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Annual report suggests many in U.S. face health risks

Monday December 17, 2012
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Americans are living longer due to various medical advances, but unhealthy behavior and preventable illness threaten quality of life, according to the "2012 America’s Health Rankings" by the United Health Foundation.

While premature, cardiovascular and cancer deaths have declined since 1990 by 18%, 34.6% and 7.6%, respectively, Americans are experiencing significant levels of obesity (27.8% of the adult population), diabetes (9.5%), hypertension (30.8%) and sedentary behavior (26.2%).

For the sixth year in a row, Vermont is the nation’s healthiest state, according to the report. Hawaii is ranked second, followed by New Hampshire, Massachusetts and Minnesota. The five least healthy states are South Carolina (46), West Virginia (47), Arkansas (48) and Mississippi and Louisiana (tied for last).

States that showed the most substantial improvement in rankings include New Jersey (nine slots), Maryland (five slots), and Alabama, Colorado, Massachusetts, Nebraska, Oklahoma and Rhode Island (three slots). The complete rankings are available at www.americashealthrankings.org.

Risk factors

Rates of sedentary behavior, which is defined as not doing any physical activity outside of work for the last 30 days, are as high as 35% of the adult population in Mississippi, Tennessee and West Virginia. These statistics need to be understood in the context that even minimal action can produce meaningful results, according to the report’s authors. A 2012 study in PLoS Medicine showed that moving from sedentary to mild activity increases life expectancy by 1.8 years, for example.

Obesity continues to be at epidemic levels, according to the report. The national median of obese adults is 27.8%, meaning more than 66 million adults are obese. In even the least obese state, Colorado, more than 20% of the population is obese. The combination of sedentary behavior and poor diet inevitably leads to increasing levels of obesity, which contributes to diabetes, cardiovascular disease, cancer and other negative health outcomes, the authors noted.

Additionally, the economic burden of obesity is worrisome. By 2030, medical costs associated with treating preventable obesity-related diseases are estimated to increase to $66 billion per year, and the loss in economic productivity could be between $390 billion and $580 billion annually, according to "F as in Fat: How Obesity Threatens America’s Future 2012," a report released by Trust for America’s Health and the Robert Wood Johnson Foundation.

The rate of adults with diabetes is as high as 12% in West Virginia, South Carolina and Mississippi. The national median of adults with diabetes is 9.5%. A 2010 report from the UnitedHealth Center for Health Reform & Modernization indicated that if these rates are not reduced, diabetes and pre-diabetes will account for about 10% of total healthcare spending by 2020, at an annual cost of almost $500 billion.

In addition, 30.8% of adults nationwide reported having elevated blood pressure. The prevalence of hypertension ranges from a low of 22.9% of adults in Utah to a high of 40.1% in Alabama. A recent study from the Centers for Disease Control and Prevention found that 39.4% of hypertensive adults are unaware of their elevated blood pressure, indicating that the actual burden of hypertension might be even higher than reported. And 53.5% of adults who know they have hypertension do not have their condition under control, according to that report.

Issue of geography

This year’s rankings included stark differences between the five healthiest states (Vermont, Hawaii, New Hampshire, Massachusetts and Minnesota) and the five least healthy states (Mississippi, Louisiana, Arkansas, West Virginia and South Carolina).

In a comparison of the top five and bottom five states, the least healthy states face formidable challenges related to behavioral determinants of health and to socioeconomic factors that influence health, the researchers said.

While smoking rates in the five healthiest states range from 16.8% to 19.4% of the adult population, smoking rates are between 23.1% and 28.6% in the five least healthy states. Likewise, 27.2% to 36% of the population leads sedentary lives in the five least healthy states, compared with between 21% and 23.5% of the population in the five healthiest states.

The rankings also illustrate the impact of a state’s economic climate on its residents’ health. The five highest-ranked states report a higher median household income ($51,862 to $65,880) than the five lowest-ranked states ($37,881 to $43,939). Rates of children in poverty, which range between 8.6% and 16.4% of residents in the five healthiest states, are between 24.4% and 30.5% in Mississippi, Louisiana, Arkansas, West Virginia and South Carolina. Per-capita income and poverty affect the ability of households to afford aspects of a healthy lifestyle, the researchers said.

Healthier states also report a healthier job climate. Unemployment rates range between 5.4% and 7.3% of the population in the five highest-ranked states, compared with between 7.8% and 10.5% of residents in the five lowest-ranked states.

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