Which States Have the Best and Worst Health Rankings in 2011?

The 22nd annual America’s Health Rankings® report was released on December 5, 2011, grading and ranking the 50 U.S. states in terms of the level of their overall health and health care, determined by 23 objective measurements.

The annual America’s Health Rankings® report is funded by the United Health Foundation, a non-profit organization, and is prepared by a Scientific Advisory Committee of the United Health Foundation, in concert with the American Public Health Association (APHA) and Partnership for Prevention, commissioned the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill.

In the America’s Health Rankings® a panel of leading public health scholars, evaluates and grades the overall health of each state based on objective data measuring 23 different factors that indicate both health “determinants” (actions or conditions that affect the future health of the population) and health “outcomes” in each state.

As explained by the United Health Foundation, “America’s Health Rankings® employs a unique methodology, developed and periodically reviewed by a panel of leading public health scholars, which balances the contributions of various factors, such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care and incidence of preventable disease, to a state’s health.”

The Top Ten Best States: According to the 2011 America’s Health Rankings®, here are the Top Ten Best States for health, in the order of their rankings:

  1. Vermont
  2. New Hampshire
  3. Connecticut
  4. Hawaii
  5. Massachusetts
  6. Minnesota
  7. Utah
  8. Maine
  9. Colorado
  10. Rhode Island

The Bottom Ten, Worst States: The Bottom Ten, Worst States for health, in order or their rankings (with # 50 being the worst), are:

  • # 41. West Virginia
  • # 42. Nevada
  • # 43. Kentucky
  • # 44. Texas
  • # 45. South Carolina
  • # 46. Alabama
  • # 47. Arkansas
  • # 48. Oklahoma
  • # 49. Louisiana
  • # 50. Mississippi

A full PDF copy of the 2011 America’s Health Rankings® report, along with an interactive map providing data for each state can be found at: AmericasHealthRankings.org/Rankings

A complete list of the 50 states’ scores and rankings, both in order of the rankings and alphabetically by state, is found at: AmericasHealthRankings.org/mediacenter/mediacenter2.aspx

The Measures

According to the report, the 23 weighted measures of overall health by which the states were graded are divided into indicators of health “determinants” and indicators of health “outcomes,” as follows:

  • Health Determinants: Indicators of actions or conditions that can affect the future health of the population, such as,
    • Behaviors: for example, extent of smoking, binge drinking, and obesity among the population — behaviors which, according to the authors of the report “are modifiable with effort by the individual supported by community, policy and clinical interventions,” and can affect the future health of the population;
    • Community and Environmental Conditions: factors which have a positive or negative impact upon health, including extent of High School Graduation (positive factor), Violent Crime (negative factor), Occupational Fatalities (negative factor), Infectious Disease (negative factor), Children in Poverty (negative factor) and Air Pollution (negative factor);
    • Public and Health Policies: public and health policies and practices of our health care and prevention systems which positively or negatively impact the health resources available and consequently health, including Lack of Health Insurance (negative factor), Public Health Funding (positive factor), and Immunization Coverage (positive factor); and
    • Clinical Care: factors which affect and reflect the quality, appropriateness and cost of the care we receive at doctors’ offices, clinics and hospitals. The health determinants among these factors include extent of Early Prenatal Care (positive factor), Primary Care Physicians (positive factor), and Geographic Disparity (negative factor). Other Clinical Care Factors include health “outcomes” measures, referenced below.

  • Health Outcomes: Indicators of health results that have already occurred, which measure the overall level of health in the state, such as extent of death, disease, missed days due to illness, or hospitalizations for preventable conditions. The specific health Outcomes measures used in the report included: extent of Preventable Hospitalizations (negative factor), Diabetes (negative factor), Poor Mental Health Days (negative factor), Poor Physical Health Days (negative factor), Infant Mortality (negative factor), Cardiovascular Deaths (negative factor), Cancer Deaths (negative factor), and Premature Death (negative factor).

The rankings are based on data from the U.S. Departments of Health and Human Services, Commerce, Education and Labor; U.S. Environmental Protection Agency; the American Medical Association; the Dartmouth Atlas Project; and the Trust for America’s Health.

Changes, Successes and Challenges – Measured over 22 Years

The 2011 America’s Health Rankings® report summarized findings as to the changes found over the 22 years this report has been prepared, grouped in terms of Successes and Challenges, as follows:


Smoking: The prevalence of smoking decreased 41 percent from 29.5 percent in the 1990 Edition to 17.3 percent of the adult population in the current edition. Smoking dropped from 17.9 percent to 17.3 percent in the last year, continuing a gradual decline over the past eight years.

Violent Crime: The violent crime rate declined 34 percent from 609 offenses in the 1990 Edition to 404 offenses per 100,000 population in the 2011 Edition. Violent crime dropped by 25 offenses per 100,000 population in the last year.

