Americas Health Rankings: The influence of preventive indicators on improved state rankings

For 20 years, America's Health Rankings have served as an important stimulus for change as states worked to improve population health. Many of the indicators used in the Rankings have improved over time, raising the bar for states trying to improve their overall ranking. We describe trends at the indicator level, and examine the influence of state-level indicator-specific improvements on the overall state ranking.

Changes in indicator levels from 1990 – 2010 were calculated at the state and national levels. Changes in the state overall rank for the same time period were categorized as “better,” “worse” or “no change.” Association between a better state ranking and change observed in associated indicators was examined using logistic regression.

All mortality measures improved over the two decades. Of the behavioral measures, prenatal care visits, tobacco use and immunization all improved; obesity rates decreased. Half the states saw improved rankings, with five states experiencing double digit rank improvement: Maine, Maryland, New York, Oregon and Vermont. Four states saw no change in their ranks; the remaining states had worse rankings in 2010 than in 1990. Improvements in the tobacco cessation indicator were significantly associated with improved overall ranking (OR=11.0, 95% CI: 2.0 – 60) for states in the highest quartile of smoking cessation).

States can use rankings to make policy and programmatic changes to improve health. Achieving improvements in preventive indicators can improve state rankings.