Alabama

Alabama is tied with West Virginia for 43^rd this year; it was also 43^rd in 2003. Strengths include strong support for public health with 7.3 percent of the state health budget allocated to public health, high access to adequate prenatal care with 77.8 percent of pregnant women receiving adequate prenatal care and a moderate rate of uninsured population at 14.2 percent. Alabama's challenges include a high prevalence of obesity at 28.4 percent of the population, a high premature death rate with 9,814 years of potential life lost before age 75 per 100,000 population and a low high school graduation rate with 57.2 percent of incoming ninth graders who graduate within four years. Alabama is 39^th for the combined measures of risk factors and 47^th for the combined measures of outcomes, indicating that the state's relative healthiness may remain steady or improve in future years. Disparities in health outcomes are high in Alabama, as shown in the difference in premature death rates. Non-Hispanic blacks lose 14,215 years of potential life before age 75 per 100,000 population compared to Hispanics, Asian/Pacific Islanders and American Indians who lose under 4,000 years per 100,000 population.

In the past year, the infant mortality rate declined from 9.4 to 8.6 deaths per 1,000 live births, the prevalence of smoking increased from 24.4 percent to 25.3 percent of the population and the rate of uninsured population increased from 12.7 percent to 14.2 percent.

Since 1990, access to adequate prenatal care has increased from 67.6 percent to 77.8 percent of pregnant women receiving adequate prenatal care, and the prevalence of obesity has increased from 12.3 percent to 28.4 percent of the population.

To learn more about health and health initiatives in Alabama, visit the Alabama state department of health Web site at: www.adph.org

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Alaska

Alaska is 24^th this year; it was 38^th in 2003. Overall, Alaska has steadily improved its ranking since 1990.  Strengths include strong support for public health with 34.5 percent of the state health budget allocated to public health, a low percentage of children in poverty at 11.2 percent of persons under age 18 and a low rate of deaths from cardiovascular disease at 289.4 deaths per 100,000 population.  Alaska's challenges include a high prevalence of smoking at 26.2 percent of the population, a high rate of uninsured population at 18.9 percent and low access to adequate prenatal care with 68.0 percent of pregnant women receiving adequate prenatal care. The state is 33^rd for the combined measures of risk factors and 15^th for the combined measures of outcomes, an improvement in both since 2003. Health disparities within the state are high, as shown by access to adequate prenatal care - this varies from 46.6 percent of pregnant American Indian women to 76.4 percent of pregnant white women who receive adequate prenatal care.

In the past year, the percentage of children in poverty declined from 12.5 percent to 11.2 percent of persons under age 18, the prevalence of smoking decreased from 29.3 percent to 26.2 percent of the population, the infant mortality rate declined from 7.5 to 5.9 deaths per 1,000 live births and the high school graduation rate decreased from 63.8 percent to 60.7 percent of incoming ninth graders who graduate within four years.

Since 1990, the total mortality rate has decreased from 876.4 to 799.4 deaths per 100,000 population, the infant mortality rate has decreased from 10.6 to 5.9 deaths per 1,000 live births and the percentage of children in poverty has declined from 16.6 percent to 11.2 percent of persons under age 18.  Also, the violent crime rate has increased from 455 to 563 offenses per 100,000 population, despite a decline in violent crime rates nationally.

To learn more about health and health initiatives in Alaska, visit the Alaska state department of health Web site at: health.hss.state.ak.us/

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Arizona

Arizona is 23^rd this year, the highest it has ever ranked; it was 32^nd in 2003. Strengths include strong support for public health with 15.5 percent of the state health budget allocated to public health, a low rate of cancer deaths at 184.6 deaths per 100,000 population and a low rate of deaths from cardiovascular disease at 293.9 deaths per 100,000 population. Challenges continue to include a high rate of motor vehicle deaths at 2.2 deaths per 100,000,000 miles driven, low access to adequate prenatal care with only 68.7 percent of pregnant women receiving adequate prenatal care and a high percentage of children in poverty at 19.1 percent of persons under age 18. Arizona is 30^th for the combined measures of risk factors and 21^st for the combined measures of outcomes, indicating the state's relative healthiness may remain steady or decline in future years if the risk factors are not addressed. Disparities in health are high, as illustrated by differences in access to adequate prenatal care between American Indians and other races. Only 51.8 percent of pregnant American Indian women receive adequate prenatal care compared to 77.7 percent of pregnant Asian/Pacific Islander women, 69.6 percent of pregnant white women and 69.1 percent of pregnant black women.

In the past year, the prevalence of smoking decreased from 23.4 percent to 20.8 percent of the population, the percentage of children in poverty decreased from 22.3 percent to 19.1 percent of persons under age 18 and per capita public health spending has almost doubled from $67 to $128 per person.

Since 1990, the incidence of infectious disease has declined from 91.0 to 26.2 cases per 100,000 population, and access to adequate prenatal care has increased from 62.8 percent to 68.7 percent of pregnant women receiving adequate prenatal care. The percentage of children in poverty has declined from 19.8 percent to 19.1 percent of persons under age 18, slower than the U.S. overall.

To learn more about health and health initiatives in Arizona, visit the Arizona state department of health Web site at: www.hs.state.az.us/

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Arkansas

Arkansas is 46^th this year; it was 47^th in 2003. Strengths include a relatively high rate of high school graduation with 74.2 percent of incoming ninth graders who graduate within four years, a relatively low incidence of infectious disease at 18.5 cases per 100,000 population and moderate per capita public health spending at $57 per person. Arkansas' challenges include a high percentage of children in poverty at 26.8 percent of persons under age 18, a high rate of deaths from cardiovascular disease at 379.0 deaths per 100,000 population and a high premature death rate with 9,325 years of potential life lost before age 75 per 100,000 population. Arkansas is 43^rd for the combined measures of risk factors and 45^th for the combined measures of outcomes, possibly indicating that the relative health of the population will remain at current levels in the near future. Disparities in health within the state are high, as shown in the difference in premature death rates. Non-Hispanic blacks lose 14,219 years of potential life before age 75 per 100,000 population compared to Hispanics, Asian/Pacific Islanders and American Indians who lose under 4,000 years per 100,000 population.

In the last year, the prevalence of smoking decreased from 26.3 percent to 24.8 percent of the population, per capita public health spending increased from $32 to $57 per person and the infant mortality rate increased from 8.4 to 8.8 deaths per 1,000 live births.

Since 1990, access to adequate prenatal care has increased from 61.4 percent to 71.4 percent of pregnant women receiving adequate prenatal care, and the infant mortality rate has decreased from 10.3 to 8.8 deaths per 1,000 live births, a decrease that is less than the national decline in infant mortality.  The rate of cancer deaths has increased from 198.0 to 213.1 deaths per 100,000 population.

To learn more about health and health initiatives in Arkansas, visit the Arkansas state department of health Web site at: www.healthyarkansas.com/

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California

California is 22^nd this year, unchanged from 2003. Since 1990, California has steadily improved its ranking, rising from 33^rd. Its strengths continue to include a low prevalence of smoking at 16.8 percent of the population, a low infant mortality rate at 5.0 deaths per 1,000 live births and a low rate of cancer deaths at 193.2 deaths per 100,000 population. California's challenges include a high violent crime rate at 593 offenses per 100,000 population, a high incidence of infectious disease at 28.2 cases per 100,000 population and a high rate of uninsured population at 18.4 percent. The state is 31^st for the combined measures of risk factors and 14^th for the combined measures of outcomes, possibly indicating that the relative health of California may slightly decline in the future if the risk factors are not addressed. Health disparities within California are evident, as shown by two to three times more years of potential life lost before age 75 for non-Hispanic black individuals compared to all other groups.

