The latest annual state-by-state survey gauging Americans' health finds there has been little improvement over the past year. The 2008 America's Health Rankings, conducted for the past 19 years by a consortium of the nation's private health service companies, also shows the U.S. falling behind 27 other countries in the quality and availability of health care.  
The overall health of Americans hasn't improved much for the past four years, according to this year's edition of America's Health Rankings. Dr. Manuel Selva Jr. - medical advisor with the United Health Foundation, the nonprofit research group that conducts the rankings - cites three key reasons why America's overall health rankings aren't budging.

"Twenty percent of our population still smokes," he says. "Over 400,000 lives are lost every year due to smoking. Second is obesity. We've doubled the number of obese persons in this country in the last generation. The third most important reason is the fact that 46 million Americans - almost 16 percent of our population  - are without health care."

The rankings analyze 22 different measures for assessing the nation's health, using a combination of health determinants - such as lifestyle and availability of medical services - and health outcomes - such as disease trends and death rates. Based on these measures, Selva says, the state-by-state rankings show Vermont, in America's northeast, is the healthiest state for the second year in a row.

"Vermont has maintained this No. 1 position because it continues to do the things that help improve people's behavior," he says. "What I'm referring to in particular is that since last year, the prevalence of smoking in Vermont has gone down by over 17 percent. So they are attempting to improve the health of their citizens year after year."

Vermont was ranked 16th when the first edition of America's Health Rankings was released almost two decades ago. Over the past eight years, Selva says, Vermont has lowered the percentage of its children living in poverty, increased access to primary medical care for residents and improved immunization coverage.
The Pacific island state of Hawaii this year climbed from its No. 3 ranking in 2007 to second place, followed by New Hampshire, Minnesota and Utah. At the bottom of the rankings, Selva notes, is the southern Gulf state of Louisiana. Still struggling to recover from the physical and economic ravages of 2005's Hurricane Katrina, Louisiana displaced Mississippi this year as the unhealthiest state in the country.

"The percentage of children in poverty has gone up. They have a high rate of uninsured," he says. "Also, because of Katrina, there were a number of physicians that left the state and had not come back. However, there are positive signals.  The per capita health spending has increased 37 percent. The access to primary care has improved by 5 percent."

America's Health Rankings report also compares the United States to other industrialized countries. Selva finds these rankings especially troubling.

"We as a country, we are spending over $2 trillion a year, and despite that spending, which is more than any other country in the world, we're still lagging behind our industrialized partners," he says. "For instance, there are 27 other countries that exceed the United States in terms of healthy lifestyle, life expectancy. In terms of child's health, we are second to the last among 21 developed nations."

Dr. Georges Benjamin, spokesman for the American Public Health Association, which collaborates on the rankings, says he's concerned about this year's findings.

"This flattening of our improvement has occurred in a time in which our nation was fairly prosperous," he says. "So we're concerned that these health outcomes may get worse because of the economic turndown."

Benjamin says he is hopeful that changes in the American political landscape - a new president in the White House and a newly constituted U.S. Congress - could lead to improvements in the nation's health care:

"We're very excited about the new administration," he says. "We're seeing a great promise in the kind of things the new administration wants to focus on. They want to focus on covering the uninsured. They want to focus on addressing chronic diseases like the obesity epidemic. They've shown interested in trying more seriously on fighting smoking and certainly investing in public health system. We think those are very important pyrometers to try to turn these statistics around."

Both Benjamin and Selva say they hope America's Health Rankings 2008 will generate more public debate about the health care challenges in America and spark new efforts - by individuals, public health professionals and policy-makers - to make all Americans healthier.