In a disturbing development, the 2008 America™s Health Rankings„: A Call to Action for Individuals & Their Communities revealed that the health of Americans has failed to improve for the fourth consecutive year. Key factors contributing to these results included unprecedented levels of obesity, an increasing number of uninsured people, and the persistence of risky health behaviors, particularly tobacco use.

For 19 years, America™s Health Rankings„ has provided an annual analysis of national health on a state-by-state basis. The longest running report of its kind, America™s Health Rankings„ evaluates a historical and comprehensive set of health, environmental, and socio-economic data to determine national health benchmarks and an annual ranking of the healthiest and least healthy states. Despite the discouraging national story, some states are making significant strides against some of the country™s biggest health challenges ” demonstrating that there are workable solutions to the most prevalent health problems.

United States Comes to a Standstill in Efforts to Improve the Health of Americans

During the 1990s, health improved at an average rate of 1.5 percent per year, but improvements against national health measurements have remained flat for the last four years. Smoking, obesity, and the uninsured are the nation™s three most critical challenges.

Significant reductions in the prevalence of smoking have not occurred since the early 1990s and have virtually stalled in the last four years. According to the Centers for Disease Control (CDC), the adverse health effects from smoking account for an estimated one out of every five deaths each year in the United States.

The prevalence of obesity has more than doubled in the last 19 years. An alarming one in four Americans is currently considered obese putting them at increased risk for health issues such as heart disease, stroke, high blood pressure, Type 2 diabetes, and cancer (endometrial, breast, colon, and gallbladder).

Nearly 46 million Americans are currently uninsured, leaving them without adequate medical care for chronic conditions or preventive treatment that would help reduce future illnesses.

Our collective national failure to successfully address the determinants of health over the past several years is tragically documented in this year™s report, said Reed Tuckson, M.D., United Health Foundation board member and UnitedHealth Group executive vice president and chief of medical affairs. Without action in these severe economic times, the harsh findings of this report will only be worse next year for our nation, states, communities, families, and individuals. This is a time for urgent and focused action. Our nation™s and our children™s health are too important to do otherwise.

Vermont Leads Rankings With Statewide Healthy Behavior Changes

America™s Health Rankings„ 2008 edition shows Vermont as the healthiest state for the second year in a row. A broad range of health initiatives have made it possible for Vermont to make progress in areas where the rest of the country needs the greatest improvement. Within the state, the prevalence of smoking has declined to 17.6 percent of the population, there is a slower rise in obesity than the U.S. national average, and the number of people without health insurance remains low.

Vermont leads the nation for all health determinants measured. Vermont was ranked 16th when the first edition of America™s Health Rankings„ was released and has been climbing steadily in the rankings for the last eight years. Strengths include a low percentage of children in poverty, ready access to primary care for residents, a high rate of high school graduation, and high immunization coverage. Over the last year, Vermont has increased its per capita public health funding by 49 percent. Since 1990, the statewide prevalence of smoking has decreased by 43 percent and the infant mortality rate has decreased by 37 percent.

Comparison of States Across the Nation Against Health Measures

Hawaii climbed from a ranking of third to second this year, followed by New Hampshire (3), Minnesota (4), and Utah (5) to round out the top five healthiest states. Utah currently leads the nation as the state with the lowest prevalence of smoking. Other states making progress against the nation™s biggest health challenges include Massachusetts (6), which leads the nation as the state with the lowest uninsured rate, and Colorado (19), which ranks as the state with the lowest prevalence of obesity.

Louisiana replaces Mississippi as the least healthy state this year. Challenges include a high prevalence of obesity, a high percentage of children in poverty, and a high rate of uninsured population. Mississippi improved to 49th followed by South Carolina (48), Tennessee (47), and Texas (46). Each of these states continues to struggle with difficult socioeconomic challenges that manifest themselves in these rankings.

A comparison of state rankings from 2007 to 2008 indicates that 36 states had positive changes in their overall health scores and 14 experienced declines. States with the greatest overall health score improvement from 2007 are Arkansas, New Mexico, and Kentucky. Texas and Montana have shown the least improvement in health over the last year.