In the past year, the prevalence of obesity increased from 19.2 percent to 23.2 percent of the population, and access to adequate prenatal care increased from 79.9 percent to 81.0 percent of pregnant women receiving adequate prenatal care.

Since 1990, the premature death rate has decreased from 8,453 to 6,470 years of potential life lost before age 75 per 100,000 population, the rate of cancer deaths has decreased from 202.6 to 193.2 deaths per 100,000 population and the prevalence of obesity has increased from 9.8 percent to 23.2 percent of the population.

To learn more about health and health initiatives in California, visit the California state department of health Web site at: www.dhs.ca.gov/

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Colorado

Colorado is 13^th this year; it was ninth in 2003. Colorado ranks among the top ten states for seven of the 18 individual measures; the state has a low prevalence of smoking at 18.6 percent of the population, a low prevalence of obesity at 16.0 percent of the population, a low percentage of children in poverty at 11.9 percent of persons under age 18, a low number of limited activity days per month at 1.7 days in the previous 30 days, a low rate of deaths from cardiovascular disease at 278.6 deaths per 100,000 population, a low rate of cancer deaths at 179.1 deaths per 100,000 population and a low total mortality rate at 806.2 deaths per 100,000 population. One challenge for Colorado is its low access to adequate prenatal care with only 67.3 percent of pregnant women receiving adequate prenatal care. The state is 14^th for the combined measures of risk factors and sixth for the combined measures of outcomes, indicating that the state's relative healthiness may remain steady or decline in future years if the risk factors are not addressed. Differences in access to adequate prenatal care illustrate health disparities within the state. Only 54.8 percent of pregnant American Indian women receive adequate prenatal care compared to 69.6 percent of pregnant Asian/Pacific Islander women and 67.7 percent of pregnant white women.

In the past year, the rate of motor vehicle deaths declined from 1.7 to 1.4 deaths per 100,000,000 miles driven.

Since 1990, the prevalence of smoking has decreased from 28.6 percent to 18.6 percent of the population, the percentage of children in poverty has decreased from 21.8 percent to 11.9 percent of persons under age 18 and access to adequate prenatal care has decreased from 71.2 percent to 67.3 percent of pregnant women receiving adequate prenatal care.

To learn more about health and health initiatives in Colorado, visit the Colorado state department of health Web site at: www.cdphe.state.co.us/

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Connecticut

Connecticut is eighth this year; it was sixth in 2003 and has always been in the top 10 states since 1990. It is in the top 10 states for 13 of the 18 individual components, including third for a low rate of motor vehicle deaths at 1.0 deaths per 100,000,000 miles driven, third for a low percentage of children in poverty at 10.1 percent of persons under age 18 and fourth for a low prevalence of smoking at 18.6 percent of the population. A challenge for Connecticut is low support for public health with 1.5 percent of the state health budget allocated to public health. The state ranks 10^th for the combined measures of risk factors and seventh for the combined measures of outcomes, implying a continued strong ranking for the state in the future. Health disparities, as indicated by access to adequate prenatal care, are not as severe as in many states. However, when using premature death rates as an indicator of disparity, non-Hispanic blacks lose 11,028 years of potential life before age 75 per 100,000 population compared to Asian/Pacific Islanders and American Indians who lose 2,506 years and 5,090 years per 100,000 population, respectively.

In the past year, the infant mortality rate declined from 6.3 to 5.6 deaths per 1,000 live births, the premature death rate declined from 6,499 to 6,297 years of potential life lost before age 75 per 100,000 population and per capita public health spending decreased from $53 to $18 per person.

Since 1990, the prevalence of smoking has dropped from 29.6 percent to 18.6 percent of the population, the violent crime rate has decreased from 419 to 311 offenses per 100,000 population and the rate of cancer deaths has declined from 203.9 to 193.6 deaths per 100,000 population.

To learn more about health and health initiatives in Connecticut, visit the Connecticut state department of health Web site at: www.dph.state.ct.us/

Go to the Connecticut page

Delaware

Delaware is tied with Indiana for 32^nd this year; it was 34^th in 2003. Its strengths include a low percentage of children in poverty at 11.0 percent of persons under age 18, strong support for public health with 9.4 percent of the state health budget allocated to public health and high access to adequate prenatal care with 81.1 percent of pregnant women receiving adequate prenatal care. Challenges include a high incidence of infectious disease at 34.2 cases per 100,000 population, a high rate of cancer deaths at 217.9 deaths per 100,000 population and a high infant mortality rate at 8.7 deaths per 1,000 live births. Health disparities within the state are present, as illustrated by the differences in premature death rates between races - black non-Hispanic individuals experience 12,567 years of potential life lost before age 75 per 100,000 population compared to Hispanic individuals who experience 6,759 years lost. Delaware is 25^th for the combined measures of risk factors and 38^th for the combined measures of outcomes, implying the state is on a positive course and may be able to improve its relative healthiness in future years.

In the past year, the prevalence of smoking decreased from 24.7 percent to 21.9 percent of the population, and the rate of uninsured population increased from 9.9 percent to 11.1 percent.

Since 1990, access to adequate prenatal care has increased from 69.9 percent to 81.1 percent of pregnant women receiving adequate prenatal care, the prevalence of smoking has declined from 31.8 percent to 21.9 percent of the population, the total mortality rate has declined from 929.6 to 874.8 deaths per 100,000 population and the prevalence of obesity has increased from 14.4 percent to 24.0 percent of the population.

To learn more about health and health initiatives in Delaware, visit the Delaware state department of health Web site at: www.state.de.us/dhss/dph/index.htm

Go to the Delaware page

Florida

Florida is 42^nd this year, unchanged from 2003. Its strengths are high support for public health with 10.8 percent of the state health budget allocated to public health, a low prevalence of obesity at 19.9 percent of the population, a low rate of cancer deaths at 193.5 deaths per 100,000 population and a low total mortality rate at 807.5 deaths per 100,000 population. The state continues to face several challenges, including a high violent crime rate at 770 offenses per 100,000 population, a low high school graduation rate with 55.7 percent of incoming ninth graders who graduate within four years and a high incidence of infectious disease at 43.8 cases per 100,000 population. Florida is 47^th for the combined measures of risk factors and 27^th for the combined measures of outcomes, indicating that Florida is unlikely to improve its relative ranking in the near future without reductions in the risk factors. Health disparities in the state are high for both access to adequate prenatal care and premature death rates. Black non-Hispanics experience 12,767 years of potential life lost before age 75 per 100,000 population compared to Hispanic individuals who experience 5,342 years lost.

In the past year, the prevalence of smoking increased from 22.0 percent to 23.9 percent of the population, the rate of motor vehicle deaths declined from 2.0 to 1.8 deaths per 100,000,000 miles driven and the rate of cancer deaths declined from 196.0 to 193.5 deaths per 100,000 population.

Since 1990, access to adequate prenatal care has increased from 62.8 percent to 80.4 percent of pregnant women receiving adequate prenatal care, the rate of motor vehicle deaths has declined from 3.1 to 1.8 deaths per 100,000,000 miles driven and the incidence of infectious disease has decreased from 47.0 to 43.8 cases per 100,000 population, a slower decline than other states.

To learn more about health and health initiatives in Florida, visit the Florida state department of health Web site at: www.doh.state.fl.us/

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Georgia

Georgia is 45^th this year, its lowest ranking in the 15 years of this report; it was 41^st in 2003. Its strengths include a low number of limited activity days per month at 2.0 days in the previous 30 days, a low rate of cancer deaths at 203.0 deaths per 100,000 population and high access to adequate prenatal care at 76.7 percent of pregnant women receiving adequate prenatal care. Challenges include a very low high school graduation rate with 53.6 percent of incoming ninth graders who graduate within four years, a high incidence of infectious disease at 41.3 cases per 100,000 population and low support for public health with just 0.8 percent of the state health budget allocated to public health. Health disparities within the state's prenatal care program are low compared to other states, but more disparity is illustrated by the differences in premature death rates. Black non-Hispanic individuals experience 12,773 years of potential life lost before age 75 per 100,000 population compared to 4,360 years lost for the Hispanic population. Georgia is 45^th for the combined measures of risk factors and 41^st for the combined measures of outcomes, indicating the state is unlikely to change significantly in ranking in the near future.

