Changes from 1990 Results

Overall, the health of the United States’ population has improved 18.7 percent since 1990, up by 0.3 percent from the 2005 Edition.  As Graph 1 shows, the rate of improvement in the health of the United States’ population has slowed in the past seven years.  During the 1990s, health improved at an average annual rate of 1.5 percent per year.  Since 2000, the annual rate of improvement has slipped to an average of 0.3 percent per year.

The United States has great potential to continue to increase its overall health and return to the rates of improvement typical of the 1990s.   However, it must address many of the drivers of health more directly and focus on reducing important risk factors.  For example, while there has been an overall 30 percent decrease in the prevalence of smoking from 29.5 percent of the population in 1990 to 20.6 percent of the population in 2006, most of this decrease occurred in the early 1990s (Graph 2). 
Between 1993 and 2003, there was no improvement in the overall prevalence of smoking in
the United States.  There are optimistic signs in the last two years that the prevalence of smoking has started to decline, but these changes need to be reinforced by continuing and strengthening efforts to curtail tobacco use.

Improvements in the overall health of the United States are greatly hindered by the unchecked growth in the prevalence of obesity.  The prevalence of obesity has exploded from 11.6 percent of the population in 1990 to 24.4 percent of the population in 2005.  Now, nearly one in four people are considered obese – a category that the Centers for Disease Control and Prevention reserves for those who are significantly over the suggested body weight given their height.  The rate of increase shows no evidence of slowing (Graph 3).

There have been health improvements since 1990:

·        A 40 percent decline in the rate of motor vehicle deaths from 2.5 to 1.5 deaths per 100,000,000 miles driven,

·        A 45 percent decrease in the incidence of infectious disease from 40.7 to 22.6 cases per 100,000 population,

·        A 23 percent decline in the violent crime rate from 609 to 469 offenses per 100,000 population, and

·        An 20 percent decrease in the rate of deaths from cardiovascular disease from 406.3 to 326.0 deaths per 100,000 population.  

However, many of these have not continued the rate of improvement established in the ‘90s. 

These improvements are offset by a 19 percent increase in the percentage of uninsured population from 13.4 percent to 15.9 percent of the population. 

A summary of the changes in rank and score from 1990 to 2006 for each state appears in Table 19.  

All states show a positive change in overall score between 1990 and 2006.  Vermont, Oregon, Alaska, California and New York have improved more than 25 percent since the 1990 Edition and have greatly exceeded the national average change in score of 18.7 percent (Table 8).  Eighteen other states also exceeded the national rate of improvement. 

Table 8 - States with the Greatest Overall Health Improvement 1990 to 2006

The principal reasons for the changes in these states from 1990 to 2006 are:

·        Vermont: The prevalence of smoking declined from 30.7 percent to 19.3 percent of the population,  the premature death rate declined from 7,842 to 5,842 years of potential life lost before age 75 per 100,000 population and the prevalence of obesity increased from 10.7 percent to 20.2 percent of the population.  Infant mortality decreased from 9.2 to 5.3 deaths per 1,000 live births and the rate of deaths from cardiovascular disease decreased from 409.1 to 298.1 deaths per 100,000 population.

·        Oregon: The incidence of infectious disease declined from 92.8 to 14.1 cases per 100,000 population, and the rate of motor vehicle deaths declined from 3.0 to 1.4 deaths per 100,000,000 miles driven.  The percentage of children in poverty increased from 12.4 percent to 17.7 percent of persons under age 18, the violent crime rate dropped from 540 to 287 offenses per 100,000 population, the prevalence of obesity increased from 10.9 percent to 23.8 percent of the population, the infant mortality rate declined from 9.9 to 5.6 deaths per 1,000 live births and the rate of deaths from cardiovascular disease decreased from 383.9 to 293.7 deaths per 100,000 population.

·        Alaska: The incidence of infectious disease decreased from 92.2 to 14.4 cases per 100,000 population, the infant mortality rate decreased from 10.6 to 5.7 deaths per 1,000 live births, and the percentage of children in poverty declined from 16.6 percent to 12.1 percent of persons under age 18.  Also, the violent crime rate increased from 455 to 632 offenses per 100,000 population, despite a decline in crime rates nationally.  The prevalence of obesity increased from 13.4 percent to 27.4 percent of the population.

·        California: The prevalence of smoking decreased from 25.6 percent to 15.2 percent of the population, the violent crime rate decreased from 918 to 526 offenses per 100,000 population, the incidence of infectious disease decreased from 70.6 to 24.8 cases per 100,000 population, and the infant mortality rate decreased from 9.0 to 5.1 deaths per 1,000 live births.  The premature death rate declined from 8,453 to 6,505 years of potential life lost before age 75 per 100,000 population.

·        New York: The prevalence of smoking decreased from 28.7 percent to 20.5 percent of the population, the rate of motor vehicle deaths decreased from 2.3 to 1.0 deaths per 100,000,000 miles driven, the violent crime rate decreased from 1,007 to 446 offenses per 100,000 population, and the infant mortality rate decreased from 10.7 to 6.1 deaths per 1,000 live births. The premature death rate declined from 9,754 to 6,527 years of potential life lost before age 75 per 100,000 population.

Twenty seven states are below the national rate of improvement and are slipping further behind in healthiness.  Oklahoma, South Carolina and Tennessee have improved their overall score 10 percent or less, respectively, compared to the national 18.7 percent rate of improvement (Table 9).

Table 9 - States with the Least Overall Health Score Improvement - 1990 to 2006

The principal reasons for changes in these states from 1990 to 2006 are:

·        Oklahoma: The prevalence of obesity increased from 11.6 percent to 26.8 percent of the population, the prevalence of smoking decreased from 33.0 percent to 25.1 percent of the population, and the violent crime rate increased from 419 to 509 offenses per 100,000 population. The rate of cancer deaths increased from 197.8 to 216.5 deaths per 100,000 population.

·       Tennessee: The violent crime rate increased from 534 to 753 offenses per 100,000 population, the prevalence of obesity more than doubled from 11.8 percent to 27.4 percent of the population, and the percentage of children in poverty declined from 29.6 percent to 19.5 percent of persons under age 18.  The premature death rate increased from 9,504 to 9,683 years of potential life lost before age 75 per 100,000 population – counter to the decline in the United States as a whole.

·        South Carolina: The prevalence of smoking in this state decreased at a much slower rate than nationally, from 27.1 percent to 22.5 percent of the population.  The high school graduation rate decreased from 67.8 percent to 51.7 percent of incoming ninth graders who graduate within four years.  The violent crime rate increased from 665 to 761 offenses per 100,000 population. The percentage of uninsured population has increased from 12.8 percent to 17.7 percent of the population without health insurance.

Table 19 contains the changes in scores and rankings for all 50 states since the 1990 Edition of America’s Health Rankings™.  States that have changed less than 18.7 percent are not improving as quickly as the nation as a whole.