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America’s Health Rankings®provides a framework for identifying and measuring factors that impact population health. It offers decision-makers and advocates a way to understand their state’s health and compare it with that of other states and the nation overall.
The data and tools available on the platform allow leaders to assess changes over time and better understand where they can take action to address their states’ needs.
This analysis uses one state’s experience over time to illustrate how shifts in ranking can reflect long-term change across a range of health measures.
How America’s Health Rankings Measures Health
State rankings are based on the America’s Health Rankings model, developed under the guidance of its advisory council and committees. The model reflects a holistic understanding of health across five categories: Social and Economic Factors, Physical Environment, Behaviors, Clinical Care and Health Outcomes. Each category includes several measures that impact health. For example, cigarette smoking is a measure under Behaviors.
Maryland: State With the Largest Improvement Over Time
America’s Health Rankings has been analyzing the nation’s health on a state-by-state basis for decades. Since the first rankings in 1990, Maryland has risen more spots in overall rank than any other state, from No. 31 in 1990 to No. 8 in the 2025 Annual Report.
Over that time, Maryland has demonstrated meaningful improvements in two key measures of health: cigarette smoking and premature death. While this progress reflects broader nationwide trends, Maryland’s values improved in both, which contributes to its progress compared to other states.
nationwide. Since 1995, smoking in Maryland has decreased 63% (21.3% to 7.8%), and the state’s rank in that measure has improved nine spots, from No. 12 to No. 3.
Premature death measures years of potential life lost due to death before age 75, placing greater weight on deaths that occur within younger populations. It is a strong indicator of health of a community across diseases and illnesses, unintentional injuries like drug and motor vehicle deaths, and social and economic factors that shape health. The premature death rate in Maryland has decreased 7% since 1999 (8,164 to 7,594 years of potential life lost before age 75 per 100,000 population), with a 17-place improvement in rank (No. 37 to No. 20).
While these examples reflect real, absolute changes in health, rankings are relative measures of health; not all improvements in rankings reflect true improvements in health. For example, although the percentage of adults with three or more chronic conditions has worsened in Maryland since 2016 (8.4% to 10.0%), the state’s rank for the measure has improved from No. 13 to No. 12, as the nationwide rate has worsened (9.7% to 11.3%).
Core Measure Impact: How Measures Contribute to Overall Health and Ranking
The platform’s holistic model of health is built upon the World Health Organization definition: “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The model relies on a broad set of measures, yet recognizes that some measures are more important than others as public health indicators and consequently have a comparatively large impact on a state’s overall rank.
The America’s Health Rankings website allows users to explore the measures of health that contribute to a state’s ranking — in both positive and negative directions — relative to other states.
In addition to Health Outcomes, like premature death, and Behaviors, like cigarette smoking and e-cigarette use, Maryland’s overall health and ranking have been shaped by measures across the Social and Economic Factors, Physical Environment and Clinical Care categories. The state’s relatively healthy values of economic hardship index, childhood immunizations and excessive drinking positively contribute to its ranking, while its homicide rate has a negative impact.
Core measure impact can be viewed by navigating to Explore Data -> Choose Your State.
Adjust My Rank: How Changes Across Measures Could Impact Overall Ranking
The platform’s Adjust My Rank tool estimates how changes in select measures may affect a state’s ranking, which provides insights into how progress over time can help contribute to better overall health and well-being in a state.
For example, the tool estimates that Maryland’s rank could rise to No. 4 if several measures most negatively impacting the state’s health were to improve by the following amounts.*
Homicide: improving from a rate of 9.4 to 5.9 deaths per 100,000 population. In addition to the lives lost, homicide can have significant psychological implications on individuals and communities, and living in a community experiencing violence may limit engagement in healthy outdoor or neighborhood activities.
Insufficient sleep: improving from 38.0% to 34.7% of adults reporting sleeping less than seven hours on average. Insufficient sleep is a public health challenge that costs an estimated $411 billion annually in reduced productivity; sleep is critical for basic functions, and insufficient sleep is a risk factor for many chronic diseases.
Chlamydia: improving from 579.8 to 453.3 new cases of chlamydia per 100,000 population. Chlamydia is the most commonly reported sexually transmitted infection (STI) and can cause permanent damage if untreated.
Housing with lead risk: improvingfrom 16.3% to 9.5% of housing stock with potential elevated lead risk. Housing built before 1978 carries elevated risk of lead exposure; even low levels of lead can be detrimental to cognitive development in children.
To access the Adjust My Rank tool, navigate to a state’s page under Explore State Data.
Further Explore State Rankings
America’s Health Rankings reveals insights for leaders into how sustained improvements in key measures of health can contribute to overall well-being across states and over time. To further understand the factors currently influencing a state’s rank and how changes in performance relate to rankings, explore state data.