In the past year, the percentage of children in poverty decreased from 19.5 percent to 17.7 percent of persons under age 18, and per capita public health spending declined from $30 to $7 per person.

Since 1990, the prevalence of smoking has decreased from 31.8 percent to 22.8 percent of the population, access to adequate prenatal care has increased from 66.8 percent to 76.7 percent of pregnant women receiving adequate prenatal care and the prevalence of obesity has increased from 10.8 percent to 25.2 percent of the population.

To learn more about health and health initiatives in Georgia, visit the Georgia state department of health Web site at: www.ph.dhr.state.ga.us/

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Hawaii

Hawaii is fourth this year; it was 10^th in 2003. Hawaii has been among the top ten states for 13 of the 15 years of this index. It is number one for a low prevalence of obesity at 16.4 percent of the population, a low rate of deaths from cardiovascular disease at 251.6 deaths per 100,000 population, a low rate of cancer deaths at 166.0 deaths per 100,000 population and a low total mortality rate at 675.4 deaths per 100,000 population. Other strengths include a low prevalence of smoking, a low violent crime rate, a low rate of uninsured population, strong support for public health and a low premature death rate. Challenges for the state include a low high school graduation rate with 64.8 percent of incoming ninth graders who graduate within four years and a moderate incidence of infectious disease at 22.6 cases per 100,000 population. Hawaii is fourth for the combined measures of outcomes and sixth for the combined measures of risk factors, indicating that the state's relative health is likely to remain the same in the near future. Health disparities within the state are among the lowest in the country for premature death rates; however, there is some evidence of disparity in access to adequate prenatal care.

In the past year, the prevalence of smoking declined from 21.0 percent to 17.2 percent of the population, the percentage of children in poverty declined from 15.9 percent to 12.0 percent of persons under age 18 and the high school graduation rate increased from 61.0 percent to 64.8 percent of incoming ninth graders who graduate within four years. The number of limited activity days per month increased from 1.2 to 1.9 days in the previous 30 days.

Since 1990, the percentage of children in poverty has decreased from 20.7 percent to 12.0 percent of persons under age 18, access to adequate prenatal care has increased from 65.8 percent to 75.1 percent of pregnant women receiving adequate prenatal care and the high school graduation rate has declined from 84.5 percent to 64.8 percent of incoming ninth graders who graduate within four years.

To learn more about health and health initiatives in Hawaii, visit the Hawaii state department of health Web site at: www.state.hi.us/health/

Go to the Hawaii page

Idaho

Idaho is 18^th this year; it was 17^th in 2003. It is in the top 10 states for four of the 18 individual measures - the state has a low prevalence of smoking at 19.0 percent of the population, a low rate of cancer deaths at 189.7 deaths per 100,000 population, a low incidence of infectious disease at 6.0 cases per 100,000 population and a low violent crime rate at 255 offenses per 100,000 population. Challenges include a high rate of uninsured population at 18.6 percent, a high rate of motor vehicle deaths at 2.1 deaths per 100,000,000 miles driven and low support for public health with 1.8 percent of the state health budget allocated to public health. Idaho ranks 20^th for the combined measures of risk factors and 22^nd for the combined measures of outcomes, indicating that the state is likely to maintain its current overall ranking in the near future. Health disparities within the state are relatively low compared to other states, but still present. Only 70.5 percent of pregnant black women and 60.8 percent of pregnant American Indian women receive adequate prenatal care compared to 74.6 percent of pregnant white women.

In the past year, the percentage of children in poverty declined from 15.9 percent to 13.8 percent of persons under age 18, and the total mortality rate increased from 840.1 to 872.0 deaths per 100,000 population.

Since 1990, the incidence of infectious disease has improved significantly, decreasing from 38.8 to 6.0 cases per 100,000 population, and the infant mortality rate has dropped from 10.8 to 6.7 deaths per 1,000 live births. The rate of deaths from cardiovascular disease declined, but not as much as other states.

To learn more about health and health initiatives in Idaho, visit the Idaho state department of health Web site at: www.healthandwelfare.idaho.gov/

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Illinois

Illinois is tied with Michigan for 29^th this year; it was 30^th in 2003. Strengths include strong support for public health with 9.1 percent of the state health budget allocated to public health, a low number of limited activity days per month at 1.9 days in the previous 30 days, a low occupational fatalities rate at 4.0 deaths per 100,000 workers and a low rate of motor vehicle deaths at 1.4 deaths per 100,000,000 miles driven. The state's challenges continue to include a high violent crime rate at 621 offenses per 100,000 population and a high rate of cancer deaths at 213.7 deaths per 100,000 population. Risk factors and outcome measures are on par with each other, at 28^th and 31^st for their respective groups, and will likely keep Illinois ranked in the middle of the states in the near future. Health disparities within the state due to race are dramatic, as the premature death rate among black non-Hispanic individuals is 2.2 times as high as among white non-Hispanic individuals.

In the past year, the percentage of state health dollars allocated to public health increased from 5.4 percent to 9.1 percent, per capita public health spending increased from $44 to $83 per person and the prevalence of smoking increased from 22.8 percent to 24.3 percent of the population.

Since 1990, the infant mortality rate has declined from 11.9 to 7.4 deaths per 1,000 live births, access to adequate prenatal care has increased from 68.8 percent to 78.2 percent of pregnant women receiving adequate prenatal care and the incidence of infectious disease has decreased from 27.2 to 22.4 cases per 100,000 population, a slower decline than in other states.

To learn more about health and health initiatives in Illinois, visit the Illinois state department of health Web site at: www.idph.state.il.us/

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Indiana

Indiana is tied with Delaware for 32^nd this year; it was 27^th in 2003. The state's strengths continue to include a low rate of motor vehicle deaths at 1.1 deaths per 100,000,000 miles driven, a low incidence of infectious disease at 11.9 cases per 100,000 population and a low percentage of children in poverty at 13.7 percent of persons under age 18. Indiana's challenges include a high prevalence of smoking at 26.1 percent of the population, a high prevalence of obesity at 26.0 percent of the population and a high rate of cancer deaths at 220.3 deaths per 100,000 population. Health disparities within the state are large. Non-Hispanic black individuals experience almost twice as many years of potential life lost as non-Hispanic white individuals. Pregnant black women also have much lower access to adequate prenatal care, with only 59.6 percent receiving adequate prenatal care compared to 76.3 percent of pregnant white women. The state is 23^rd for the combined measures of risk factors and 39^th for the combined measures of outcomes, implying the state is on a positive course and may be able to improve its relative healthiness in future years.

In the past year, the occupational fatalities rate decreased from 6.4 to 5.9 deaths per 100,000 workers, the percentage of children in poverty increased from 11.3 percent to 13.7 percent of persons under age 18 and the number of limited activity days per month increased from 1.7 to 2.2 days in the previous 30 days.

Since 1990, the rate of motor vehicle deaths has decreased from 2.5 to 1.1 deaths per 100,000,000 miles driven, the percentage of children in poverty has declined from 20.8 to 13.7 percent of persons under age 18 and the total mortality rate has increased from 909.1 to 927.5 deaths per 100,000 population.

