Some of sickest states show healthy gains while others still lag

Increases in drug deaths, obesity and diabetes offset national declines in smoking, deaths from heart disease and infant mortality, a new report shows, but some states' dramatic improvement brightened the overall picture.

The 2015 version of America’s Health Rankings showed there was little progress among many of the poorest, sickest states, with some of the southern states – Louisiana, Mississippi and Arkansas – remaining at the bottom of the list.

"We couldn’t possibly afford all the medical care required to treat all these conditions," says physician Reed Tuckson, external senior medical adviser to the United Health Foundation which does the annual report. "If we don’t turn off the spigot of preventable illness, we will bankrupt Medicare, Medicaid and our private insurance systems."

The rankings come on the heels of a report from the Commonwealth Fund that showed more states improved than worsened over time on most of 42 indicators, including infant mortality and breast cancer deaths, examined. Poor states such as Kentucky, Louisiana and Tennessee were among those that saw the greatest gains across health measures.

Despite gains, however, smoking, lack of exercise and other issues persist in many places.

“Too many Americans today are developing chronic illnesses due to their lifestyle choices,” said Rhonda Randall, an osteopath and senior adviser to the United Health Foundation, which releases its report every year.

North Carolina showed the biggest improvement in its rank in the United Health report over the past year, jumping six places. It was buoyed by an increase in the percentage of immunizations, in physical activity and salmonella infections were down. The report also singled out Maine, Washington state, Kentucky and Delaware for their improved rankings. 
Some other positive signs in the America's Health Rankings:

• Smoking rates were down 5% in the last year, dropping nearly a percentage point to 18.1% among adults and down 39% since 1990.

• Rates of sedentary behavior measured by the number of adults who reported no physical activity in the last 30 days dropped 11% to about 23% of adults.

• Preventable hospitalizations declined 8% to less than 58% discharges per 1,000 Medicare beneficiaries.

• And steady declines were seen in infant mortality and deaths from heart disease.

Still, drug deaths were up 4%, self-reported obesity saw a 2.5-fold jump and the number of children living in poverty was up 6%.

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Some states continue to face big challenges — such as Louisiana, which ranked 48th in the Commonwealth Fund report and last in the United Health Foundation rankings.

Poverty is one of the reasons Louisiana ranks so poorly compared with other states, says Amelia Burns, press secretary at the Louisiana Department of Health and Hospitals. In rural Louisiana, the poverty rate is 24.2%, and more than half of the state’s parishes are considered rural.

“People’s socioeconomic status and daily environments can influence their behaviors and the decisions they make for their health care,” Burns says. “Poverty, especially persistent poverty, can be a major contributor to poor health outcomes.”

Given this reality, she says, her department is focusing on a goal “of building systems of care that challenge the status quo,” with input from the community and other stakeholders.

Burns says initiatives include strengthening the state's Medicaid managed-care program, bolstering access to behavioral health, moving health care delivery from the state to local governing bodies, and using technology to improve health.

She also cites the state's "Well-Ahead Louisiana" program, which makes in easier for residents to make make healthy lifestyle choices in their areas.

While the increase in physical activity is encouraging given the rise in obesity, Tuckson says there have been short-term fluctuations in that measure in the past. He hopes it marks the "beginning of a prolonged trend."

That's needed because the foundation's research shows the incidence of diabetes is increasing and now affects 10% of the population.

"The downstream consequences of that are going to be extraordinary, not only for people's health, but for the financial health of the nation," he says.