State Changes from 1990

All states show a positive change in overall score between 1990 and 2007.  Some examples of the successes that states have had since 1990 are listed in Table 18. 

Oregon, Vermont, Alaska, New York, Washington and California have improved more than 25 percent overall since the 1990 Edition and have greatly exceeded the national average change in score of 18.4 percent (Table 5).  Eighteen other states also exceeded the national rate of improvement. 

Table 5 - States with the Greatest Overall Health Score Improvement - 1990 to 2007

                                                        Oregon                            +31.6

                                                        Vermont                           +31.5

                                                        Alaska                             +28.0

                                                        New York                         +27.4

                                                        Washington                      +26.1

                                                        California                          +25.4

The principal reasons for the changes in the above states from 1990 to 2007 are:

• Oregon: The incidence of infectious disease declined from 92.8 to 13.9 cases per 100,000 population, and the violent crime rate declined from 540 to 280 offenses per 100,000 population.  The percentage of children in poverty increased from 12.4 percent to 16.7 percent of persons under age 18, and the prevalence of obesity increased from 10.9 percent to 24.8 percent of the population.  Overall determinants went from a ranking of 31^st to a ranking of 18^th, a fact that supports improvement in ranking in recent years.  On measures of health outcomes, the infant mortality rate declined from 9.9 to 5.9 deaths per 1,000 live births, and the rate of deaths from cardiovascular disease decreased from 383.9 to 286.6 deaths per 100,000 population.

• Vermont:  The prevalence of smoking declined from 30.7 percent to 18.0 percent of the population, the percentage of children in poverty declined from 15.9 percent to 8.9 percent of persons under age 18, and the prevalence of obesity increased from 10.7 percent to 21.2 percent of the population, indicating a slower rise in obesity in this area than in the U.S. overall.  Vermont leads the nation in the ranking for health determinants, an indication that it will continue to have a position at the top of the rankings in future years.  Health outcomes are also strong in the state as 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 287.9 deaths per 100,000 population. The premature death rate declined from 7,842 to 5,535 years of potential life lost before age 75 per 100,000 population.

• Alaska:  The incidence of infectious disease decreased from 92.2 to 16.2 cases per 100,000 population, the percentage of children in poverty declined from 16.6 percent to 11.6 percent of persons under age 18, and the prevalence of obesity increased from 13.4 percent to 26.2 percent of the population, a rate of increase slightly less than the national average.  The violent crime rate increased from 455 to 688 offenses per 100,000 population, despite a decline in crime rates nationally.  Health determinants as a group ranked worse in the state than health outcomes, thus indicating a possible decrease in future overall health ranking.  In health outcomes, the infant mortality rate in Alaska decreased from 10.6 to 6.2 deaths per 1,000 live births, and deaths from cancer declined from 203.6 to 189.1 deaths per 100,000 population.

• New York:  The prevalence of smoking decreased from 28.7 percent to 18.2 percent of the population and the violent crime rate decreased from 1,007 to 435 offenses per 100,000 population. Though New York has made significant improvements in the last 18 years, the current rank for health determinants is considerably lower than their rank for health outcomes, indicating the strong possibility that the overall health ranking for the state may decline in future years.  Two strong health outcome measures for the state are their infant mortality rate which decreased from 10.7 to 5.9 deaths per 1,000 live births and the premature death rate, which declined from 9,754 to 6,350 years of potential life lost before age 75 per 100,000 population.

• Washington:  The prevalence of smoking decreased from 28.6 percent to 17.1 percent of the population, the incidence of infectious disease decreased from 84.1 to 13.3 cases per 100,000 population and the occupational fatalities rate decreased from 9.9 to 3.8 deaths per 100,000 workers.  The prevalence of obesity in the state increased from 9.4 percent to 24.2 percent of the population, a rate faster than the national average.  Health determinants and health outcomes rank equally in the state, indicating Washington will likely remain near its current ranking.  A strong health outcome for the state is the declining infant mortality rate, which dropped from 9.7 to 5.3 deaths per 1,000 live births.

• California:  The prevalence of smoking decreased from 25.6 percent to 14.9 percent of the population, the violent crime rate decreased from 918 to 533 offenses per 100,000 population and the incidence of infectious disease decreased from 70.6 to 23.7 cases per 100,000 population.  However, the prevalence of obesity increased from 9.8 percent to 23.3 percent of the population, a rate faster than the U.S. average.  Health determinants and health outcomes rank equally in the state indicating California will likely remain around its current ranking.  Improvements in health outcomes from 1990 include a decrease in the premature death rate, which declined from 8,453 to 6,323 years of potential life lost before age 75 per 100,000 population and a decline in the infant mortality rate, which decreased from 9.0 to 5.4 deaths per 1,000 live births.

Twenty-five states are below the national rate of improvement and are slipping further behind in healthiness compared to the nation as a whole.   Oklahoma improved the least since 1990 and has only improved its overall score by 4.5 percent compared to the national 18.4 percent rate of improvement.  Kansas and Tennessee increased by less than 11 percent (Table 6). 

Table 6 - States with the Least Overall Health Score Improvement - 1990 to 2007

                                                        Oklahoma                        +4.5

                                                        Kansas                           +10.6

                                                        Tennessee                      +10.7

The principal reasons for changes in above states from 1990 to 2007 are:

• Oklahoma:  The prevalence of obesity increased from 11.6 percent to 28.8 percent of the population, the prevalence of smoking decreased from 33.0 percent to 25.1 percent of the population, the percentage of children in poverty has increased from 17.7 to 20.7 percent of persons under age 18 and the violent crime rate increased from 419 to 497 offenses per 100,000 population. Health determinants and health outcomes rank almost equally indicating Oklahoma will likely remain around its current rank.  Changes in health outcomes in the last 18 years in the state include an increase in the rate of cancer deaths, which increased from 197.8 to 215.2 deaths per 100,000 population and a decline in the infant mortality rate, which decreased from 10.0 to 8.0 deaths per 1,000 live births but failed to match the rate of decline elsewhere in the U.S.

• Kansas: The high school graduation rate has declined over the 18 years in the state and the prevalence of smoking has decreased from 30.2 percent to 20.0 percent of the population, a slower decline than in other states.  The violent crime rate increased from 361 to 425 offenses per 100,000 population; a change that is counter to the decline in the U.S.  Health determinants in the state have a worse ranking than health outcomes for Kansas, indicating possible continued downward movement in the state’s overall rankings in the future.   A declining infant mortality rate typified health outcomes, declining from 9.2 to 6.7 deaths per 1,000 live births, which is an improvement but lower than the U.S. trend.

• Tennessee:  The violent crime rate in the state increased from 534 to 760 offenses per 100,000 population, the prevalence of obesity more than doubled from 11.8 percent to 28.8 percent of the population, and the percentage of children in poverty declined from 29.6 percent to 20.9 percent of persons under age 18. The prevalence of smoking has declined in the state from 30.8 percent to 22.6 percent of the population, a decline that is slower than other states.  Health determinants and health outcomes rank equally in the state indicating Tennessee will likely remain around its current rank in the future unless additional focus is placed on improving health determinants.  In health outcomes, the premature death rate has stagnated with little change in the last 18 years – counter to the decline in the United States as a whole.  The rate of cancer deaths has increased from 200.9 to 220.3 deaths per 100,000 population, also counter to the U.S. trend.

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 18.4 percent are not improving as quickly as the nation as a whole.