Nation’s overall health not improving, assessment finds: Obesity, diabetes stalling U.S. progress
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* Teddi Dineley Johnson

Despite modest decreases in tobacco use, coronary heart disease and preventable hospitalizations, the nation’s overall health is not improving, a recent national report finds.

Worrisome increases in obesity, diabetes and the number of children living in poverty are offsetting modest improvements in overall health, according to “America’s Health Rankings.” The report, which is published annually, found that for every person who quit smoking in 2011, someone else became obese. Moreover, the number of U.S. children living in poverty continued to climb in 2011, as did the number of Americans who lacked health insurance.

“The health of America is in serious, serious trouble,” Reed Tuckson, MD, executive vice president and chief of medical affairs at United Health Group, said at a Washington, D.C., news conference releasing the report in December. “This ordinarily would be a celebratory moment, but quite frankly, my heart is heavy. We are delivering a tsunami of preventable chronic illness into the hands of a delivery system that America cannot afford.”

Overall, the report is a mixture of good and bad news. Tobacco use has declined 3.4 percent since 2010 and 25.4 percent since 2001. The report found that 17.3 percent of the U.S. population smoked in 2011, down from 17.9 percent in 2010.

“But the bad news is that 17.3 percent of the American people still smoke tobacco, and 440,000 people are going to die this year of tobacco-related illness, and we will spend $190 billion dollars on tobacco-related disease,” said Tuckson, who noted that while 1.4 million Americans quit smoking last year, another 1.4 million Americans became obese.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/1/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/42/1/1.1/F1)

Students at Thurgood Marshall Academy in Washington, D.C., exercise to improve their health in December. A national report released that month says that the nation’s overall health did not improve last year, in part because of health problems that are largely preventable, such as diabetes and obesity.

Photo by Marvin Joseph, courtesy Getty Images/The Washington Post

Obesity is dramatically affecting the health of the nation, according to the report. Overall, the prevalence of obesity has increased 137 percent, rising from 11.6 percent of the population in 1990 to 27.5 percent of the population in 2011. More than one in four American adults — or 65 million people — are considered obese today, according to the report.

“If current trends continue, 43 percent of Americans will be obese by 2018,” Tuckson said.

Diabetes is also taking a toll on the nation’s health. In 2011, 8.7 percent of American adults, or more than 20 million people, had been told by a physician that they have diabetes. The number is almost double the 4.4 percent diabetes prevalence seen in 1996. If the diabetes trend continues, 10 percent of all health care dollars will be spent managing the complications of diabetes by 2020.

The rankings, published jointly by APHA, the United Health Foundation and Partnership for Prevention, also depict an alarming rise in the number of children living in poverty.

“Our economic downturn is having a particularly harmful effect on our nation’s most vulnerable,” said APHA President Melvin Shipp, OD, DrPH, MPH, who spoke at the news event. “The child poverty rate is a strong indicator of the lack of access to health care, and we know that starting life in poverty has lifelong implications for nutrition, physical and emotional health and well-being, academic achieve- ment and a host of other barometers of wellness.”

In 2011, 21.5 percent of U.S. children were living in poverty, up from 20.7 percent in 2010. The number translates to a 3.9 percent increase in the number of children living in poverty since 2010 and a 33.5 percent increase in poor children since 2001.

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/1/1.1/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/42/1/1.1/F2)

APHA President Melvin Shipp, center, speaks at a December news conference. At left is Andrew Webber, president and CEO of the National Business Coalition on Health. At right is Jud Richland, MPH, president and CEO of Partnership for Prevention.

Photo by Teddi Dineley Johnson

## Vermont continues to lead the states

Published each year since 1990, the state-by-state rankings use data from a range of trusted sources, including the Centers for Disease Control and Prevention, the U.S. Census Bureau and Trust for America’s Health.

The report assesses the nation’s health based on 23 factors, including binge drinking, prenatal care, violent crime, occupational fatalities and obesity.

“This is the first time in the report’s 22-year history that not a single state has a prevalence of obesity less than 20 percent,” the report notes.

The prevalence of obesity ranges from 21.4 percent of the population in Colorado to more than one-third of the population in Mississippi, according to the report.

For the fifth year in a row, the report ranked Vermont as the healthiest state, followed by New Hampshire, Connecticut, Hawaii and Massachusetts.

Vermont’s strengths include a high rate of high school graduation, a low violent crime rate, a low rate of infectious disease, a high usage of early prenatal care, high per capita public health funding, a low rate of uninsured residents and ready availability of primary care physicians. But Vermont is challenged by low immunization coverage and a high prevalence of binge drinking, which is at 17.1 percent of the population, said the report.

New York and New Jersey made significant progress in 2011, according to the report. Both states climbed six places in the rankings, largely because of their tobacco cessation progress. Conversely, Idaho and Alaska dropped the most. Idaho, which dropped 10 spots, faces challenges such as large numbers of uninsured residents and low immunization rates. Alaska, which fell five places in the rankings this year, is challenged with high rates of binge drinking and violent crime.

For the 10th year in a row, Mississippi lags behind the rest of the nation in terms of overall health. Mississippi’s strengths include a low prevalence of binge drinking, a low violent crime rate and a high immunization rate. However, Mississippi ranks in the bottom five states in 12 of the 23 measures evaluated in the rankings, including a high prevalence of obesity, low high school graduation rates, a high percentage of children in poverty, limited availability of primary care physicians and a high rate of preventable hospitalizations.

After Mississippi, Louisiana is the nation’s second least-healthy state, according to the rankings. Oklahoma, Arkansas and Alabama round out the bottom five states.

“Unfortunately, Alabama is No. 46 on that list,” U.S. Surgeon General Regina Benjamin, MD, MBA, who is from Alabama, said at the news event. “We have to do better. If I were to pick one thing in Alabama we could improve, it would be to improve our smoking rates.”

Benjamin said stopping disease before it starts is key to helping more Americans stay healthy and better manage surging health care costs.

“I’m a longtime champion of the power of prevention, and it’s the focus of my work as surgeon general,” Benjamin said. “I believe that prevention offers the greatest opportunity to improve the health of America’s families, right now and for decades to come. I also believe that prevention is the key to building a stronger and more sustainable health care system.”

For more information, visit [www.americashealthrankings.org](http://www.americashealthrankings.org).

*   Copyright The Nation’s Health, American Public Health Association