To learn more about health and health initiatives in Indiana, visit the Indiana state department of health Web site at: www.in.gov/isdh/

Go to the Indiana page

Iowa

Iowa is 11^th this year; it was seventh in 2003. The state is in the top 10 states for six of the 18 individual measures this year - the state has a low number of limited activity days per month at 1.4 days in the previous 30 days, a high rate of high school graduation with 82.9 percent of incoming ninth graders who graduate within four years, a low premature death rate with 6,086 years of potential life lost before age 75 per 100,000 population, high access to adequate prenatal care with 84.5 percent of pregnant women receiving adequate prenatal care, a low incidence of infectious disease at 6.4 cases per 100,000 population and a low infant mortality rate at 5.4 deaths per 1,000 live births. Iowa's challenges include low support for public health with 2.2 percent of the state health budget allocated to public health and a high prevalence of obesity at 23.9 percent of the population. In general, risk factors and outcome measures (ranked at 11^th and 9^th respectively) continue to be at par with Iowa's overall ranking, indicating a balance between efforts and results. Health disparities within the state are evident in access to adequate prenatal care; only 71.8 percent of pregnant black women receive adequate prenatal care compared to 85.2 percent of pregnant white women.

In the past year, the prevalence of smoking decreased from 23.2 percent to 21.7 percent of the population, the premature death rate declined from 6,354 to 6,086 years of potential life lost before age 75 per 100,000 population, the percentage of children in poverty increased from 7.6 percent to 13.4 percent of persons under age 18 and the rate of uninsured population increased from 9.5 percent to 11.3 percent.

Since 1990, the rate of motor vehicle deaths has decreased from 2.6 to 1.4 deaths per 100,000,000 miles driven, the rate of uninsured population has increased from 7.6 percent to 11.3 percent and the total mortality rate has increased slightly.

To learn more about health and health initiatives in Iowa, visit the Iowa state department of health Web site at: idph.state.ia.us/

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Kansas

Kansas is 16^th this year; it was 20^th in 2003. Strengths include a low rate of uninsured population at 11.0 percent, high access to adequate prenatal care with 81.0 percent of pregnant women receiving adequate prenatal care, a moderate prevalence of smoking at 20.4 percent of the population, a low incidence of infectious disease at 10.4 cases per 100,000 population and a low number of limited activity days per month at 1.4 days in the previous 30 days. The state's challenges are a higher than average occupational fatalities rate at 6.6 deaths per 100,000 workers and moderate support for public health with 3.1 percent of the state health budget allocated to public health. Kansas is 15^th for the combined measures of risk factors and 25^th for the combined measures of outcomes, implying the state is on a positive course and may be able to improve its relative healthiness in future years. Disparity among races for access to prenatal care is low compared to other states, but premature death rates indicate strong differences between non-Hispanic blacks and non-Hispanic whites, with 12,998 years lost compared to 6,862 years of life lost per 100,000 population.

In the past year, the rate of motor vehicle deaths decreased from 1.8 to 1.6 deaths per 100,000,000 miles driven, and the prevalence of smoking decreased from 22.1 percent to 20.4 percent of the population.

Since 1990, the prevalence of smoking has decreased from 30.2 percent to 20.4 percent of the population, the rate of deaths from cardiovascular disease has declined from 367.6 to 321.8 deaths per 100,000 population and the total mortality rate has increased from 819.2 to 863.2 deaths per 100,000 population.

To learn more about health and health initiatives in Kansas, visit the Kansas state department of health Web site at: www.kdhe.state.ks.us/

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Kentucky

Kentucky is 39^th this year, unchanged from 2003. The state's strengths continue to include a low violent crime rate at 279 offenses per 100,000 population, high access to adequate prenatal care with 81.1 percent of pregnant women receiving adequate prenatal care and a low incidence of infectious disease at 14.1 cases per 100,000 population. Kentucky ranks among the bottom 10 states for nine of the 18 individual measures. The state has a high prevalence of smoking, a high rate of motor vehicle deaths, a high prevalence of obesity, a high occupational fatalities rate, a high number of limited activity days per month, a high rate of deaths from cardiovascular disease, a high rate of cancer deaths, a high total mortality rate and a high premature death rate. Kentucky is 37^th for the combined measures of risk factors and 42^nd for the combined measures of outcomes, possibly indicating little change in its relative health in the near future. Health disparities as illustrated by prenatal care are not as major an issue as in many other states. However, some disparities are evident within the state in premature death rates, as black non-Hispanic individuals experience almost 50 percent more potential years lost compared to white non-Hispanic individuals.

In the past year, the prevalence of smoking decreased from 32.6 percent to 30.8 percent of the population, and the violent crime rate increased from 257 to 279 offenses per 100,000 population.

Since 1990, access to adequate prenatal care has increased from 69.7 percent to 81.1 percent of pregnant women receiving adequate prenatal care, and the prevalence of obesity has increased from 12.2 percent to 25.6 percent of the population.

To learn more about health and health initiatives in Kentucky, visit the Kentucky state department of health Web site at: chs.ky.gov/publichealth/

Go to the Kentucky page

Louisiana

Louisiana is 50^th this year, a position it has held for 14 of the 15 editions of this report. It was 49^th in 2003. The state's primary strength is access to adequate prenatal care, which is available to 79.2 percent of pregnant women. It ranks in the bottom five states on six of the 18 measures - a high prevalence of smoking at 26.5 percent of the population, a high rate of uninsured population at 20.6 percent, a high percentage of children in poverty at 25.5 percent of persons under age 18, a high rate of cancer deaths at 224.2 deaths per 100,000 population, a high infant mortality rate at 9.7 deaths per 1,000 live births and a high premature death rate at 10,279 years of potential life lost before age 75 per 100,000 population. It also ranks in the bottom ten states for a high rate of motor vehicle deaths, a low high school graduation rate, a high violent crime rate, a high incidence of infectious disease, low support for public health and a high total mortality rate. Louisiana is 50^th for the combined measures of risk factors and 49^th for the combined measures of outcomes, possibly indicating that the relative health of the population will remain at current levels in the future.  Health disparities are also a challenge, as only 69.1 percent of pregnant black women receive adequate prenatal care compared to 86.5 percent of pregnant white women.

In the past year, the prevalence of obesity decreased from 25.5 percent to 24.8 percent of the population, and per capita public health spending declined from $35 to $22 per person.

Since 1990, access to adequate prenatal care has increased from 67.0 percent to 79.2 percent of pregnant women receiving adequate care, the prevalence of obesity has more than doubled from 12.3 percent to 24.8 percent of the population and the rate of cancer deaths has increased from 210.2 to 224.2 deaths per 100,000 population. The infant mortality rate has decreased from 11.8 to 9.7 deaths per 1,000 live births, a smaller decrease than the nation as a whole.

To learn more about health and health initiatives in Louisiana, visit the Louisiana state department of health Web site at: www.oph.dhh.state.la.us/

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Maine

Maine is 10^th this year; it was eighth in 2003. Strengths continue to include a low violent crime rate at 108 offenses per 100,000 population, a low infant mortality rate at 4.6 deaths per 1,000 live births, a low incidence of infectious disease at 6.2 cases per 100,000 population, a low rate of uninsured population at 10.4 percent and high access to adequate prenatal care with 83.7 percent of pregnant women receiving adequate prenatal care. One challenge for the state continues to be its high rate of cancer deaths at 219.6 deaths per 100,000 population. Maine is ninth for the combined measures of risk factors and 13^th for the combined measures of outcomes, indicating it will likely remain among the relatively healthy states in the future. Health disparities within the state are evident in access to adequate prenatal care, which varies by race, with 64.7 percent of pregnant black women receiving adequate care compared to 84.2 percent of pregnant white women.

