The United States spends far and away the most on health care per capita, yet the nation lags nearly two years behind the average life expectancy among developed nations. The Affordable Care Act will mark its five-year anniversary this upcoming March. While the plan has helped reduce the share of Americans who lack insurance — a significant burden on public health — much more will need to happen to align the U.S. health care system with that of other developed nations.
To provide a more complete picture of where the country is succeeding and where it is failing when it comes to public health, the United Health Foundation’s 2015 America’s Health Rankings report examined both determinants and health outcomes. The UHF included such factors as healthy behaviors, quality of health care, health policy, the presence of diseases, and preventable deaths across the nation. Each of these areas varies considerably between states. Based on this year’s edition of America’s Health Rankings, Hawaii is once again the healthiest, and for the first time since 2011, Louisiana is the least healthy state in the nation.
While this report includes measures of the quality and accessibility of health care, it also focuses on what leads to the poor health of Americans. Many would argue the poor health is as much a cause of high health costs as any other inefficiencies in the system.
In an interview with 24/7 Wall St., Dr. Reed Tuckson, senior medical advisor for United Health Foundation, echoed this sentiment. “Almost always, the conversation about health in America is a conversation about insurance and access to medical care as opposed to being about the prevention of disease and promotion of health. We are producing far too many unnecessarily sick people who are being delivered every day into the hands of a medical care system that we can no longer afford.”
Two of the most significant factors driving up the rate of serious diseases and reducing life expectancy are obesity and tobacco use. According to Tuckson, while tobacco use has declined in the United States, 18.1% of Americans still smoke. As evidence of the impact smoking has on overall health, the 10 least healthy states are also among the 10 states with the highest smoking rates.
Obesity, meanwhile, has increased in the United States and now approaches 30% of the adult population. According to Tuckson, while tobacco remains the greatest cause of preventable illness and death, obesity is a close second. All ten of the least healthy states have above-average obesity rates.
Another factor that strongly correlates with health is income. Eight of the 10 least healthy states are among the bottom 10 in the country in median household income. Dr. Tuckson explained that this correlation is likely due to many considerations. People with lower incomes are less likely to obtain an education, are less likely to be able to afford better healthcare, and are more likely to live in areas where healthy options are not readily accessible. Tuckson added that there may be less tangible elements contributing to the relationship as well. “From my experience as a public health official, when you don’t have as much of a sense of hope and optimism about your future, you tend not to take the steps necessary to protect that future.” he added.
To consider any one of the critical factors that make up public health on its own is to ignore the complex, interrelated nature of these factors. For example, residents in areas with low violent crime rates tend to be healthier. This does not mean, however, that less exposure to violence is all that is needed to live a healthy lifestyle. Violent crime rates tend to be lower in communities with higher incomes, which can in turn afford their residents healthier options.
According to Tuckson, the fact that many of these determinants are both causes and effects of one another, particularly all of the factors that are tied to income, has resulted in a disturbing national trend. “Overall, we are concerned that we are becoming two nations, when it comes to our health. Those that are socioeconomically more privileged have significantly better health statistics than people that are not doing as well socioeconomically.” Tuckson concluded.
Based on data provided by United Health Foundation’s America’s Health Rankings, 24/7 Wall St. reviewed and ranked all 50 states based on their overall scores. These scores were based on a number of measures that fall into two separate categories: health determinants and health outcomes. Determinants were further divided into behaviors, such as smoking and drinking; community and environmental factors, such as children living in poverty; policy factors, such as public health funding and immunization rates; and clinical care factors, such as the availability of dentists and doctors. Outcomes included rates of death from cancer and cardiovascular diseases, as well as infant mortality rates. Additionally, we also reviewed supplementary data provided by America’s Health Rankings, including economic factors such as median household income based on the U.S. Census Bureau’s Current Population Survey.
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