American Public Health Association
800 I Street, NW • Washington, DC 20001-3710
(202) 777-APHA • Fax: (202) 777-2534 •

For Immediate Release
Contact: Media Relations, (202) 777-2509

20-Year Analysis by America’s Health Rankings™ Finds U.S. Making Successful Strides in Disease Treatment, But Not Prevention

Unhealthy behaviors, such as smoking, poor eating habits and lack of exercise, are costing Americans billions on the treatment of preventable diseases

MINNEAPOLIS (Nov. 17, 2009) — As the health care reform debate continues, the 20th Anniversary Edition of America’s Health Rankings has identified trends that support the need to ensure prevention is part of the solution. Based on two decades of consistent tracking, the 2009 Rankings calls for the nation to change unhealthy behaviors that are contributing to preventable, chronic diseases as the key to improving our nation’s health. Trends cite smoking as the greatest health challenge of the past 20 years and warn obesity is likely to be the next national health battle.


The 2009 Rankings shows the nation’s health care system has become extremely adept at treating certain illnesses and disease, such as cancer and cardiovascular disease. However, Americans are struggling in the battle to modify risk factors, such as smoking, poor eating habits and lack of exercise, which may contribute to chronic diseases in the first place. The United States currently spends more per capita than any other nation on health care, including $1.5 trillion in medical costs associated with chronic diseases, such as diabetes, heart disease and cancer. These chronic, preventable conditions all have a direct link to smoking and obesity, the nation’s two largest national risk factors.


“Over the past 20 years, our national health care system has helped extend the length of life, but not the quality of life,” said Reed Tuckson, M.D., United Health Foundation board member and UnitedHealth Group executive vice president and chief of medical affairs. “Unhealthy behaviors are costing the United States billions in the treatment of preventable, chronic diseases. Obesity alone is expected to cost the nation more than $344 billion in health care related expenditures by 2018. Making progress against smoking and obesity is a critical step to successfully tackling the health reform our nation wants to achieve.”


Results From the Nation’s Only 20-Year Scorecard

The longest running report of its kind, America’s Health Rankings provides a unique, comprehensive perspective on how the nation – and each state – measures up:

·        Smoking — Biggest Battle of Past 20 Years: Despite focused efforts, nearly one in five Americans still smoke, which is only 8 million people fewer than 20 years ago. Smoking remains the leading preventable cause of disease and death in the country, leading to approximately 440,000 deaths annually. Over the past year, more than 3 million people have quit smoking, proving that smoke-free laws, smoking bans, increased cigarette taxes, access to smoking cessation programs and other interventions are beginning to make an impact.

·        Other 20-Year Improvements and Challenges: Over the past 20 years, the nation has seen significant declines in crime rates, infectious disease, smoking and infant mortality rates. Challenges since 1990 include the rising uninsured rate, lack of progress in increasing high school graduation rates and the need to continue to improve access to adequate prenatal care for pregnant women.


Economic Impact of Obesity

To help understand the financial impact obesity may have on national health care costs in the next
10 years, United Health Foundation commissioned a unique study as a supplemental report for this year’s Rankings. This supplemental “Cost of Obesity” report was written by Kenneth E. Thorpe, Ph.D., Emory University professor, executive director of the Partnership to Fight Chronic Disease, and former Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services under President Clinton. The report is the first to provide projections around future health care costs directly attributable to obesity that have been individually calculated for each state, as well as the nation as a whole.

·        Obesity: Next National Health Battle: Obesity is growing faster than any previous public health issue our nation has faced. Today, more than one in four Americans are considered obese
(31 percent). If current trends continue, 103 million American adults — or 43 percent of the population — will be considered obese by 2018, making obesity the nation’s next health battle.

·        Obesity-Related Cost Projections for 2018: Excess Pounds Creates Excess Costs: Included as supplemental data to this year’s Rankings are estimates around the growth of health care costs over the next 10 years if obesity continues to rise at unprecedented levels. Left unchecked, obesity will add nearly $344 billion to the nation’s annual health care costs by 2018 and account for more than 21 percent of health care spending. If obesity levels held at their current rates, the U.S. could save an estimated $821 per adult by 2018 — a savings of more than $198 billion.

o       Oklahoma is projected to have the highest obesity rate in the country by 2018; as a result, they are facing an estimated $3.2 billion in health care costs attributable to obesity —
or approximately $1,207 per adult.

o       Colorado is estimated to have the lowest national obesity rate by 2018, costing the state
$1.8 billion in health care costs tied to obesity.


“As a nation, we are fighting the wrong health care battle. Although there is a wealth of evidence supporting the value of prevention as a way to save lives and save money, the majority of every health care dollar goes towards treating illness,” said Georges C. Benjamin, M.D., executive director of the American Public Health Association. “Essentially, health reform should include a strong focus on prevention. Behaviors, such as smoking and obesity, are limiting our nation’s ability to make progress and costing billions in unnecessary, preventable health care costs.”

