Findings

2002 Results

The United Health Foundation State Health Rankings - 2002 Edition shows New Hampshire at the top of the list of healthiest states, a position it has held for six of the 13 years of this index. Minnesota is number two, followed by Massachusetts, Utah, and Connecticut. Louisiana is 50th as the least healthy state, while Mississippi is 49thOklahoma, Arkansas and South Carolina complete the bottom five states.

Many factors contribute to New Hampshire's success. The state is first in four measures: highest availability of adequate prenatal care, highest support for public health care, fewest limited activity days and lowest infant mortality rate. It is in the top 10 on eight other measures.  In prevalence of smoking (24.1 percent of the population), high school graduation (72.7 percent of incoming ninth graders) and cancer deaths (207.6 deaths per 100,000 population), it ranks 33rd, 22nd and 22nd respectively. In the last year, New Hampshire reduced its uninsured population from 10.2 to 9.4 percent of the population, however, violent crime rose from 97 to 175 offenses per 100,000 population.

Louisiana is 50th, placing among the bottom 10 states in 15 of the 17 measures. Its health is 23.9 percent lower than the average state. Its two strengths are high adequacy of prenatal care (78.6 percent of pregnant women receive adequate care) and low prevalence of smoking (24.6 percent of the population).  Mississippi is 49th and is 22.2 percent lower than the national average.

Table 3 lists the score and ranking for each of the 50 states.

Scores presented in the tables indicate the percentage a state is above or below the national norm. For example, a state with a score of 20 is 20 percent above the national average for that component. A negative score means the state is below the national average.  When comparing states from year to year, differences in score are more important than changes in ranking.

Table 3

2002 Overall Rankings

Alphabetical by State
Rank Order
Rank (1-50)
State
Score1
Rank (1-50)
State
Score1
45
Alabama
-12.8
1
New Hampshire
23.9
30
Alaska
0.2
2
Minnesota
21.8
34
Arizona
-3.7
3
Massachusetts
18.5
47
Arkansas
-14.9
4
Utah
17.9
24
California
3.7
5
Connecticut
16.6
7
Colorado
14.5
6
Vermont
15.8
5
Connecticut
16.6
7
Iowa
14.5
35
Delaware
-3.9
7
Colorado
14.5
43
Florida
-12.2
9
North Dakota
14.0
40
Georgia
-8.8
10
Maine
13.8
14
Hawaii
11.6
11
Washington
13.5
20
Idaho
7.8
11
Wisconsin
13.5
31
Illinois
-0.9
13
Rhode Island
11.8
22
Indiana
4.3
14
Hawaii
11.6
7
Iowa
14.5
15
Nebraska
10.5
21
Kansas
6.7
16
South Dakota
9.7
39
Kentucky
-7.6
17
Oregon
9.3
50
Louisiana
-23.9
18
Virginia
8.7
10
Maine
13.8
19
New Jersey
8.6
28
Maryland
0.8
20
Idaho
7.8
3
Massachusetts
18.5
21
Kansas
6.7
29
Michigan
0.6
22
Indiana
4.3
2
Minnesota
21.8
23
Pennsylvania
3.8
49
Mississippi
-22.2
24
Montana
3.7
32
Missouri
-2.6
24
California
3.7
24
Montana
3.7
26
Wyoming
2.7
15
Nebraska
10.5
27
Ohio
1.7
38
Nevada
-5.8
28
Maryland
0.8
1
New Hampshire
23.9
29
Michigan
0.6
19
New Jersey
8.6
30
Alaska
0.2
42
New Mexico
-10.1
31
Illinois
-0.9
32
New York
-2.6
32
New York
-2.6
36
North Carolina
-5.3
32
Missouri
-2.6
9
North Dakota
14.0
34
Arizona
-3.7
27
Ohio
1.7
35
Delaware
-3.9
46
Oklahoma
-13.3
36
North Carolina
-5.3
17
Oregon
9.3
37
Texas
-5.6
23
Pennsylvania
3.8
38
Nevada
-5.8
13
Rhode Island
11.8
39
Kentucky
-7.6
48
South Carolina
-16.4
40
Georgia
-8.8
16
South Dakota
9.7
41
West Virginia
-8.9
44
Tennessee
-12.3
42
New Mexico
-10.1
37
Texas
-5.6
43
Florida
-12.2
4
Utah
17.9
44
Tennessee
-12.3
6
Vermont
15.8
45
Alabama
-12.8
18
Virginia
8.7
46
Oklahoma
-13.3
11
Washington
13.5
47
Arkansas
-14.9
41
West Virginia
-8.9
48
South Carolina
-16.4
11
Wisconsin
13.5
49
Mississippi
-22.2
26
Wyoming
2.7
50
Louisiana
-23.9