Effective solutions to many of the health challenges facing our nation are being developed and implemented at the state and community level, said Corinne Husten, M.D., MPH, interim president of Partnership for Prevention. We must learn from those who are getting it right and be inspired to implement our own creative solutions that will help produce a healthier America. The key is to expand these successful approaches beyond smaller pockets of progress and into widespread actions that are creative, measurable, collaborative, and sustainable.

A complete listing of the 2008 state health rankings is available at

U.S. Lags Behind Other Nations on Health Outcomes

The United States currently falls behind 27 other countries in terms of a healthy life expectancy with an average of 69 years, while Japan leads all countries with an average of 75 years. Some of these differences can be attributed to the inability of the United States to effectively treat disease. The United States has the worst mortality rate from treatable conditions when compared to 18 other industrialized countries. The U.S. has fallen four spots in the last five years.

Results from a UNICEF study found the United States is second to last among 21 developed nations for child well-being as the result of high infant mortality rates, a high percentage of low-birth-weight infants, and an average rate of immunizations. In addition, the United States is last in health care system performance when compared to Australia, Canada, Germany, New Zealand, and the United Kingdom. Despite spending twice as much as these countries on a per-capita basis, the U.S. is last on dimensions of access, patient safety, efficiency, and equity.

These statistics indicate that what we are doing as a nation is not working, said Georges C. Benjamin, M.D., executive director of American Public Health Association. We know improvement is possible because other nations have achieved far better health outcomes at less cost, indicating that we, too, can do the same. The solution is to build a foundation for health by creating a culture of wellness and prevention. It is no longer acceptable to simply focus on treatment and cures.

A Call to Action

As the America™s Health Rankings„ title suggests, there are manageable action steps people can take to stay healthy and improve the health of their community including:

  • Learning about your own health, identifying risk factors, and changing your lifestyle accordingly.
  • Seeking out trustworthy information about health issues.
  • If you smoke, quit today.
  • Exercising and eating properly.
  • Contacting state and county health departments to learn about the health challenges relevant to where you live.
  • Organizing community action by helping to create a shared vision for health and mobilizing community organizations to achieve that vision.
  • Meeting with elected and appointed public officials to advocate for necessary and
    urgent action.

Other suggested action steps from the Centers for Disease Control and Prevention that people can implement to stay healthy can be found at

About America™s Health Rankings„

America™s Health Rankings„ analyzes 22 different health measures, which are a combination of health determinants and health outcomes. Health determinants are factors that can affect the future health of a population. Health outcomes measure what has already occurred, either through death or missed days due to illness. Actions to improve health determinants will eventually improve health outcomes for states and the nation. This year™s report includes two new metrics: air pollution and geographic disparity.

America™s Health Rankings„ is the result of a collaborative partnership between United Health Foundation, the American Public Health Association, and Partnership for Prevention. Visit to view an interactive U.S. map that presents, at a glance, key national findings for 2008, plus a quick snapshot of this year™s state rankings.

About the United Health Foundation

Guided by a passion to help people live healthier lives, United Health Foundation provides helpful information to support decisions that lead to better health outcomes and healthier communities. The Foundation also supports activities that expand access to quality health care services for those in challenging circumstances and partners with others to improve the well being of communities. Since established by UnitedHealth Group [NYSE: UNH] in 1999 as a not for profit private foundation, the Foundation has committed more than $160 million to improve health and health care. For more information, visit

About the American Public Health Association

The American Public Health Association (APHA) is the oldest and most diverse organization of public health professionals in the world and has been working to improve public health since 1872. The Association aims to protect all Americans, their families, and their communities from preventable, serious health threats and strives to assure community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States. APHA represents a broad array of health professionals and others who care about their own health and the health of their communities. More information is available at

About Partnership for Prevention

Partnership for Prevention is a membership organization of businesses, nonprofit organizations, and government agencies advancing policies and practices to prevent disease and improve the health of all Americans. The organization seeks to increase investment in preventing disease, promoting health, and making prevention a national priority among both the public and private sectors. For additional information, visit