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Prevalence of Obesity is the percentage of the population estimated to be obese, defined as having a body mass index (BMI) of 30.0 or higher. BMI is equal to your weight in pounds divided by your height in inches squared and then multiplied by 703.  CDC has a calculator for BMI at http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.  Weight status is determined per Table 11.  Obesity is known to contribute to a variety of diseases, including heart disease, diabetes and general poor health (http://www.cdc.gov/nccdphp/dnpa/obesity/). The data are collected by each state as part of the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention.

Table 11 - Body Mass Index (BMI)

Table 23 displays the 2007 ranks, based on 2006 data (Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention).  The average for the United States is 25.1 percent of the adult population, up from 24.4 percent of the population in 2006 and over double the rate of 11.6 percent of the population in 1990. In the United States, this means that one-in-four are obese - this is 56 million adults with a body mass index of 30.0 or higher.  If the population of the United States could return to the weight status of 1990, there would be over 25 million fewer obese individuals - more than the entire population of the second largest state in the United States, Texas.

The prevalence of obesity ranges from 18.2 percent of the population in Colorado to over 30 percent of the population in Mississippi, West Virginia and Alabama.  In the last year, only Louisiana experienced a decline of over 3 percent in this measure.  In Nevada and Ohio, the prevalence of obesity in their populations increased by 3 percent or more.  Since 1990, the prevalence of obesity increased in all states.  It increased the least in Connecticut, Florida and Wyoming where an additional one of 11 people are now considered obese. It increased the most in Alabama, where an additional one of six people is now considered obese. 

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High School Graduation estimates the percentage of students who graduate within four years and are considered regular graduates.  The National Center for Education Statistics collects the enrollment and completion data and, now, as part of the No Child Left Behind initiative, estimates the graduation rate for each state.  The rate is the number of graduates divided by the estimated count of freshmen four years earlier. This average freshman enrollment count is the sum of the number of 8^th graders five years earlier, the number of 9^th graders four years earlier (because this is when current year seniors were freshmen), and the number of 10^th graders three years earlier divided by three.  Enrollment counts include a proportional distribution of students not enrolled in a specific grade.   

Data are not adjusted for the presence or quality of basic health and consumer health education in the curriculum, for continuing education programs or for other non-traditional learning programs.  Also, individual states are increasingly altering graduation requirements, which may affect their reported number of regular graduates, their graduation rate and the comparability of these rates across time. 

Education is vital as consumers must be able to learn about, create and maintain a healthy lifestyle and  understand their options for care. 

Table 24 displays the 2007 ranks, based on 2003 to 2004 data (National Center for Education Statistics, Washington, D.C., U.S. Department of Education).  The rate varies from 87.6 percent of incoming ninth graders who graduate within four years in Nebraska to 60.6 percent in South Carolina.  The national average is 74.3 percent, up 0.4 percent from 73.9 percent in the 2006 Edition.  Louisiana improved the most with an increase from 64.1 percent to 69.4 percent of incoming ninth graders who graduate within four years.  Arizona and Nevada indicated a drop of five percent or more in the last year.  

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Community Environment

Four measures are used to represent the community environment: the violent crime rate, the occupational fatalities rate, the percentage of children in poverty and the incidence of infectious disease.  Measures of community environment reflect the reality that the daily conditions in which we live our lives have a great effect on achieving optimal individual health.  The presence of violence, illegal drugs, infectious disease and unsafe workplaces are detrimental.  In addition, studies indicate that the general socio-economic conditions have a significant relationship to the healthiness of a community's residents.   

These determinants measure both positive and negative aspects of the community environment of each state and their effects on the population's health.   Again, there are many additional efforts of communities that improve the overall health of a population but are not directly reflected in these four measures.  Each community has its strengths, challenges and resources and should undertake a careful planning process to determine what action plans are best for them. 

Violent Crime measures the effect of criminal behavior on a population's health.  It represents factors such as illegal drug use and various social ills.  Violent crime measures the annual number of murders, rapes, robberies and aggravated assaults per 100,000 population.  Violent crime reflects an aspect of current U.S. lifestyle and is an indicator of health risk and death.

Table 25 displays the 2007 ranks, based on 2006 data (Crime in the United States: 2006. Washington, D.C., Federal Bureau of Investigation).  Crime rate is dependent upon many factors, not just population; thus when taking action to combat crime, each state must consider its specific circumstances.

The violent crime rate varies from a low of 116 offenses per 100,000 population in Maine, 128 offenses per 100,000 population in North Dakota, 137 offenses per 100,000 population in Vermont and 139 offenses per 100,000 population in New Hampshire to a high of 766 offenses per 100,000 population in South Carolina and 760 offenses per 100,000 population in Tennessee.  The national average is 474 offenses per 100,000 population, up 5 offenses per 100,000 population from the revised FBI crime rate for the prior year and down 135 offenses per 100,000 population from the 1990 Edition.  

The largest reported decrease in violent crime from the 2006 Edition occurred in Montana where reported offenses decreased by 28 offenses per 100,000 population, Maryland where reported offenses decreased by 25 offenses per 100,000 population and in Rhode Island where reported offenses decreased by 24 offenses per 100,000 population.  The largest reported increases occurred in Nevada, from 608 to 742 offenses per 100,000 population and in Louisiana, from 597 to 698 offenses per 100,000 population.

