Special Report

The Most (and Least) Healthy States: A Survey of All 50

16. California
> Pct. obese
24.7% (4th lowest)
> Cardiovascular deaths per 100,000 people: 234 (23rd lowest)
> Primary care physicians per 100,000 people: 123 (22nd highest)
> Pct. with health insurance: 85.2% (13th lowest)

Based on health-related behavior alone, California is one of the healthiest states in the country. Smoking and obesity are the greatest causes of preventable deaths in the country, and California has the second-lowest smoking rate nationwide. Of adults in the state, 12.8% smoke, versus the national smoking rate of 18.1%. Similarly, while nearly 30% of U.S. adults are obese, the obesity rate in California is only 24.7%.

Other elements, however, negatively affect California’s health ranking. For example, the state has the highest rate of air pollution in the country, with the average state resident exposed to 12.5 micrograms of unhealthy particulate matter per cubic meter. By contrast, in Wyoming, the state with the least air pollution, residents are exposed to just 5.0 micrograms of particulate. This could explain California’s environmental laws, which are some of the most numerous and strict regulations in the country.

17. Idaho
> Pct. obese
28.9% (22nd lowest)
> Cardiovascular deaths per 100,000 people: 228 (19th lowest)
> Primary care physicians per 100,000 people: 82 (the lowest)
> Pct. with health insurance: 85.1% (12th lowest)

Idaho has an above-average rate of public health spending. According to the United Health Foundation, an additional $10 per person spent on public health programs can markedly improve health outcomes, and in Idaho, $130 are spent per person on public health programs, the fourth highest rate in the country. However, by many other measures of health policy, the state does not compare so favorably. For example, only 65.9% of the state’s children are immunized, the sixth lowest rate in the country. Nearly 30% of adolescents are not vaccinated against tetanus, diphtheria, and pertussis, the second lowest rate in the country. Also, nearly 15% of state adults do not have health insurance, one of the worst uninsured rates in the United States.

18. Maryland
> Pct. obese
29.6% (25th lowest)
> Cardiovascular deaths per 100,000 people: 250 (21st highest)
> Primary care physicians per 100,000 people: 184 (2nd highest)
> Pct. with health insurance: 91.0% (9th highest)

Higher income is typically a strong indicator of a healthy population, but that connection is not as strong in Maryland. The typical household in the state earns $76,165 annually, the highest of all states, and well over $20,000 above the U.S. median income. Despite the high incomes, with the exception of heart disease and heart attack, the state is not among the top 10 in the majority of health outcomes measured by the United Health Foundation’s annual report. This may be due in part to the high level of health inequality in the state. The gap between the health of those residents with a high school education and the 15% of adults who did not graduate high school is one of the widest in the country.

19. South Dakota
> Pct. obese
29.8% (23rd highest)
> Cardiovascular deaths per 100,000 people: 233 (22nd lowest)
> Primary care physicians per 100,000 people: 115 (22nd lowest)
> Pct. with health insurance: 89.5% (17th highest)

South Dakota ranks as less than optimally healthy by several measures. For example, the state reported an above average rate of heart attacks and one of the highest rates of infant mortality in the nation. However, South Dakota leads the nation in one important measure — sleep. According to the National Center on Sleep Disorders, “Each year, sleep disorders, sleep deprivation, and sleepiness add an estimated $15.9 billion to the national health care bill.” South Dakota residents are the least likely in the country to deal with the negative health impacts associated with a lack of sleep. Only 27.8% of residents report sleeping less than seven hours each night, versus 34.2% of U.S. adults who report sleeping so little. Perhaps due in part to sleeping better than most Americans, state residents on average report just 2.7 days of poor mental health each month, the lowest in the country.

20. Oregon
> Pct. obese
27.9% (17th lowest)
> Cardiovascular deaths per 100,000 people: 212 (5th lowest)
> Primary care physicians per 100,000 people: 135 (14th highest)
> Pct. with health insurance: 87.8% (24th lowest)

No state had a worse decline in its health ranking compared to the 2014 report than Oregon. The state ranked as the 12th healthiest in the country last year. This year, Oregon ranks 20th overall. One reason for the change may be the recent increase in health inequality among state residents. Oregon has the lowest high school graduation rate in the country, and the difference in health between those who graduated from high school and those who have not has gotten worse. Over the past two years, the health gap between adults with a high school education and those without a diploma widened by 16%. This year, the disparity is the 15th worst gap in the country.

Not everything is negative, however. Oregon has the second lowest rate of physical inactivity among adults. Physical activity can help reduce the likelihood of certain cancers, diabetes, heart disease, and obesity. Just 16.5% of Oregon adults report doing no physical activity or exercise on a regular basis, the second lowest rate in the U.S.

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