Good health depends on a confluence of factors: behavior, genes, community environment, access to care — and not least of all, where you live.
People in the northeast, for instance — in small states with low poverty rates and good access to state-of-the-art health facilities — tend to be healthiest overall, according to the most recent state-by-state health rankings, published by the United Health Foundation, in partnership with the American Public Health Association (APHA).
By contrast, Americans in the deep South, in states with high poverty rates and low access to high-quality medical care, rank at the bottom.
The United Health Foundation has been publishing its state health rankings since 1990. The report collects data on 23 measures of health compiled by various federal agencies, including the Centers for Disease Control and Prevention and the Census Bureau. The rankings take into account health "determinants" — behavioral, socioeconomic and other factors that predict a state's good health — such as rates of binge drinking, smoking and obesity; community and environmental factors like air pollution, violent crime and childhood poverty; and problems like low rates of health insurance and poor immunization coverage.
The report also takes into account traditional health "outcomes," including chronic conditions like Type 2 diabetes, mental illness, infant mortality, heart disease and cancer deaths, and unequal access to care.
As a country, the U.S. is not faring well. While health measures improved steadily each year between 1990 and 2000, that improvement slowed, then stalled over the past decade. In 2011, there was no improvement at all. That may due in part to the bleak economy, which may have led people to fall into bad health habits. The report suggests also that some unhealthy behaviors are being replaced with others. For example, the researchers found that for every person who quit smoking in 2011, another person became obese. Both factors are associated with increased risks of heart disease, cancer and a host of other chronic conditions.
Regarding the three major avoidable contributors to chronic ill health threats, the report found that Americans are in a bad way: 27.5% of the population is obese; 17.3% still smoke cigarettes and 8.7% have diabetes.
Prevention efforts must focus on these factors and should be tailored to individual communities, Dr. Georges Benjamin, the executive director of the APHA, told Health.com. "Physical activity, nutrition, and tobacco: If we could get people focused on those three, we could take a huge bite out of the chronic disease epidemic," he said. "This is not an infinite list of things that people have to address."
Following are the five healthiest and least healthy states, from worst to best. For a view of the full report, you can download it here.