This is the eighth year that the national violent crime rate is lower than the 1990 Edition, and it has not changed appreciably in the last three years.  However, several states experienced significant increases since 1990, led by Delaware, Alaska and Tennessee with increases of 250 offenses, 233 offenses and 226 offenses per 100,000 population, respectively.  New York, California and Florida reduced violent crime the most since the 1990 Edition, decreasing from 1,007 to 435 offenses per 100,000 population, from 918 to 533 offenses per 100,000 population, and from 1,024 to 712 offenses per 100,000 population, respectively. 

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Occupational Fatalities represents the impact of hazardous jobs on the population.  Occupational injuries would be a preferred component; however, there is not a uniform reporting system used by all 50 states.  Due to the different industry mixes in each state, occupational fatalities are adjusted to more accurately reflect the actual safety differences between the states.  

Occupational fatalities are measured over a three-year span because of their low incidence rate.  The industry adjustment is based on the ratio of workers in the following industries: construction, manufacturing, trade, transportation, utilities, professional and business services as defined by North American Industry Classification System (NAICS). 

Table 26 displays the 2007 ranks, based on 2004 to 2006 data (Census of Fatal Occupational Injuries, Bureau of Labor Statistics, U.S. Department of Labor, Washington, D.C.).  Last year, ranks were based on data from 2002 to 2004. Scores vary from 3.1 deaths per 100,000 workers in Massachusetts to 10 or more deaths per 100,000 workers in Wyoming, Alaska, Mississippi, West Virginia, Montana and Arkansas.  The national norm is 5.3 deaths per 100,000 workers, up from 4.9 deaths per 100,000 workers in the 2006 Edition.  In Wyoming, the occupational fatalities rate decreased by 6.9 deaths per 100,000 workers in the past year and reversed the large increase from 2005 to 2006 Editions of this report. 

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Children in Poverty measures the percentage of related persons under age 18 living in a household that is below the poverty threshold.  The poverty threshold established by the U.S. Census Bureau for a household of four people is approximately $20,650 in household income.   

Table 27 displays the 2007 ranks, based on 2006 data (March 2007 Current Population Survey, Washington, D.C., U.S. Census Bureau).  The percentage of children in poverty ranged from less than 10 percent of persons under age 18 in New Hampshire and Vermont to a high of more than 25 percent in Mississippi and Arkansas.  The national average is 17.4 percent, down 0.2 percent from the 2006 Edition and up 1.6 percent from the low of 15.8 percent of the population reported in the 2002 Edition.  It is 3.2 percent below the 1990 Edition.  In the past year, the percentage of children in poverty increased in 21 of 50 states. It increased by 8.0 percent in Arkansas.  The number of children in poverty decreased by more than four percent in Alabama, Washington and Indiana.  Since 1990, the percentage of children in poverty has increased in 14 of 50 states.  The percentage increased by more than five percent in Kansas.  It decreased by 10 percent or more in Louisiana, Florida, Hawaii and Minnesota since 1990. 

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Infectious Disease includes the occurrence of Acquired Immune Deficiency Syndrome (AIDS), tuberculosis and hepatitis (all types) as representative of all major infectious diseases in a state.  It is a running three-year average.

This component is neither age- nor race-adjusted.  Also, as reporting comes from each individual state health department, the level of accuracy may differ from state to state. 

Table 28 displays the 2007 ranks based on 2004 to 2006 data (Mortality and Morbidity Weekly Reports, Centers for Disease Control and Prevention).  AIDS cases in 2006 were not available as the data collection system for this measure is being revised.  For this year only, 2006 AIDS cases were assumed equal to 2005 AIDS cases.  The incidence of infectious disease per 100,000 population varies from a reported low of five cases or less in North Dakota, Wyoming, Montana and South Dakota to a reported high of more than 40 cases in New York and Florida.  The national average is 22.5 cases per 100,000 population, down from 22.6 cases per 100,000 population from the 2006 Edition and down considerably from 40.7 cases per 100,000 population from the 1990 Edition.

Reported infectious disease decreased by 4.0 or more cases per 100,000 population in Arizona.  It increased in New York by 2.5 cases per 100,000 population.  Since the 1990 Edition, Oregon, Alaska, Washington and Arizona have seen the greatest decreases in reported cases with more than 70 fewer cases per 100,000 population.  No states have experienced increases in the incidence of infectious disease since the 1990 Edition. 

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Public Health Policies

Three measures are used to represent public and health policies and programs: per capita public health spending, immunization coverage and lack of health insurance.  These components are indicative of the availability of resources and the extent of the program's reach to the public.

States have many additional public health programs, too numerous and individualized to list, that contribute to the overall health of the population but are not explicitly included in these rankings.  Contact your state public health officials to obtain additional information about programs in your state that are enacted to optimize individual and community health.  Each state summary lists the Web site for that state's health department.  Individuals can also see the spectrum of options available to states and communities by visiting www.thecommunityguide.org, a Web site that provides a systemic review of programs and evidence-based recommendations for health and community officials.

