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For Nation, a Mixed Review on Health

Steady Rise in Well-Being of Americans Is Slowing, Study of 50 States Finds

By David Brown
Washington Post Staff Writer
Monday, November 8, 2004; Page A03

Scrape off the color on the red states and the blue states and underneath is a different way of looking at America's regional differences.

There are the smoking states and the obesity states; the high-infant-mortality states and the stay-in-high-school states; the heart attack states and the killed-on-the-job states.

Jesse Ventura does push-ups for National Employee Health and Fitness Day in 2000, when he was governor of Minnesota, named the healthiest state. (Jim Mone -- AP)

State Health Rankings
A Weekly Shot of News and Notes (The Washington Post, Nov 9, 2004)
Bottomless Hunger (The Washington Post, Nov 2, 2004)
Data Find a Taller, Fatter America Since 1960 (The Washington Post, Oct 28, 2004)
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_____Sally Squires_____
Past Lean Plate Club Columns
Lean Plate Club Discussion Transcripts

Today, for the 15th time, a public health organization is releasing its assessment of the health of the nation, and of each state, as measured by a composite of 18 variables.

"We really hope this represents a call to action," said Reed V. Tuckson, an official of the Minnesota-based United Health Foundation who served as the District's health commissioner from 1987 to 1990. "Each state is unique, each has its own problems. The point is to address the problems where you live."

Healthiness has increased for the country and every state since the first report was produced in 1990. Overall improvement has slowed in the past five years, however, and by some measures -- obesity rates, lack of health insurance, poverty levels and infant mortality -- national performance is worsening.

The three healthiest states are Minnesota, New Hampshire and Vermont. Among other things, their high rankings reflect low rates of poverty and premature death, safer-than-average drivers and generous spending on public health. Minnesota has ranked No. 1 for nine of the past 15 years and has never been out of the top two.

At the other end of the list are Tennessee, Mississippi and, as in 14 of the past 15 years, Louisiana in last place.

Their low rankings arise from high rates of poverty, infant mortality and cancer; large numbers of smokers; and, with the exception of Tennessee, many people without health insurance.

Virginia ranked No. 20 and Maryland, 34. The District was not ranked. However, it had lower-than-average death rates from cardiovascular disease and cancer; an average prevalence of smoking (22 percent of adults); and higher-than-average rates of violent crime, child poverty, infant mortality and infectious disease.

The project was started by Northwestern National Life Insurance Co. in 1990 as a way to explain why insurers' claims experience differed so much from state to state -- and to identify interventions that might improve a state's health.

United Health Foundation, a public health research organization, took over the project in 1999. In 2001, it was joined by the American Public Health Association, the professional organization of public health officials, and the advocacy group Partnership for Prevention.

States are scored using data from the Centers for Disease Control and Prevention, the National Safety Council, the Census Bureau and similar agencies. The data fall into four categories: risk behaviors, such as smoking and obesity; health outcomes, such as death rates; community environment, such as crime rates and the number of uninsured; and health policies, as measured by public health budgets.

Nationally, motor vehicle deaths fell by 36 percent (from 2.5 to 1.6 deaths per 100 million miles driven) from 1990 to 2004. Infant mortality fell 31 percent. The percentage of Americans who are smokers dropped from 30 percent to 22 percent.

In recent years, governments have spent more on public health, much of it on homeland defense and bioterrorism prevention. "That may or may not affect traditional public health functions as we know them," said Thomas E. Eckstein, a researcher with the Arundel Street Consulting firm of St. Paul, Minn., who helped prepare the report. "If a threat presents itself, it will have a huge impact."

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