Four New England states among nation’s healthiest

Massachusetts ranked second after Hawaii as the healthiest overall state in the nation in the latest America’s Health Rankings Annual Report released in December 2016.

Connecticut ranked third, Minnesota fourth, Vermont fifth and New Hampshire sixth in the 27th annual assessment of the country’s health on a state-by-state basis. The report published by the United Health Foundation measures how health benchmarks in each state change year to year.

All New England states landed in the top half of the rankings with Rhode Island at 14th and Maine at 22nd. Maine had the largest decline in rank over the previous year, dropping from 15th, while Vermont fell from second place to fifth.

Connecticut showed the most notable improvement, however, in rising from sixth to third. While the Northeast generally ranks among the healthiest overall states, the bottom five states are all southern states with Oklahoma, Alabama, Arkansas, Louisiana and, in last place, Mississippi.

Public health funding increased 9 percent from $86 to $94 per person over the previous year. Alaska spent the most per person – $261 – followed by Hawaii at $220 and West Virginia at $205.

Among New England states, Rhode Island’s per person public health expenditures were the highest at $124 while New Hampshire spent the lowest at $66. In between, Vermont spent $115, Massachusetts $102, Maine $85 and Connecticut $76.

Per person public health spending is an important measure because the impact can be substantial, said Rhonda Randall, DO, chief medical officer of UnitedHealthcare Retiree Solutions and a member of the Scientific Advisory Committee that meets annually to review the America’s Health Rankings report.

“The more a state spends on public health, the less you see premature death,” Randall said.

But, she added, the report can’t explain how effectively each state is spending every dollar.

“It may be that some states that spend less and still rank high are spending each dollar more efficiently in the right places, that they’ve got good data to tell them where to invest their dollars.”

Premature death measures the years of potential life lost before age 75. Nearly half of U.S. premature deaths are because of behavioral factors such as tobacco use, lack of physical activity, and poor diet.

The states with the lowest rates of premature death were Minnesota followed by Connecticut, California, New York and Massachusetts.

“They are getting a very good outcome as far as mortality is concerned,” Randall said.

The 2016 report revised the way it examines mental health data as a result of data surveillance changes by the U.S. Centers for Disease Control and Prevention, Randall said.

Instead of measuring poor mental health days, the report looks at the percentage of adults who reported their mental health was not good on 14 days or more in the past 30. The national average of adults experiencing “frequent mental distress,” (FMD) as the new outcome criteria is called, was 11.2 percent.

Associated with housing and food insecurity and insufficient sleep, FMD is considered a significant predictor of future health problems, hospitalization or mortality. Among New England states, Maine’s FMD score was nearly triple the national average at 31 percent of adults, far higher than the other five states.

Vermont (10.6 percent), New Hampshire (10.9 percent) and Connecticut (11.1 percent) all did better than the FMD national average while Massachusetts had 11.6 percent and Rhode Island had 12.4 percent.

Across the nation, the rate of drug deaths increased 9 percent over the past five years, rising 4 percent in the past year alone. Rhode Island ranked in the bottom five states with 21.4 deaths because of a drug injury of any intent (unintentional, suicide, homicide or undetermined) per 100,000 population. The national average is 14. West Virginia, at 32.2, ranked worst in the nation.

“Where you live matters,” Randall said. “So, the environment around you matters in a micro way and in a macro way.”

Communities with clean air, low rates of infectious disease and violent crime can certainly have a positive influence on residents living in them, Randall added.

“But maybe the impactful thing is you have to adopt the behaviors of the people in that community,” Randall said. “If it’s a community that doesn’t smoke, if it’s a community that has low rates of obesity, if it’s a community that encourages everybody to finish high school and get a high school diploma, if you adopt those behaviors no matter where you live, you as an individual are going to be healthier.”

Among the report’s findings:

• All New England states exceeded the national average for binge drinking, defined as the percentage of adults who reported either having four or more drinks on one occasion for women and five or more drinks for men and chronic drinking, defined as having eight or more drinks in the past week for women and 15 or more for men.

The national average for excessive drinking was 17.7 percent. Maine and Vermont both showed excessive drinking at 19.6 percent of adults, Massachusetts was slightly behind at 19.5 percent, Connecticut at 18.6 percent, New Hampshire at 18.4 percent and Rhode Island at 17.9 percent.

• The national average continued to show a decline in the prevalence of smoking, which has decreased 41 percent since 1990, including 17 percent drop over the past four years. But Maine had the highest percentage of smokers in New England, defined as the percentage of adults reported smoking at least 100 cigarettes in their lifetime who still smoke every or some days.

The national average is 17.5 percent. At 19.5 percent, Maine was the only New England state to have a higher percent of smokers than the national average.

• The prevalence of obesity remained high with 29.8 percent of U.S. adults having a body mass index of 30 or higher. Massachusetts had New England’s lowest obesity rate and the fifth lowest in the country at 24.3 percent.

Obesity increased across all education groups between 2012 and 2016, but the average annual rate of change was 2.5 times higher among high school graduates than college graduates.

While Vermont’s overall prevalence of obesity was considered low, the Green Mountain State saw a 2.52 percent increase in obesity among adults who did not graduate from high school, the highest rate of change among all 50 states.

In Connecticut, smoking and obesity are increasing at rates faster than the national average among adults aged 25 years and older who did not graduate from high school.

• In Rhode Island, 28.1 percent of adults reported doing no physical activity or exercise other than their regular job in the past 30 days.

Rhode Island and Massachusetts at 26.5 percent, were the only New England states to exceed the national average of 26.2 percent.