In the past year, the prevalence of obesity decreased from 20.7 percent to 19.9 percent of the population, the rate of uninsured population declined from 11.3 percent to 10.4 percent and the percentage of children in poverty increased from 12.4 percent to 15.6 percent of persons under age 18.

Since 1990, the rate of deaths from cardiovascular disease has declined from 416.7 to 307.5 deaths per 100,000 population, and the prevalence of obesity has not increased as rapidly as other states.

To learn more about health and health initiatives in Maine, visit the Maine state department of health Web site at: www.state.me.us/dhs/boh/index.htm

Go to the Maine page

Maryland

Maryland is 34^th this year, the lowest it has ever ranked; it was 29^th in 2003. Strengths for the state include a low percentage of children in poverty at 10.6 percent of persons under age 18, a low occupational fatalities rate at 3.7 deaths per 100,000 workers, a low rate of motor vehicle deaths at 1.2 deaths per 100,000,000 miles driven and a moderate prevalence of smoking at 20.1 percent of the population. Challenges continue to include a high violent crime rate at 770 offenses per 100,000 population, a high infant mortality rate at 8.2 deaths per 1,000 live births and a high incidence of infectious disease at 43.9 cases per 100,000 population. Maryland ranks 32^nd for the combined measures of risk factors and 34^th for the combined measures of outcomes, indicating that the relative health of the population will likely remain at current levels in the near future. Health disparities in the state are an issue - black non-Hispanic individuals experience 13,077 years of potential life lost before age 75 per 100,000 population, while white non-Hispanic individuals experience only 6,586 years lost.

In the past year, the prevalence of smoking decreased from 21.9 percent to 20.1 percent of the population, and the prevalence of obesity increased from 19.4 percent to 21.9 percent of the population.

Since 1990, the rate of cancer deaths has decreased from 219.7 to 208.4 deaths per 100,000 population, the rate of uninsured population has increased from 8.9 percent to 13.9 percent and the incidence of infectious disease has increased from 41.1 to 43.9 cases per 100,000 population.

To learn more about health and health initiatives in Maryland, visit the Maryland state department of health Web site at: www.dhmh.state.md.us/

Go to the Maryland page

Massachusetts

Massachusetts is sixth this year; it was fifth in 2003. Massachusetts has been among the top ten states for 14 of the 15 editions of this index. It ranks first in the nation for a low prevalence of obesity at 16.8 percent of the population and a low occupational fatalities rate at 2.5 deaths per 100,000 workers. Massachusetts is also among the top ten states for a low prevalence of smoking, a low rate of motor vehicle deaths, a low rate of uninsured population, high access to adequate prenatal care, a low rate of deaths from cardiovascular disease, a low infant mortality rate and a low premature death rate. Two of its challenges are a high violent crime rate at 484 offenses per 100,000 population and a high rate of cancer deaths at 208.5 deaths per 100,000 population. Massachusetts is fourth for the combined measures of risk factors and seventh for the combined measures of outcomes, indicating a balance between efforts and results. There are some health disparities within the state, as evidenced in differences in premature death rates between black non-Hispanic individuals (10,060 years of potential life lost before age 75 per 100,000 population) and white non-Hispanic individuals (5,821 years lost).

In the past year, the prevalence of obesity declined from 18.3 percent to 16.8 percent of the population, and the high school graduation rate decreased from 75.3 percent to 74.0 percent of incoming ninth graders who graduate within four years.

Since 1990, the percentage of children in poverty has decreased from 18.8 percent to 12.0 percent of persons under age 18, and the rate of deaths from cardiovascular disease has decreased from 385.5 to 284.3 deaths per 100,000 population.  The prevalence of obesity has increased from 10.1 percent to 16.8 percent of the population, a smaller increase than the U.S. as a whole.

To learn more about health and health initiatives in Massachusetts, visit the Massachusetts state department of health Web site at: www.state.ma.us/dph/dphhome.htm

Go to the Massachusetts page

Michigan

Michigan is tied with Illinois for 29^th this year; it was 28^th in 2003. Its strengths include a low rate of uninsured population at 10.9 percent, a low rate of motor vehicle deaths at 1.3 deaths per 100,000,000 miles driven, high access to adequate prenatal care with 80.6 percent of pregnant women receiving adequate prenatal care and a low occupational fatalities rate at 4.1 deaths per 100,000 workers. Challenges are a high prevalence of smoking at 26.1 percent of the population, a high prevalence of obesity at 25.2 percent of the population, a high rate of deaths from cardiovascular disease at 365.3 deaths per 100,000 population and a high infant mortality rate at 8.4 deaths per 1,000 live births. Health disparities in Michigan are present, as illustrated by the differences in premature death rates between black non-Hispanic individuals (14,787 years of potential life lost before age 75 per 100,000 population) and white non-Hispanic individuals (6,698 years lost). Michigan ranks 23^rd for the combined measures of risk factors and 37^th for the combined measures of outcomes, indicating that it may improve its relative healthiness in future years if it continues with its improvements in reducing health risk factors.

In the past year, the rate of uninsured population decreased from 11.7 percent to 10.9 percent, the prevalence of smoking increased from 24.2 percent to 26.1 percent of the population and the high school graduation rate declined from 74.7 percent to 71.5 percent of incoming ninth graders who graduate within four years.

Since 1990, the percentage of children in poverty has declined from 22.1 percent to 14.6 percent of persons under age 18, and the violent crime rate has decreased from 780 to 540 offenses per 100,000 population.

To learn more about health and health initiatives in Michigan, visit the Michigan state department of health Web site at: www.michigan.gov/mdch

Go to the Michigan page

Minnesota

Minnesota is first this year, a position it has held for nine of the 15 years since the 1990 Edition. It was tied for first with New Hampshire in 2003. Strengths include ranking first for a low rate of deaths from cardiovascular disease at 259.2 deaths per 100,000 population, a low premature death rate with 5,595 years of potential life lost before age 75 per 100,000 population and a low rate of uninsured population at 8.7 percent. It is also in the top five states for high support for public health, a low percentage of children in poverty, a low total mortality rate, a low infant mortality rate, a low occupational fatalities rate and a high rate of high school graduation. Minnesota's biggest challenges are a high prevalence of obesity at 23.0 percent of the population and low access to adequate prenatal care with 76.0 percent of pregnant women receiving adequate prenatal care. This measure also illustrates the wide health disparities within the state, with only 44.9 percent of pregnant American Indian women receiving adequate care compared to 79.1 percent of pregnant white women. The state ranks first for the combined measures of risk factors and first for the combined measures of outcomes, indicating it will likely remain among the relatively healthy states in the future.

In the past year, the percent of state health dollars allocated to public health increased from 3.6 percent to 16.8 percent.

Since 1990, the percentage of children in poverty has declined from 21.2 percent to 9.7 percent of persons under age 18, and the prevalence of obesity has increased from 10.2 percent to 23.0 percent of the population.

To learn more about health and health initiatives in Minnesota, visit the Minnesota state department of health Web site at: www.health.state.mn.us/

Go to the Minnesota page

Mississippi

Mississippi ranks 49^th this year; it was 50^th in 2003. Mississippi's strengths are its moderate violent crime rate at 343 offenses per 100,000 population and its prenatal care programs with 77.8 percent of pregnant women receiving adequate prenatal care. The state faces numerous challenges; Mississippi has the nation's highest infant mortality rate at 10.2 deaths per 1,000 live births and ranks among the bottom ten states for ten of the remaining 18 measures, including a high premature death rate, a high total mortality rate, a high rate of deaths from cardiovascular disease and a high prevalence of obesity. Within the state, there are health disparities in access to adequate prenatal care with 68.6 percent of pregnant black women receiving adequate care compared to 85.4 percent of pregnant white women. Mississippi ranks 49^th for the combined measures of risk factors and 50^th for the combined measures of outcomes.