1 Score is the percent above or below the national average.

Health Disparity Within States

Many of the statewide measures reflect the condition of the "average" resident. However, when those measures are examined more closely, startling differences based upon race, sex and/or economic status may exist.

For example, Table 33 ranks the states based upon Premature Death, an age-adjusted measure of the years of potential life lost (YPLL) before age 75 per 100,000 population for the year 1999.  In the United States overall, 7,734 years of life before age 75 were lost per 100,000 population in 1999 when all races were included.  However, startling differences emerge when you look at national information about Premature Death by race.  To make accurate comparisons, the annual average over the period 1997 to 1999 must be considered.  See Table 4 below.

Table 4

Years of Potential Life Lost (YPLL) Before Age 75 Years
By Race/Ethnicity. 1997-1999, Age-adjusted2
Race
Yrs/100,000 population
Percent of All Races
All Races
7825
---
White, Non-Hispanic
7045
90.9%
Black, Non-Hispanic
14217
181.7%
Hispanic
6372
84.4%
American Indian
9723
124.3%
Asian, Pacific Islanders
4052
51.8%
2 Source:  1997-1999 data, Centers for Disease Control and Prevention.

The table shows the difference in YPLL before age 75 when individual races and ethnic groups are compared to the overall rate. Asians and Pacific Islanders experience considerably less premature death than the average number (51.8 percent) whereas the black, non-Hispanic group experiences almost twice the loss. The maximum variation between races occurs between two minority races; black, non-Hispanic individuals experience 3.5 times as much loss as Asians and Pacific Islanders. Thus, many more black Americans are less able to lead full, productive lives than their Asian and Pacific Islander counterparts.

Disparity in health outcomes is not only a national issue, but also an issue for each state. While each state has unique issues that contribute to disparity, states that have been successful in reducing disparities in health indicators while retaining high overall health can serve as models for other states.

Table 12 shows YPLL before age 75 per 100,000 for each state by race and ethnicity. It shows the maximum disparity between any two races within a state and the rank of each state based upon the ratio of the maximum loss to the minimum loss.  A low rank means less disparity within the state.

The wide range in indicators by race and ethnicity is apparent, ranging from a low of 1.4 times difference in Hawaii to 8.3 times in Maryland and 6.7 times difference in New Jersey

A uniformly healthy state would rank among the top states in both the overall YPLL and in the intrastate disparity shown in Table 12..Minnesota, is first in YPLL before age 75 for all races, and is 11th in the disparity among races.  Massachusetts, is second in YPLL before age 75, is 22nd in the disparity among races. Both of these results show that even though the states lead the country in overall YPLL before age 75, not all population groups within the state participate equally in this benefit. Thus, in Minnesota, many more white, non-Hispanic individuals enjoy a longer, productive life than their black and Hispanic counterparts while in Massachusetts, Asians and Pacific Islanders and Hispanics enjoy longer, more productive lives when compared to whites and to black Americans. The differences in race are significant and can be used to identify and benchmark areas where increased efforts are justified.

Disparity is also present in other measures; prenatal care is one example.  In the United States, 76.0 percent of pregnant women receive adequate prenatal care. By race, it varies from a low of 57.6 percent for American Indians to a high of 78.2 percent for whites, a ratio of 1.36 (78.2/57.6).  Individual states, however, have different degrees of variation among races ranging from a low in Rhode Island of 1.14 to a high in Minnesota of 1.79 (Table 13). This means that in Minnesota, a pregnant white woman is almost twice as likely as an American Indian woman to receive adequate prenatal care. In Rhode Island, the white woman is only 14 percent more likely to receive adequate prenatal care as compared to the American Indian woman.

Disparity may be based on issues other than race.  For example, it has been shown that mortality is strongly related to economic status. However, this type of data is not as readily available on a state-by-state level.