Over the past 20 years, America’s Health Rankings has evolved from a source of information for limited audiences to a robust, interactive tool that urges all populations and communities to take action to improve health. The Rankings is published jointly by United Health Foundation, the American Public Health Association and Partnership for Prevention.

on Top for 2009 State Rankings; New York Most Improved in 20 Years

This year, the Rankings not only provided an annual list of the healthiest and least healthy states, and also determined which states had improved the most over the past 20 years in overall health and how the states compared in their progress against smoking and obesity since 1990.


2009 State Rankings

The 2009 Anniversary Edition shows Vermont as the healthiest state this year. The state has had a steady climb in the Rankings for the past 12 years, moving up from 20th in 1990. Utah climbed from a ranking of fifth to second this year, followed by Massachusetts (3), Hawaii (4) and New Hampshire (5) to round out the Top 5 healthiest states for 2009. For the second year in a row, Utah leads the nation as the state with the lowest prevalence of smoking, and Colorado ranks as the state with the lowest prevalence of obesity.


Mississippi is ranked 50th this year, followed by Oklahoma (49), Alabama (48), Louisiana (47) and South Carolina (46). A complete listing of the 2009 state health rankings is available at

“The primary drivers of poor health and high health care costs are behaviors — tobacco use, poor diet, physical inactivity and alcohol consumption — that are largely preventable,” said
Robert J. Gould, Ph.D., president and CEO of Partnership for Prevention. “The increasing incidence of chronic disease poses a severe financial threat to our health care system and economy, but even worse is what it portends for Americans in the future. Without addressing these underlying causes of poor health, we will never be able to do more than provide temporary solutions to the difficult problems facing our health system and the nation’s health.”


States With the Most Improvement Since 1990

Over the past 20 years, New York has demonstrated the most improvement in the overall health of its population. This improvement has primarily been based on a 60 percent reduction in violent crime and significant reductions in infant mortality and smoking rates. Other states showing the most improvement since 1990 include Vermont, Hawaii, New Hampshire, New Jersey and Minnesota.


States with the greatest success against smoking in the past 20 years include Rhode Island, Virginia, Maryland, Florida, Delaware and Vermont. States with the greatest success against obesity in the past 20 years include Connecticut, Rhode Island, Massachusetts, Wyoming and Florida.


Get Informed and Take Action to Improve National Health

The 20th Anniversary Edition of America’s Health Rankings has more data than ever before,
and the data is now easier to access, compare and share. The following tools are now available at

·        e-Rankings is a searchable database that makes it possible to find out how each state — and the nation — rates now compared to 20 years ago.

·        Healthy Actions Center features tips, tools and programs offered by proven experts to help everyone — from individuals to elected officials — make a difference now.

·        Obesity Cost Calculator highlights national and state-specific costs of obesity today and projects how those costs could skyrocket in the future.


About America’s Health Rankings

America’s Health Rankings is the longest running report of its kind. For 20 years, the Rankings has provided an analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socio-economic data to determine national health benchmarks and state rankings. The Rankings employs a unique methodology, developed and annually reviewed by a Scientific Advisory Committee of leading public health scholars. For more information, visit

About the United Health Foundation

Guided by a passion to help people live healthier lives, United Health Foundation provides helpful information to support decisions that lead to better health outcomes and healthier communities. The Foundation also supports activities that expand access to quality health care services for those in challenging circumstances and partners with others to improve the well being of communities. Since established by UnitedHealth Group [NYSE: UNH] in 1999 as a not‑for‑profit, private foundation, the Foundation has committed more than $170 million to improve health and health care. For more information, visit

About the American Public Health Association

The American Public Health Association (APHA) is the oldest and most diverse organization of public health professionals in the world and has been working to improve public health since 1872. The Association aims to protect all Americans, their families and their communities from preventable, serious health threats and strives to assure community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States. APHA represents a broad array of health professionals and others who care about their own health and the health of their communities. More information is available at 

About Partnership for Prevention

Partnership for Prevention is a membership organization of businesses, nonprofit organizations and government agencies advancing policies and practices to prevent disease and improve the health of all Americans. The organization seeks to increase investment in preventing disease, promoting health and making prevention a national priority among both the public and private sectors. For additional information, visit     



# # #
Founded in 1872, the APHA is the oldest, largest and most diverse organization of public health professionals in the world. The association aims to protect all Americans and their communities from preventable, serious health threats and strives to assure community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States. APHA represents a broad array of health providers, educators, environmentalists, policy-makers and health officials at all levels working both within and outside governmental organizations and educational institutions. More information is available at