Lack of Health Insurance measures the percentage of the population not covered by private or public health insurance.  Individuals without health insurance have great difficulty accessing the health care system, frequently do not participate in preventive care programs and can add substantially to the cost of healthcare due to delayed care  and emergency department treatment.

Table 29 displays the 2007 ranks, based on 2006 data (March 2007 Current Population Survey, Washington, D.C., U.S. Census Bureau). 

Lack of coverage ranged from less than 10 percent in Rhode Island, Hawaii, Wisconsin, Minnesota, Maine and Connecticut to over 20 percent in Texas, New Mexico, Louisiana, Florida, Arizona and Mississippi.  The national average is 15.8 percent (47 million people) uninsured, which is an increase of 0.5 percent from the restated 2006 Edition.  If the United States as a whole could emulate the best state, the number of uninsured would decrease by about 22 million people or about the population of Texas, the second largest state in the United States.

In the last year, the rate of uninsured population decreased in 13 states, including West Virginia (a decrease of 3.4 percent) and Rhode Island (a decrease of 2.9 percent).  The rate of uninsured population increased in 35 states, including an increase of 4.2 percent in Louisiana and 3.9 percent in Mississippi.

The Guide to Community Preventive Services has numerous proven methods to increase the rate of vaccinations in a community that include ways to increase the demand in the community, improving access and system-based or provider-based innovations.  See their suggestions at http://www.thecommunityguide.org/vaccine/default.htm.

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Health Services

Preventive and curative care must be delivered in an effective, appropriate and timely manner.  In the 2007 Edition, three measures are included in this section.  Adequacy of prenatal care has been included since the 1990 Edition; however Primary Care Physicians and Preventable Hospitalizations are new to this Edition. 

Adequacy of Prenatal Care is a measure of both access to and frequency of prenatal care based on the Adequacy of Prenatal Care Utilization (APNCU) Index developed by Kotelchuck. This index considers two aspects of prenatal care: the month it was initiated and the number of visits occurring after initiation.  The 1990 through 2004 Editions of the report defined Adequacy of Prenatal Care using the Kessner Index, a measure highly correlated to Kotelchuck; however, it does not consider both initiation and frequency of visits.

Adequacy of prenatal care is not adjusted for age or race.

Table 32 displays the 2007 ranks, based on 2004 data (National Center for Health Statistics. Adequacy of Care by State, United States, Hyattsville, Md.).  Not all prenatal care numbers are comparable since the data is collected from two different forms of birth certificates.  The states marked with asterisks have begun using the 2003 revision to the birth certificate and can only be compared to other states with an asterisk.  All other states use the 1988 revision and are directly comparable.  The states using the 2003 revision were assigned scores and ranks based upon prior year data to avoid a lowering of their scores due to the improved data collection method.

Access to adequate prenatal care ranges from more than 85 percent of pregnant women in New Hampshire, Maine and Vermont to less than 60 percent in New Mexico. 

The data has not changed since the 2006 Edition.

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Primary Care Physicians is a measure of the availability of primary care physicians to the general population as measured by number of primary care physicians per 100,000 population.  Primary care physicians provide a combination of direct care to the patient and, as necessary, counsel the patient in the appropriate use of specialists and advance treatment locations. 

This measure is new to the 2007 Edition and is weighted as 5.0 percent of the overall score.  It is not adjusted by characteristics of the population served, such as age or health status. 

Table 33 displays the 2007 ranks, based on 2005 data (American Medical Association, Physician Characteristics and Distribution in the United States, 2007 Edition, Chicago, Ill. Data used with permission).  Primary care physicians include all those who identify themselves as Family Practice physicians, General Practitioners, Internists, Pediatricians, Obstetricians or  Gynecologists. 

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Preventable Hospitalizations is a measure of the discharge rate from hospitals for ambulatory care-sensitive conditions.  Ambulatory care-sensitive conditions are those "for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. [3] 
These hospitalizations can often be reduced by strong outpatient care systems and include conditions such as adult asthma, bacterial pneumonia, congestive heart failure, chronic obstructive pulmonary disease, diabetes, low birth weight, urinary tract infection and other conditions.

These discharges are also highly correlated with general admissions and reflect the tendency for a population to over use the hospital setting as a site for care.

This measure is new to the 2007 Edition and is weighted as 5.0 percent of the overall score.  It is not adjusted by characteristics of the population served, such as age or health status.

Table 34 displays the 2007 ranks, based on 2005 data (The Dartmouth Atlas of Health Care, The Dartmouth Institute for Health Policy and Clinic Practice, Lebanon, N.H.).  The rate of preventable hospitalizations ranges from a low of under 50 discharges per 1,000 Medicare enrollees in Hawaii and Utah to over 100 discharges per 1,000 Medicare enrollees in West Virginia, Kentucky, Louisiana and Mississippi. The national average is 78.4 discharges per 1,000 Medicare enrollees.  In the last seven years, the national discharge rate has declined from 82.5 to 78.4 discharges per 1,000 Medicare enrollees.

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End Notes