Executive Brief

“What makes America’s Health Rankings especially valuable is its ability to turn complex data into clear, actionable insights to help leaders move between evidence and impact.”
– Jonathan Fielding, MD, Distinguished Professor of Health Policy and Management, UCLA Fielding School of Public Health; Distinguished Professor of Pediatrics, David Geffen School of Medicine at UCLA

“As we reflect on the findings in this year’s Annual Report, we must rededicate ourselves to improving health care in this country and creating a healthier nation for all.”
– Margaret-Mary Wilson, MD, Executive Vice President & Chief Medical Officer, UnitedHealth Group

Users can explore population data by metropolitan status for a variety of measures by looking for this icon throughout the Executive Brief, comprehensive 2025 Annual Report and State Summaries.

Premature death decreased 8% between 2022 and 2023, from 8,522 to 7,862 years lost before age 75 per 100,000 population, after rising sharply amid the COVID-19 pandemic in 2020 and 2021. This included significant improvements across 44 states, led by reductions of 13% in Maine (9,327 to 8,082) and 12% in both South Dakota (9,120 to 8,047) and West Virginia (13,647 to 12,053). In 2023, the top five leading causes of premature death

— unintentional injury, cancer, heart disease, suicide and homicide — were largely consistent with the year prior. Homicide replaced COVID-19 in the top five, after previously being the sixth-leading cause of premature death.

During the same time period, the drug death rate decreased 3%, from 32.4 to 31.4 deaths per 100,000 population. The recent improvement represents roughly 2,900 fewer deaths nationwide and marks a meaningful reversal after years of steady increases; this is the first national improvement since 2018. However, the drug death rate, which Healthy People 2030 considers a leading health indicator for the U.S., remains far above the goal to reduce the rate to 20.7 deaths per 100,000 population

. Nationwide, drug deaths have risen steeply over the past two decades, increasing

more than 500% between 1999 and 2022 to become a leading cause of injury-related death.

• Frequent mental distress — the percentage of adults who reported their mental health was not good 14 or more days in the past 30 days — remained stable (15.4% to 15.6%) between 2023 and 2024. This comes after a 33% increase since 2011.
• Depression also remained steady between 2023 and 2024, at 22.0% of adults. Differences by gender persisted, as rates of depression were 1.7 times higher among women (26.5%) compared with men (15.4%).
• The suicide rate remained relatively unchanged between 2022 and 2023 (14.8 to 14.7 deaths due to intentional self-harm per 100,000 population), after increasing 23% since 2009 (12.0). This rate remains higher than the Healthy People 2030 target to reduce the rate to 12.8 deaths per 100,000 population
  
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• Non-medical drug use — including misuse of pain relievers, stimulants, and sedatives or illicit drugs — did not change significantly between 2024 and 2025 (17.6% to 16.8%), after rising 49% since 2019 (11.3%). Still, almost 44.2 million adults nationwide reported drug use in 2025.

Cancer screenings increased 15% between 2022 and 2024, from 56.0% to 64.5% of adults who received recommended colorectal and/or breast cancer screenings. There were significant improvements in 47 states and Washington, D.C. Racial/ethnic differences persisted: Cancer screening prevalence was 1.3 times higher among white (67.7%) and Black (67.4%) adults compared with Hispanic (52.8%) adults. Preventive screenings

can help improve outcomes by detecting cancers early, when there are more treatment options.

During this time, colorectal cancer screening increased 15%, from 61.8% to 71.1% of adults ages 45-75, and breast cancer screening increased 3% nationwide, from 72.1% to 74.5% of women ages 40-74. However, both remained below the Healthy People 2030 goals of 72.8% of adults ages 45-75 years

and 80.3% of females ages 50 to 74 years

, respectively. 

Both colorectal and breast cancer screenings remained below the Healthy People 2030 goals.

Physical inactivity reached its healthiest level since 1996, the earliest year for which America’s Health Rankings has data on this measure. Between 2023 and 2024, the percentage of adults reporting no physical activity outside of work decreased 10%, from 24.2% to 21.8%, meeting the Healthy People 2030 goal of 21.8% of adults

. Nineteen states recorded improvements, led by Minnesota with a 23% decrease in physical inactivity, from 22.8% to 17.5%. Regular physical activity

benefits people of all ages and can help prevent chronic conditions and mortality.

Between 2023 and 2024, the percentage of adults who had three or more chronic health conditions — including arthritis, asthma, cancer, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease (COPD), depression or diabetes — increased 6%, from 10.7% to 11.3% of adults. The more chronic conditions an individual has, the higher their risk

for physical, social and cognitive limitations, as well as mortality.

Obesity, a risk factor for other serious health conditions, stabilized at 34.2%, showing no meaningful change between 2023 and 2024. This plateau comes after a 23% increase between 2011 and 2023, from 27.8% to 34.3% of adults.

Notable improvements were made among adults living in rural areas, but differences in cancer screenings and physical inactivity persist compared with metropolitan peers

Between 2023 and 2024, cigarette smoking decreased 4% from 12.1% to 11.6% of adults. Smoking decreased 10% among adults ages 18-44 (11.1% to 10.0%) — the only age group that saw significant improvement. These reductions are encouraging, as cigarette smoking

remains the leading cause of preventable disease and death in the United States, responsible for more than 480,000 deaths each year. However, the overall prevalence remains above the Healthy People 2030 goal of reducing cigarette smoking to 6.1% of adults

.

Smoking prevalence decreased in two states: 16% in Minnesota (12.2% to 10.2%) and 12% in Washington (9.0% to 7.9%).

However, during the same period, e-cigarette use — including use of other electronic vaping products — increased 4%, from 7.7% to 8.0% of adults. E-cigarette use increased significantly in two states: 41% in Wyoming, from 7.6% to 10.7% of adults, and 26% in Wisconsin, from 6.6% to 8.3%. Increasing e-cigarette use

, particularly among young adults, raises concern about long-term health impacts and nicotine dependence.

Both cigarette smoking and e-cigarette use were more prevalent among adults in rural communities. Smoking was 1.5 times higher among rural (15.5%) compared with metropolitan (10.1%) adults and e-cigarette use was 1.2 times higher among rural (9.1%) compared with metropolitan (7.4%) adults.

Between 2021 and 2023, volunteerism increased 22%, from 23.2% to 28.3% of the population age 16 and older. Participation rose equally among both females (25.3% to 30.9%) and males (21.0% to 25.6%). Volunteerism

is strongly associated with improved well-being, as well as lower rates of high blood pressure, obesity and depression.

However, homelessness increased 16% between 2023 and 2024, from 19.4 to 22.6 people per 10,000 population, underscoring the challenges many communities face in addressing economic and social difficulties

. Thirteen states saw increases in homelessness of 16% or higher, with the largest being 114% in Illinois from 9.5 to 20.3. During the same time period, there was a national uptick in unemployment, which increased 7% from 4.3% to 4.6% of civilian workers ages 16-64.

“The data contained in this report provide a clear roadmap, helping public health leaders identify what’s working, where progress is needed and how to transform insight into measurable and meaningful improvement.”

– Joseph Kanter, MD, MPH, CEO, Association of State and Territorial Health Officials