Lake Wobegon Environs Judged Healthiest State

MINNETONKA, Minn., Dec. 6 -- The healthiest state in the nation appears to be Minnesota, land of Wobegon and 10,000 other lakes, low cardiovascular death rates, and a well-insured population, according to the United Health Foundation here.

But lest those in Minnesota get smug, consider that nearly one in four Minnesotans is obese, one in five smoke, and one out of every four pregnant residents does not receive adequate prenatal care, noted the authors of the report, titled "America's Health Rankings: A Call to Action for People & Their Communities."

Whether it's something about the northern latitudes that's conducive to overall health is unclear, but Minnesota has been top-ranked for 11 of the past 17 years, and it was followed in order by two New England states, Vermont and New Hampshire.

On the other hand, Hawaii came in a respectable fourth. It was followed by Connecticut and Utah.

At the other end of the healthiest spectrum, Louisiana, a perennial bottom-dweller on state health rankings, occupied the lowest tier on this year's list again, because of factors such as a high prevalence of obesity (30.8%) and on-the-job fatalities, a high percentage of children in poverty, and high rates of infant mortality, cancer deaths, and premature deaths. The Pelican State also ranked in the bottom 10 for seven other health measures.

On the positive side of the ledger for Louisiana is the fact that it surpassed Minnesota at providing adequate health care services to pregnant women, with 82.8% receiving appropriate prenatal care (tied for fourth overall), versus 75.9% for Minnesota (27th overall), and a low number of poor mental health days per month (2.7, fourth lowest overall).

The purpose of the annual rankings is not to promote the benefits of one state over another or to shame residents of states with lower rankings, but "to stimulate public conversation concerning health in our states, as well as provide information to facilitate citizen participation," the report's authors wrote. "We encourage participation in all elements: personal behaviors, community environment, clinical care and public and health policies."

The rankings are calculated by assembling and sifting through data from a variety of sources on health factors such as smoking prevalence, highway deaths, high school graduation rates, children living in poverty, access to care, and rate of preventable disease.

Data source include the U.S. Departments of Health and Human Services, Commerce, Education and Labor; the National Safety Council, and the National Association of State Budget Officers.

The report offers glimpses of health care promise and perils in these United States, including the following examples of changes from 1990, when the first such report was published, to 2006.

On the positive side:

• Motor vehicle deaths dropped 40%, from 2.5 to 1.5 deaths per 100,000,000 miles driven.
• There was a 45% percent decrease in the incidence of infectious diseases, from 40.7 cases per 100,000 population in 1990, to 22.6 per 100,000 this year.
• Infant mortality was reduced by 35%, from 10.2 per 1,000 live births then to 6.6 per 1,000 now.
• Smoking prevalence slipped from 29.5% in 1990 to 20.6%
• Violent crimes dipped 23% with 609 offenses per 100,000 recorded in 1990, and 469 per 100,000 in 2006.
• The cardiovascular death rate went down 20%, from 406.3 per 100,000 at the start of the last decade of the 20th century, to 326.0 per 100,000 halfway through the first decade of the 21st century.
• The proportion of children under age 18 living in poverty showed a modest decline, from 20.6% to 17.6% (a 15% overall decrease).
• Occupational deaths slide 44%, from 8.7/100,000 to 4.9 per 100,000 workers.
• Immunization coverage jumped by 47%, with only 55.1% of children from the ages of 19 to 35 months getting properly vaccinated in 1996, to 80.8% getting their full immunization schedule in 2006.
• Provision of prenatal care improved by about 10%, with 75.4% of all pregnant women receiving adequate prenatal care in 2006.

On the negative side:

• The prevalence of obesity rose by 110% percent, with slightly more than one in 10 Americans (11.6%) being seriously overweight in 1990, to nearly one in four (24.4%) obese in 2006.
• There was a 19% increased in rate of Americans who go without health insurance, with 13.4% lacking coverage in 1990, and 15.9% having no health insurance in 2006.
• In just one year, from 2005 to 2006, the violent crime rate increased from 463 to 489 offenses per 100,000 population.

In a commentary in the introductory section of the report, Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, noted that while 14 states and numerous communities have enacted laws banning smoking in restaurants, bars, and workplaces, "the majority of Americans still do not live in jurisdictions with smoke-free laws. While smoke-free laws are widely popular, the tobacco industry and its allies continue to resist their enactment."

Another troubling issue is the high percentage of American children who do not have health insurance, noted Marian Wright Edelman, president and founder of the Children's Defense Fund in a separate commentary.

"Among the 46.6 million people in the United States without health insurance coverage, more than nine million are children -- one out of every nine children is uninsured," she wrote. "Every 51 seconds another child is born uninsured. Millions more children are underinsured. The majority of uninsured children live in two-parent households, and 87% live in families where at least one parent works."

Edelman noted that access to health care for children is not guaranteed in the United States, and that the nation ranks 26th among 30 industrialized countries (tied with Hungary and Poland and ahead of only Latvia and Lithuania) in infant mortality, despite spending more of our gross national product on health care than any other nation in the world.

"It is long past time for all children in America to have a fair chance to survive and thrive in the richest nation on earth," she wrote. "Health coverage for all of them must be the top priority of all of us."

The report is available free of charge for viewing or download at: http://www.unitedhealthfoundation.org/ahr2005.html