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An annual ranking finds evidence that Americans made "a notable shift" toward better health in 2013.
Gains were seen in more than two-thirds of the measures analyzed for the 2013 America's Health Rankings report, out today, including:
A decline in the smoking rate, down from 21.2% of the adult population in 2012 to 19.6%. Seventeen states had significant drops in smoking, the largest in Nevada, Maryland, Oklahoma, Kansas and Vermont.
A drop in physical inactivity, defined as doing no activity outside of work for 30 days, down from 26.2% of adults in 2012 to 22.9% in 2013. States range from 31.4% inactive in Arkansas to 16.2% in Oregon.
A leveling off of the obesity epidemic as the percentage of adults who are obese (30 or more pounds over a healthy weight) holds steady.
This marks the first year since 1998 that obesity rates did not increase, making it "a victory of sorts," says Reed Tuckson, senior medical adviser to the not-for-profit United Health Foundation, which sponsors the report with the American Public Health Association and the Partnership for Prevention. It uses data from the Centers for Disease Control and Prevention, American Medical Association, Census Bureau, Department of Education and even the FBI. It looks at 27 measures including tobacco and alcohol abuse, exercise, infectious diseases, crime rates, public health funding, access to immunizations, premature birth rates and cancer and heart disease rates.
"The big conclusion is that these trends give us reason to be empowered to do more. We're seeing it all across America -- individuals and families are making the decision to be active, to eat a more appropriate diet, to stop smoking. ... People can do it. ... Now we have to do more of it.
"We are in no way declaring the war is over but ... that there is reason for optimism," he adds.
Among challenges the report cites: the growing percentage of adults diagnosed with diabetes, which affects 9.7% of adults, double the rate in the mid-1990s. State rates range from 7% of adults in Alaska to 13% in West Virginia. Diabetes is the USA's seventh leading cause of death and contributes to heart disease and stroke, first and fourth.
Hawaii is this year's healthiest state. Last year, Vermont was No. 1. Hawaii scored well on most measures, including low rates of uninsured, high rates of childhood immunization and low rates of obesity, smoking and preventable hospitalizations. But the report says it has room for improvement: high rates of binge drinking and occupational fatalities and below-average rates of high school graduation.
Last-ranked Mississippi has been in the bottom three states since the rankings began in 1990. States with the greatest improvements: Wyoming (up eight places); Idaho (up seven); Montana (five); New Mexico (four); and New York (three).
"People love rankings, and they do provide a real positive function," says Steven Wallace, the associate director of the UCLA Center for Health Policy Research, which was not involved in the report. "Being at the top is reason to crow, and being at bottom is a real motivator for policymakers, public health officials and communities to say we can do a lot better than we have been."