Changes from 1990

Overall, the health of the United States' population has improved 15.5 percent since 1990, although there was a 0.9 percent decrease nationally from the 2001 rankings. Nationally, there have been several improvements since 1990: a 22 percent decrease in the prevalence of smoking from 29.5 percent to 22.9 percent of the population; a 40 percent decrease in motor vehicle deaths from 2.5 to 1.5 deaths per 100,000,000 miles driven; a 17 percent drop in violent crime from 609 to 506 offenses per 100,000 population; a 11 percent increase in prenatal care from 68.7 percent to 76.0 percent of pregnant women receiving adequate care; a doubling of support for public health care; a reduction in heart disease; a 32 percent reduction in infant mortality from 10.2 to 6.9 deaths per 1,000 live births; and fewer premature deaths. However, these gains are offset by a 3 percent drop in high school graduation from 72.9 percent to 70.7 percent of incoming ninth-graders who graduate within four years.

The United Health Foundation State Health Rankings - 2002 Edition is based upon a consistent model over the last 13 years. Minor revisions have been made throughout the years; however, all historical data, if available, have been updated to reflect these changes. Each edition creates results based upon the average health of the states for that year. This historical perspective, however, is based upon the average health of the states in 1990, the first edition of the index. Therefore, ranks and scores referenced in this section and in Table 15 may vary from the ranks and scores for the current year because of the different reference points.

All states show a positive change in overall score between 1990 and 2002. Four of these states, New Hampshire, Oregon, Colorado and Alaska, have improved 10 percent faster than the national average of 15.5 percent - representing a 25.5 or more percent improvement from 1990 (Table 7).

Table 7

The principal reasons for the improvement in these states are:

-New Hampshire has led the country in decreasing infant mortality declining from 8.4 to 3.8 deaths per 1,000 live births and increased support for public health care from 11th to first in the country.

-In Oregon, infant mortality has declined from 9.9 to 5.6 deaths per 1,000 live births and motor vehicle deaths has declined from 3.0 to 1.4 deaths per 100,000,000 miles driven.

-In Colorado, the percentage of children in poverty has decreased from 21.8 percent to 10.9 percent of children and infant mortality has declined from 9.2 to 6.5 deaths per 1,000 live births.

-In Alaska, the prevalence of smoking has declined from 34.3 percent to 26.2 percent of the population and infant mortality has declined from 10.6 to 6.5 deaths per 1,000 live births.

Nineteen states have not matched the national rate of change and, hence, are slipping further behind the average. Oklahoma have improved only 5 percent, thus it has slipped 10.5 percent behind the increasing national average.

Table 8

The principal reasons for the slow health improvements are:

-In Oklahoma, there has been little improvement in the prevalence of smoking and a rise in the percentage of children in poverty.

-In Nebraska, the key mortality measures, heart disease, total mortality and premature death, have failed to match changes in other states. Since 1990 the availability of adequate prenatal care has decreased and the percentage of children under the age of 18 living in poverty has increased.

-In Wyoming, premature death has increased from 7,289 to 7,844 years lost before age 75 per 100,000 population and support for public health care has remained below the national average. Adequacy of prenatal care has improved, but slower than in other states.

-In Wisconsin, the prevalence of smoking has declined from 26.3 percent to 23.6 percent of the population, much less than in other states, and infant mortality has declined from 8.9 to 6.6 deaths per 1,000 live births - also slower rate than other states.

Table 15 contains the changes in scores and rankings for all 50 states since the 1990 edition of the State Health Rankings. States that have changed 15.5 percent or less are not improving as fast as the nation as a whole.