In the past year, the prevalence of smoking declined from 27.3 percent to 25.6 percent of the population, and the percent of health care dollars allocated to public health decreased from 4.9 percent to 2.7 percent of the state health budget. 

Since 1990, the rate of cancer deaths has increased from 192.4 to 215.2 deaths per 100,000 population, the violent crime rate has increased from 269 to 343 offenses per 100,000 population and the high school graduation rate has declined from 65.6 percent to 59.1 percent of incoming ninth graders who graduate within four years. The percentage of children in poverty has declined from 36.3 percent to 23.1 percent of persons under age 18.

To learn more about health and health initiatives in Mississippi, visit the Mississippi state department of health Web site at: www.msdh.state.ms.us/

Go to the Mississippi page

Missouri

Missouri is 36^th this year; it was 33^rd in 2003. The state's strengths continue to include high access to adequate prenatal care with 82.9 percent of pregnant women receiving adequate prenatal care, a low rate of uninsured population at 11.0 percent and strong support for public health with 7.4 percent of the state health budget allocated to public health. Challenges for the state include a high prevalence of smoking at 27.2 percent of the population and a high rate of deaths from cardiovascular disease at 370.5 deaths per 100,000 population. Health disparities in Missouri are present, as illustrated by the differences by race for access to adequate prenatal care and premature death rates. For example, the black non-Hispanic population experiences 14,277 years of potential life lost before age 75 per 100,000 population, compared to white non-Hispanics, who lose 7,491 years. Missouri ranks 34^th for the combined measures of risk factors and 40^th for the combined measures of outcomes, indicating that the state should be able to reverse its decline in relative healthiness in the future.

In the past year, per capita public health spending increased from $44 to $76 per person, and the infant mortality rate increased from 7.3 to 7.9 deaths per 1,000 live births.

Since 1990, the prevalence in smoking has only declined from 27.7 percent to 27.2 percent of the population, a decrease much lower than in other states. The infant mortality rate has declined from 10.5 to 7.9 deaths per 1,000 live births, and the rate of deaths from cardiovascular disease has declined from 400.7 to 370.5 deaths per 100,000 population, but both of these declines are also slower than the improvements experienced nationally. The percentage of children in poverty has declined from 19.4 percent to 14.7 percent of persons under age 18.

To learn more about health and health initiatives in Missouri, visit the Missouri state department of health Web site at: www.health.state.mo.us/

Go to the Missouri page

Montana

Montana is tied with Ohio for 26^th this year, it was 25^th in 2003. Its strengths include a low incidence of infectious disease at 5.6 cases per 100,000 population, a low prevalence of obesity at 18.8 percent of the population, a high rate of school graduation with 77.3 percent of incoming ninth graders who graduate within four years, a low prevalence of smoking at 20.0 percent of the population and a low rate of deaths from cardiovascular disease at 296.2 deaths per 100,000 population. Its challenges include a high rate of motor vehicle deaths at 2.5 deaths per 100,000,000 miles driven, a high rate of uninsured population at 19.4 percent, a high percentage of children in poverty at 20.2 percent of persons under age 18 and a high occupational fatalities rate at 12.3 deaths per 100,000 workers. The disparity within the state for access to adequate prenatal care is large - only 49.6 percent of pregnant American Indian women receive adequate prenatal care compared to 76.5 percent of pregnant white women. Montana is 29^th for the combined measures of risk factors and 26^th for the combined measures of outcomes, indicating that the state's relative healthiness is unlikely to change in the near future.

In the past year, the number of limited activity days per month decreased from 2.1 to 1.8 days in the previous 30 days, the rate of uninsured population increased from 15.3 percent to 19.4 percent and the infant mortality rate increased from 6.4 to 7.0 deaths per 1,000 live births.

Since 1990, the incidence of infectious disease has decreased from 23.2 to 5.6 cases per 100,000 population, the violent crime rate has increased from 151 to 352 offenses per 100,000 population and the total mortality rate has increased from 791.0 to 880.2 deaths per 100,000 population.

To learn more about health and health initiatives in Montana, visit the Montana state department of health Web site at: www.dphhs.state.mt.us/

Go to the Montana page

Nebraska

Nebraska is 12^th this year; it was 16^th in 2003. Strengths include a high rate of high school graduation with 80.0 percent of incoming ninth graders who graduate within four years, a low percentage of children in poverty at 11.0 percent of persons under age 18, a low number of limited activity days per month at 1.6 days in the previous 30 days and a low incidence of infectious disease at 9.3 cases per 100,000 population. Challenges include a high occupational fatalities rate at 8.2 deaths per 100,000 workers, moderate access to adequate prenatal care with 74.6 percent of pregnant women receiving adequate prenatal care and an above average prevalence of obesity at 23.9 percent of the population. Nebraska is 13^th for the combined measures of risk factors and 12^th for the combined measures of outcomes, indicating that the relative healthiness of the state will likely remain steady in the future. Differences among races in access to adequate prenatal care and premature death rates indicate that there are strong disparities in health within the state. Less than 60 percent of pregnant black women and American Indian women receive adequate prenatal care compared to over 75 percent of pregnant white women.

In the past year, the percentage of children in poverty decreased from 13.5 percent to 11.0 percent of persons under age 18, and the infant mortality rate declined from 7.0 to 6.3 deaths per 1,000 live births.

Since 1990, access to adequate prenatal care has decreased from 76.8 percent to 74.6 percent of pregnant women receiving adequate prenatal care, the prevalence of obesity has increased from 11.6 percent to 23.9 percent of the population and the prevalence of smoking has declined much slower than in other states, from 24.9 percent to 21.2 percent of the population.

To learn more about health and health initiatives in Nebraska, visit the Nebraska state department of health Web site at: www.hhs.state.ne.us/

Go to the Nebraska page

Nevada

Nevada is 37^th this year; it was 36^th in 2003. The state's strengths include a low occupational fatalities rate at 4.6 deaths per 100,000 workers, a low infant mortality rate at 6.1 deaths per 1,000 live births and a moderate prevalence of obesity at 21.2 percent of the population. Nevada's challenges include a high rate of uninsured population at 18.9 percent, low access to adequate prenatal care with 69.7 percent of pregnant women receiving adequate prenatal care, a high rate of cancer deaths at 215.3 deaths per 100,000 population and a high total mortality rate at 934.4 deaths per 100,000 population. It is 41^st for the combined measures of risk factors and 33^rd for the combined measures of outcomes, indicating the state's relative health may remain steady or decline in the future if the risk factors are not addressed. Health disparities within the state are not as evident as in other states.

In the past year, the occupational fatalities rate decreased from 5.2 to 4.6 deaths per 100,000 workers, the percentage of children in poverty increased from 9.1 percent to 14.8 percent of persons under age 18 and the number of limited activity days per month increased from 1.9 to 2.1 days in the previous 30 days.

Since 1990, the prevalence of smoking has decreased from 35.7 percent to 25.2 percent of the population, the incidence of infectious disease has dropped from 49.8 to 22.7 cases per 100,000 population and the high school graduation rate has declined from 81.8 percent to 70.2 percent of incoming ninth graders who graduate in four years.

To learn more about health and health initiatives in Nevada, visit the Nevada state department of health Web site at: health2k.state.nv.us/

Go to the Nevada page

New Hampshire

New Hampshire is second this year; it was first in 2003. It has ranked in the top two states for the past seven years. Its biggest strengths include a low percentage of children in poverty at 7.2 percent of persons under age 18, high access to adequate prenatal care with 88.2 percent of pregnant women receiving adequate prenatal care, a low infant mortality rate at 4.4 deaths per 1,000 live births and a low premature death rate at 5,706 years of potential life lost before age 75 per 100,000 population. In addition, New Hampshire ranks in the top ten states for a low rate of motor vehicle deaths, a low violent crime rate, a low rate of uninsured population, high support for public health, a low incidence of infectious disease and a low total mortality rate. One challenge for the state is a higher than average rate of cancer deaths at 204.5 deaths per 100,000 population. Although both prenatal care and the premature death measures indicate some health disparities within the state, the amount is less than in most other states. The state ranks second for the combined measures of risk factors and third for the combined measures of outcomes, indicating that it is likely to remain among the top states for relative healthiness in the future.

