As the new year approaches, many people focus on improving their health -- but how does where you live rank when it comes to health?
Hawaii now ranks as the healthiest state in America, beating out Massachusetts to return to the top spot in a new report by the United Health Foundation, a nonprofit division of UnitedHealth Group, which also owns the insurance company United Healthcare and Optum.
Hawaii, Massachusetts, Connecticut, Vermont and Utah are the five healthiest states of the year, while the five least healthy are Arkansas, Oklahoma, Alabama, Mississippi and, coming in last, Louisiana, according to the annual America's Health Rankings report, released last week.
The report has been conducted annually for the past 29 years.
"A rank means that you overall are healthier than the states below you in the rank and are overall less healthy than the states above you in the rank," said Dr. Rhonda Randall, chief medical officer of UnitedHealthcare National Markets and a senior adviser to the America's Health Rankings report.
"The report provides a benchmark of how the health of each state's population has changed year over year, by comparison to other states, and insights into challenges and successes. The states that are in the top five on the list have areas where they could improve. The states that are in the bottom five have areas that they have done well," she said. "So every state has some areas where they're challenged and some areas where they have some really strong measures around their health."
Last year, the five healthiest states were the same but in different order: Massachusetts, Hawaii, Vermont, Utah and Connecticut. The least healthy last year were West Virginia, Alabama, Arkansas, Louisiana and Mississippi. Previously, Hawaii had a five-year reign as healthiest state.
'Obesity has hit an all-time high'
To create the rankings, the report takes into account 35 health factors and examines them by state.
Those 35 measures fall into categories: "the behaviors that we are choosing in our lifestyle; the community and environment where we live; the public policy that happens at a state level; and the clinical care that we receive when we go to the doctor and the hospital ultimately influence the outcomes around our health," Randall said.
"A scientific advisory committee looks at each one of those measures and determines, based on scientific evidence, how much of an impact that measure has on the overall health of a population," she said. "Then, the states get a ranking for each individual measure, and then they get an overall ranking."
The data in the report also provided a snapshot of the nation's overall health, which Randall said revealed both concerning and encouraging trends.
"Starting with the thing that concerned us the most, obesity has hit an all-time high. The obesity rate in America for the adult population, for the first time in the history of producing this report, is up 5% in the past year. It hit 31.3% for 2018," Randall said.
In other words, nearly one in three US adults is obese.
Obesity rates also appeared to be high in many of the states ranked as least healthy. For instance, the prevalence of obesity in West Virginia is 38.1%, nearly double the prevalence in Colorado, where it is 22.6%, according to the report.
"Another thing that concerns us that we found in this report was that premature death increased 3% in the past year. That means years of life lost before people are reaching the age of 75," Randall said.
"That often has correlation with a number of factors -- things like our lifestyle choices, living with more chronic diseases," she said. "We also know that the suicide rate has increased as well, and that would contribute to the increase in premature death rate, along with other causes."
The report measured the suicide rate as the number of deaths due to intentional self-harm per 100,000 deaths recorded on death certificates, and the data showed that America's suicide rate has increased 16% since 2012.
The report wasn't all doom and gloom; it also had some positive findings.
"Childhood poverty has decreased," Randall said.
"That's a key indicator of somebody's socioeconomic status and a good predictor of how their overall health is going to be for the rest of their life. That childhood poverty measure decreased 6% since the prior year," she said.
"We're also seeing there are more mental health providers available than in prior years," she said. "That measure looks at mental health providers of all degrees, so it looks at psychiatrists, psychologists, mental health professionals, marriage and family therapists as examples, and so that number has increased nationally."
What's behind the state-by-state differences
Some of the state-by-state differences in the rankings could be explained by social determinants of health, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the new report.
The US Centers for Disease Control and Prevention defines social determinants as the complex social structures and economic systems that can drive most health inequities, such as access to health care or education.
"If you think about the things that cause premature death -- heart disease, perinatal deaths, tobacco-related diseases -- in many ways, those are spurred by social determinants," Benjamin said.
For instance, "Mississippi, Alabama, Louisiana continue to be at the bottom, and that kind of carries up to the Arkansas and Tennessee region. When you look at some of the challenges they have, it's still around tobacco use and poverty and, to some degree, physical inactivity," he said. "Those are the things that we know result in fundamentally poor health outcomes. What we would like to see is all states improving."
Hopes for better health in the new year
As the nation looks toward 2019, Randall said, she has some hopes for public health.
"What I hope we will see next year is that some of these trends really start to go in a better direction. As an example, the smoking trend in the United States has come down consistently over the 29 years of this report. That encourages me," Randall said.
"Now, if we focus our attention to other lifestyle choices -- like physical inactivity, like obesity -- and find out as individuals what motivates us, what are the small changes that we can make that we'll stick with," she said.
"Whatever that is -- whether that's wearing something that's tracking your activity and it's encouraging you to just add a little bit more walking in your daily life; whether it is having a buddy who you're going to get up and take the dog for a walk together with -- whatever that is that's going to motivate you, it's going to be something that can help you stick with it."
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