Preventable Hospitalizations: Preventable hospitalizations continue a 10-year decline. In the 2001 Edition, there were 82.5 discharges; in this edition, there were 68.2 discharges per 1,000 Medicare enrollees.

Occupational Fatalities: Occupational fatalities have declined slightly in the last five years from 5.3 deaths in the 2007 Edition to 4.0 deaths per 100,000 workers in the 2011 Edition. Rates are the lowest in 22 years.

Air Pollution: The average amount of fine particulate in the air continues to decline from 13.2 micrograms in the 2003 Edition to 10.8 micrograms per cubic meter in 2011.

Infectious Disease: Infectious disease has dropped from 19.7 cases in the 1998 Edition to 10.3 cases per 100,000 population in the 2011 Edition. However, the incidence is above the rate of 9.0 cases achieved in 2009 and 2010.

Infant Mortality: The infant mortality rate decreased 33 percent from 10.2 deaths in the 1990 Edition to 6.7 deaths per 1,000 live births in 2011. Improvements have slowed dramatically in the last 10 years as compared to the 1990s.

Premature Death: Years of potential life lost before age 75 per 100,000 population declined 16 percent from 8,716 in the1990 Edition to 7,279 years of potential life lost before age 75 per 100,000 population in 2011. Premature deaths, like several other metrics, have leveled off in the last decade compared to gains in the 1990s.


Obesity: The prevalence of obesity increased 137 percent from 11.6 percent in the 1990 Edition to 27.5 percent of the population in the 2011 Edition.

Diabetes: Diabetes has almost doubled in prevalence since the 1996 Edition, rising from 4.4 percent to 8.7 percent of the adult population. This continued 0.3 percent annual increase does not show signs of abating in the near term.

Children in Poverty: The percentage of children in poverty has increased for the last four editions and, at 21.5 percent of persons under age 18, is approaching the 22-year historical high of 22.7 percent in the 1994 Edition. This is far above the 22-year low of 15.8 percent in the 2002 Edition.

Lack of Health Insurance: The rate of uninsured population has increased 17 percent from 13.9 percent in the 2001
Edition to 16.2 percent in 2011. The rate of uninsured population has slowly but steadily increased during the last 10 years.

Binge Drinking: The percent of adults who report binge drinking remains above 15 percent of the population.

High School Graduation Rate: Over the last seven years, the high school graduation rate remains locked in the range of 73 percent to 75 percent of incoming ninth graders who graduate in four years.”

International Comparisons

The 2011 America’s Health Rankings® also highlights some disappointing facts about America’s rank among nations in the world in terms of our health and health care.

The report points out that according to the annual World Health Statistics 2011 report of the World Health Organization, which compares the United States to the nations of the world on a large variety of measures, the U.S. lags behind other developed countries both in terms of life expectancy and in rate of infant mortality.

According to the report, “With a life expectancy of 81 years for women, the United States is 32nd among the 193 reporting nations of the World Health Organization and at 76 years for men, the United States is 34th among nations.” Japan leads other nations, with a life expectancy for 86 years for females and 80 years for males.

In addition, the report points out, “The infant mortality rate for the U.S. in 2009 was seven deaths per 1,000 live births, ranking the United States 43rd among WHO nations. Rates for Sweden, Spain, Italy, Germany, France, Czech Republic, Slovenia and Iceland are all half of the United States rate.”

In addition the rate of improvement in effectiveness of treating diseases amenable to care has been “much slower [in the U.S.] than in other Organization for Economic Cooperation and Development (OECD) nations studied,” according to the report. “This study estimated that if the United States achieved rates on par with comparative counties, between 59,500 and 84,300 deaths before age 75 would have been saved,” the authors wrote.

Yet, despite our disappointing international ranking in health, in the U.S. we spend more on health care than in any other country of the world. “Per capita healthcare spending in the United States continues to lead the world. The median expenditure among OECD countries is $2,995 per person; in the United States, it is $7,538 per person,” the authors reported.

In conclusion, the authors of the 2011 America’s Health Rankings® report, stated: “The results of these studies should be a wake-up call to everyone in the United States to strive to improve all aspects of our health system however possible, including education, safety, prevention and clinical care. Other countries have improved their overall health, indicating that we too can do the same.”

More Information

A complete PDF copy of the 2011 America’s Health Rankings® report is found on the AmericasHealthRankings.org website maintained by the United Health Care Foundation.

A 3D interactive map, displaying the findings state by state is also found on AmericasHealthRankings.org.

See also the previous HelpingYouCare™ reports on:

Which State Provides the Best Health Care?

National Prevention Strategy Released June 16 Under Affordable Care Act

Under Affordable Care Act, Preventive Services Now Free to Medicare Beneficiaries

HHS Announces Comprehensive Primary Care Initiative to Reward Better Coordination of Care

Medicare’s Free Annual Wellness Visits

And, see the HelpingYouCare™ resource pages on VoicesForCare™, including:


Copyright © 2011 Care-Help LLC, publisher of HelpingYouCare™.


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