In the past year, the prevalence of smoking decreased from 23.2 percent to 21.2 percent of the population, per capita public health spending increased from $54 to $106 per person and the number of limited activity days per month increased from 1.5 to 2.0 days in the previous 30 days.

Since 1990, the rate of uninsured population has decreased from 11.2 percent to 10.3 percent, the incidence of infectious disease has declined from 18.3 to 6.7 cases per 100,000 population and the rate of deaths from cardiovascular disease has decreased from 401.6 to 297.5 deaths per 100,000 population.

To learn more about health and health initiatives in New Hampshire, visit the New Hampshire state department of health Web site at: www.dhhs.state.nh.us/

Go to the New Hampshire page

New Jersey

New Jersey is 17^th this year; it was 18^th in 2003. Its strengths include a high rate of school graduation with 89.8 percent of incoming ninth graders who graduate within four years, a low rate of motor vehicle deaths at 1.0 deaths per 100,000,000 miles driven, a low occupational fatalities rate at 3.6 deaths per 100,000 workers, a low prevalence of smoking at 19.4 percent of the population and a low percentage of children in poverty at 11.2 percent of persons under age 18. Challenges include low support for public health with 1.2 percent of the state health budget allocated to public health, a high incidence of infectious disease at 34.2 cases per 100,000 population and low access to adequate prenatal care with only 68.1 percent of pregnant women receiving adequate prenatal care. New Jersey is 17^th for the combined measures of risk factors and 22^nd for the combined measures of outcomes, indicating that it may remain steady or improve its relative healthiness in future years if it continues reducing health risk factors. Health disparities are widespread in the state, as shown by differences in access to adequate prenatal care and in premature death rates among races. Just 50.1 percent of pregnant black women receive adequate prenatal care compared to 72.0 percent of pregnant white women.

In the past year, the infant mortality rate declined from 6.4 to 5.6 deaths per 1,000 live births, and per capita public health spending declined from $32 to $14 per person.

Since 1990, the prevalence of smoking has declined from 27.9 percent to 19.4 percent of the population, the high school graduation rate has increased from 79.7 percent to 89.8 percent of incoming ninth graders who graduate within four years and access to adequate prenatal care has decreased from 72.0 percent to 68.1 percent of pregnant women receiving adequate prenatal care.

To learn more about health and health initiatives in New Jersey, visit the New Jersey state department of health Web site at: www.state.nj.us/health/

Go to the New Jersey page

New Mexico

New Mexico is 38^th this year; it was 40^th in 2003. New Mexico has gradually increased its ranking since 1996 when it ranked 48^th. Its strengths are a low rate of cancer deaths at 178.5 deaths per 100,000 population, a low rate of deaths from cardiovascular disease at 284.9 deaths per 100,000 population, a low infant mortality rate at 5.9 deaths per 1,000 live births and a low total mortality rate at 819.8 deaths per 100,000 population. Challenges include a high percentage of children in poverty at 26.9 percent of persons under age 18, low access to adequate prenatal care with 56.0 percent of pregnant women receiving adequate prenatal care, a high rate of uninsured population at 22.1 percent and a high violent crime rate at 740 offenses per 100,000 population. Access to adequate prenatal care indicates there are also health disparities among races within the state. For example, 46.4 percent of pregnant American Indian women receive adequate prenatal care compared to 57.4 percent of pregnant white women. New Mexico is 48^th for the combined measures of risk factors and 17^th for the combined measures of outcomes, indicating that the state is not likely to continue to improve its relative healthiness without additional focus on risk factors.

In the past year, the infant mortality rate decreased from 6.5 to 5.9 deaths per 1,000 live births, and the percentage of the state health budget allocated to public health declined from 5.7 percent to 2.3 percent.

Since 1990, the incidence of infectious disease has decreased from 64.2 to 15.8 cases per 100,000 population, and the high school graduation rate has declined from 73.2 percent to 61.5 percent of incoming ninth graders who graduate within four years. The prevalence of smoking has declined from 28.5 percent to 22.0 percent of the population.

To learn more about health and health initiatives in New Mexico, visit the New Mexico state department of health Web site at: www.health.state.nm.us/

Go to the New Mexico page

New York

New York is 31^st this year, unchanged from 2003. Its strengths include a low rate of motor vehicle deaths at 1.1 deaths per 100,000,000 miles driven, a low occupational fatalities rate at 3.8 deaths per 100,000 workers, a low rate of cancer deaths at 196.1 deaths per 100,000 population and a low total mortality rate at 809.8 deaths per 100,000 population. Challenges include a high incidence of infectious disease with 50.6 cases per 100,000 population, low access to adequate prenatal care with only 68.5 percent pregnant women receiving adequate prenatal care and a high percentage of children in poverty at 19.9 percent of persons under age 18. Health disparities within the state are present as illustrated by access to adequate prenatal care. Only 56.0 percent of pregnant black women receive adequate prenatal care compared to 72.4 percent of pregnant white women. New York is 36^th for the combined measures of risk factors and 24^th for the combined measures of outcomes, indicating the state is unlikely to improve in relative healthiness unless the risk factors are more aggressively addressed.

In the past year, the rate of uninsured population decreased from 15.8 percent to 15.1 percent, the high school graduation rate increased from 57.8 percent to 62.1 percent of incoming ninth graders who graduate within four years and the occupational fatalities rate increased from 3.4 to 3.8 deaths per 100,000 workers.

Since 1990, the violent crime rate has declined from 1,007 to 496 offenses per 100,000 population, the infant mortality rate has declined from 10.7 to 6.3 deaths per 1,000 live births and the rate of uninsured population has increased from 10.7 percent to 15.1 percent.

To learn more about health and health initiatives in New York, visit the New York state department of health Web site at: www.health.state.ny.us/home.html

Go to the New York page

North Carolina

North Carolina is 41^st this year; it was 36^th in 2003. Two strengths for the state are the access to adequate prenatal care at 80.0 percent of pregnant women receiving adequate prenatal care and a low number of limited activity days per month at 2.0 days in the previous 30 days. Challenges include low support for public health with 1.2 percent of the state health budget allocated to public health, a low high school graduation rate with 60.6 percent of incoming ninth graders who graduate within four years and a high percentage of children in poverty at 23.1 percent of persons under age 18. North Carolina is 42^nd for the combined measures of risk factors and 35^th for the combined measures of outcomes, indicating that the relative healthiness of the state isn't likely to improve without increased focus on the risk factors. Health disparities within the state are illustrated by the differences in premature death rates between black non-Hispanic individuals (13,244 years of potential life lost before age 75 per 100,000 population) and white non-Hispanic individuals (7,290 years lost).

In the past year, the infant mortality rate decreased from 8.6 to 8.0 deaths per 1,000 live births, and the percentage of children in poverty increased from 16.4 percent to 23.1 percent of persons under age 18.

Since 1990, the rate of motor vehicle deaths has declined from 2.7 to 1.6 deaths per 100,000,000 miles driven, the rate of uninsured population has increased from 12.6 percent to 17.3 percent and the percentage of children in poverty has increased from 19.3 percent to 23.1 percent of persons under age 18.

