males] drinks per week)
Behavioral Risk Factor Surveillance System, 2020
Frequent Mental Distress
Percentage of adults who reported their mental health was not good 14 or more days in the past 30 days
Behavioral Risk Factor Surveillance System, 2020
Non-medical Drug Use**
Percentage of adults who reported using prescription drugs non-medically (including pain relievers, stimulants, sedatives) or illicit drugs (excluding cannabis) in the last 12 months
Survey of Non-Medical Use of Prescription Drugs, 2021
Suicide*
Deaths due to intentional self-harm per 100,000 population
CDC WONDER, Multiple Cause of Death Files, 2019

Mortality

Premature Death
Years of potential life lost before age 75 per 100,000 population
CDC WONDER, Multiple Cause of Death Files, 2019
Premature Death Racial Disparity
Ratio of the racial/ethnic group with the highest premature death rate before age 75 (varies by state) to the non-Hispanic white population
CDC WONDER, Multiple Cause of Death Files, 2017-2019

Physical Health

Frequent Physical Distress
Percentage of adults who reported their physical health was not good 14 or more days in the past 30 days
Behavioral Risk Factor Surveillance System, 2020
High Health Status*
Percentage of adults who reported that their health was very good or excellent
Behavioral Risk Factor Surveillance System, 2020
Low Birthweight
Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth
CDC WONDER, Natality Public Use Files, 2019
Low Birthweight Racial Disparity
Ratio between low birthweight rates among births to mothers in the racial/ethnic group with the highest rate (varies by state) and births to non-Hispanic white mothers
CDC WONDER, Natality Public Use Files, 2019
Multiple Chronic Conditions**
Percentage of adults who had three or more of the following chronic health conditions: arthritis, asthma, chronic kidney disease, chronic obstructive pulmonary disease, cardiovascular disease (heart disease, heart attack or stroke), cancer (excluding skin), depression and diabetes
Behavioral Risk Factor Surveillance System, 2020

Risk Factors

High Blood Pressure*‡
Percentage of adults who reported being told by a health professional that they had high blood pressure
Behavioral Risk Factor Surveillance System, 2019
High Cholesterol*‡
Percentage of adults who reported having their cholesterol checked and being told by a health professional that it was high
Behavioral Risk Factor Surveillance System, 2019
Obesity
Percentage of adults with a body mass index of 30.0 or higher based on reported height and weight
Behavioral Risk Factor Surveillance System, 2020
Download the PDF for details

‡ Data in this edition were repeated from last edition.
* Not included in calculation of overall, category and topic composite measures. State-level data for these measures are available on the website only.
** Data for subcomponents are available at www.AmericasHealthRankings.org.

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