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.
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."
At the same time that improvements were occurring in some categories since 1990, the prevalence of obesity almost doubled, from 12 percent to 23 percent. Those without health insurance rose from 13 percent to 16 percent. The percentage of ninth-graders who graduated from high school within four years fell from 73 percent to 68 percent.
Last year brought some bad news.
Obesity prevalence increased from 22.1 to 22.8 percent of the population. The percentage of children in poverty rose from 16.3 to 17.6. In the smallest -- but possibly most significant -- change, infant mortality rose for the first time in 40 years, from 6.9 to 7 deaths in the first year of life for every 1,000 live births.
"Given the meaning of infant mortality as the definer of quality of a civilization, this statistic is worrisome," Tuckson said.
The United States is now 28th in the world in infant mortality. Hong Kong has the lowest rate (3.1), followed by Japan and Sweden (each at 3.4). Angola has the highest infant mortality rate of any country, variously estimated to be between 150 and 260, according to documents on the World Health Organization Web site.
The report reveals wide variations among states in many of the 18 measurements.
The percentage of children in poverty ranged from 7 percent in New Hampshire and 10 percent in Minnesota to 32 percent in the District and 27 percent in West Virginia, Arkansas and New Mexico. Maryland had 11 percent and Virginia 14 percent.
The high school graduation rate was 90 percent in New Jersey, 84 percent in North Dakota and 83 percent in Iowa, but only 54 percent in Georgia and 49 percent in South Carolina. In the District, it was 70; in Maryland and Virginia, 74.
Colorado and Hawaii each had 16 percent of the adult population qualifying as obese -- the lowest in the nation. Mississippi and Alabama had the highest, at 28 percent. For the District, the obesity prevalence was 20 percent; for Maryland and Virginia, it was 22 percent.
Vermont, Massachusetts and Connecticut had the safest drivers, with one or fewer deaths per 100 million miles driven. Montana had the highest motor vehicle death rate -- three times Vermont's -- with South Dakota and Mississippi close behind.
Massachusetts had the lowest rate of occupational fatalities -- three per 100,000 workers. Alaska's rate was five times higher.
There were similarly wide health disparities among ethnic groups within states.
In the District, for every 100,000 people, blacks lost 19,000 years of life because of death before age 75. For whites, this measure of "premature death" was 5,300 years.
Indians in North Dakota suffered 15,000 years of potential life lost compared with 5,800 years for that state's whites.
In New Mexico, Hispanics lost 8,300 years compared with 7,100 for whites, but in Virginia the relationship was reversed. Hispanics there lost 4,000 years of potential life before age 75 for every 100,000 people, compared with 6,400 for whites.
The full report, "America's Health: State Health Rankings," is available at www.unitedhealthfoundation.org.