John Clymer of Partnership for Prevention (l) and Reed Tucker of United Health Foundation

"America’s Health: State Health Rankings 2003" is an annual analysis of the relative healthiness of Americans compiled by the non-profit foundation United Health Foundation, in partnership with APHA and the Partnership for Prevention. The report draws upon data from sources such as the U.S. Departments of Health and Human Services, Education and Labor and the National Safety Council.

The rankings use criteria that fall into three broad categories: personal behavioral decisions, such as quitting smoking; community environment, such as violence rates in neighborhoods; and policy decisions of public and elected officials, such as providing access to prenatal care. Unusual in surveys of this kind, "America’s Health" includes not only traditional health data, but also non-traditional information such as high school graduation rates, which reflect individuals’ abilities to make informed health care decisions, said Georges Benjamin, APHA’s executive director.

Massachusetts has always been among the top 10 healthiest states during the 14 years in which the report has been produced. In 2003, the state had a low prevalence of smoking; low rates of motor vehicle deaths, heart disease, and premature deaths; and high access to prenatal care, according to the report.

However, Massachusetts was one of four states that showed the biggest decreases in their scores from 2002 to 2003. A primary reason for the decline was a dramatic drop in support for public health care from 49 percent above the average state ranking to one percent above the average. The support for public health care refers to the ratio of health care expenditures to low-income population. The factor indicates whether a state’s budget priorities reflect the public health care needs of the population, according to the report.

The U.S. overall health improved 1.4 percent since the release of the 2002 report, due in large part to declines in infectious disease as well as premature death rates. Since 1990, the overall healthiness of the nation has improved 16.9 percent.

While those trends are positive, the improvements are beginning to level off, said Reed Tucker, vice president, United Health Foundation. The rate of improvement has steadily slowed over the past four years. More worrisome, the apparent plateau does not yet reflect forces in direct opposition to further improvements, said Tucker: increased numbers of uninsured people, cutbacks in state budgets, funneling of public health money to bioterrorism preparedness efforts and the emergence of SARS.

When put together, the factors indicate "not a very healthy future scenario," said Tucker. "We all have reason to be concerned."

The methodology used in the report was determined and weighted by an independent panel of public health and methodological professionals organized by the School of Public Health at the University of North Carolina at Chapel Hill.

The complete report is available at www.unitedhealthfoundation.org.

Top 10 Healthiest States

1. Minnesota
1. New Hampshire (tied)
3. Utah
4. Vermont
5. Massachusetts
6. Connecticut
7. Iowa
8. Maine
9. Colorado
10. Hawaii

Bottom 10 Healthiest States

41. Georgia
42. Florida
43. Alabama
44. West Virginia
45. Oklahoma
46. Tennessee
47. Arkansas
48. South Carolina
49. Louisiana
50. Mississippi

Rankings according to "America’s Health: State Health Rankings 2003" by the United Health Foundation.