To learn more about health and health initiatives in North Carolina, visit the North Carolina state department of health Web site at: www.dhhs.state.nc.us/

Go to the North Carolina page

North Dakota

North Dakota is seventh this year; it was 12^th in 2003. North Dakota has one of the lowest violent crime rates at 78 offenses per 100,000 population, lowest incidence of infectious disease at 2.3 cases per 100,000 population and lowest total mortality rate at 718.6 deaths per 100,000 population. It also ranks in the top 10 states for its high rate of high school graduation, a low number of limited activity days per month and a low rate of uninsured population. The state's challenges continue to include low access to adequate prenatal care with 74.4 percent of pregnant women receiving adequate prenatal care and a high occupational fatalities rate at 9.5 deaths per 100,000 workers. North Dakota is seventh for the combined measures of risk factors and 10^th for the combined measures of outcomes, indicating that the state's relative healthiness will likely remain steady in the future. Health disparities within the state are a significant issue, as shown by the differences in access to adequate prenatal care and premature death rates - 77.5 percent of pregnant white women receive adequate prenatal care compared to 47.6 percent of pregnant American Indian women; and non-Hispanic white individuals experience 5,798 years of potential life lost before age 75 per 100,000 population compared to 14,972 years lost for American Indian individuals.

In the past year, the percentage of children in poverty decreased from 19.5 percent to 12.7 percent of persons under age 18 and the infant mortality rate declined from 8.4 to 6.9 deaths per 1,000 live births.

Since 1990, the incidence of infectious disease has decreased from 11.1 to 2.3 cases per 100,000 population, the occupational fatalities rate has increased from 8.9 to 9.5 deaths per 100,000 workers and the infant mortality rate has declined from 8.6 to 6.9 deaths per 1,000 live births, a slower decline than other states.

To learn more about health and health initiatives in North Dakota, visit the North Dakota state department of health Web site at: www.health.state.nd.us/

Go to the North Dakota page

Ohio

Ohio is tied with Montana for 26^th this year; it was also 26^th in 2003. Strengths for the state include high access to adequate prenatal care with 82.8 percent of pregnant women receiving adequate prenatal care, a low rate of motor vehicle deaths at 1.2 deaths per 100,000,000 miles driven and a low incidence of infectious disease at 11.7 cases per 100,000 population. Challenges include a high prevalence of obesity at 24.9 percent of the population, a high prevalence of smoking at 25.2 percent of the population and a high rate of cancer deaths at 216.9 deaths per 100,000 population. Ohio is 19^th for the combined measures of risk factors and 35^th for the combined measures of outcomes, indicating that the state may improve its relative healthiness in future years if it continues to focus on reducing health risk factors. Access to adequate prenatal care is not evenly spread across the state, with 70.4 percent of pregnant black women receiving adequate care compared to 84.9 percent of pregnant white women.

In the past year, the prevalence of smoking decreased from 26.6 percent to 25.2 percent of the population, and the prevalence of obesity increased from 23.0 percent to 24.9 percent of the population.

Since 1990, the rate of motor vehicle deaths has decreased from 2.2 to 1.2 deaths per 100,000,000 miles driven, the rate of uninsured population has increased from 8.7 percent to 12.1 percent and the prevalence of obesity has increased from 11.3 percent to 24.9 percent of the population.

To learn more about health and health initiatives in Ohio, visit the Ohio state department of health Web site at: www.odh.state.oh.us/

Go to the Ohio page

Oklahoma

Oklahoma is 40^th this year; it was 45^th in 2003. Oklahoma's strengths are strong support for public health with 9.4 percent of the state health budget allocated to public health and a low rate of motor vehicle deaths at 1.4 deaths per 100,000,000 miles driven. Challenges include a high rate of deaths from cardiovascular disease at 411.6 deaths per 100,000 population, a high rate of uninsured population at 20.4 percent, low access to adequate prenatal care with 67.6 percent of pregnant women receiving adequate prenatal care and a high total mortality rate at 984.7 deaths per 100,000 population. Oklahoma is 35^th for the combined measures of risk factors and 44^th for the combined measures of outcomes, indicating that the state may improve its relative healthiness in future years if it continues to focus on reducing health risk factors. Health disparities among racial groups are present but not as great as in most other states.

In the past year, the percentage of children in poverty declined from 21.4 percent to 17.0 percent of persons under age 18, and the incidence of infectious disease decreased from 19.9 to 15.9 cases per 100,000 population. The prevalence of obesity increased from 22.9 percent to 24.4 percent of the population, and the rate of uninsured population increased from 17.3 percent to 20.4 percent.

Since 1990, the incidence of infectious disease has decreased from 34.9 to 15.9 cases per 100,000 population, the rate of cancer deaths has increased from 197.8 to 215.4 deaths per 100,000 population and the premature death rate has increased from 8,551 to 8,828 years of potential life lost before age 75 per 100,000 population.

To learn more about health and health initiatives in Oklahoma, visit the Oklahoma state department of health Web site at: www.health.state.ok.us/

Go to the Oklahoma page

Oregon

Oregon is 21^st this year; it was 19^th in 2003. Its strengths are a low occupational fatalities rate at 3.5 deaths per 100,000 workers, a low infant mortality rate at 5.9 deaths per 1,000 live births, a low violent crime rate at 292 offenses per 100,000 population and a low rate of deaths from cardiovascular disease at 302.5 deaths per 100,000 population. Challenges for the state include low support for public health with 2.2 percent of the state health budget allocated to public health, a high percentage of children in poverty at 20.1 percent of persons under age 18 and a high number of limited activity days per month at 2.4 days in the previous 30 days. Although both prenatal care and premature death rates indicate some health disparities within the state, the amount is less than in most other states. Oregon is 26^th for the combined measures of risk factors and 20^th for the combined measures of outcomes, indicating that the state is unlikely to improve its relative healthiness in the near future without additional focus on the risk factors.

In the past year, the rate of uninsured population increased from 14.6 percent to 17.2 percent, the percentage of children in poverty increased from 15.1 percent to 20.1 percent of persons under age 18 and per capita spending on public health declined from $27 to $19 per person.

Since 1990, the incidence of infectious disease has declined from 92.8 to 17.2 cases per 100,000 population, and the rate of motor vehicle deaths has declined from 3.0 to 1.5 deaths per 100,000,000 miles driven. The percentage of children in poverty has increased from 12.4 percent to 20.1 percent of persons under age 18, the violent crime rate has dropped from 540 to 292 offenses per 100,000 population and the infant mortality rate has declined from 9.9 to 5.9 deaths per 1,000 live births.

To learn more about health and health initiatives in Oregon, visit the Oregon state department of health Web site at: www.ohd.hr.state.or.us/

Go to the Oregon page

Pennsylvania

Pennsylvania is 25^th this year; it was 24^th in 2003. Its strengths include strong support for public health with $98 spent per person on public health, a low occupational fatalities rate at 4.0 deaths per 100,000 workers, a high rate of high school graduation with 77.1 percent of incoming ninth graders who graduate within four years and a low rate of uninsured population at 11.4 percent. Challenges include a high prevalence of smoking at 25.4 percent of the population and low access to adequate prenatal care with 71.8 percent of pregnant women receiving adequate prenatal care. Access to adequate prenatal care shows health disparities within the state, with 57.2 percent of pregnant black women receiving adequate care compared to 74.4 percent of pregnant white women. Pennsylvania is 21^st for the combined measures of risk factors, higher than its 31^st for the combined measures of outcomes. This indicates that, with continued emphasis on improving the risk factors, the state may improve its relative healthiness in future years.

In the past year, the high school graduation rate increased from 75.3 percent to 77.1 percent of incoming ninth graders who graduate within four years, and the incidence of infectious disease increased from 21.7 to 26.1 cases per 100,000 population.

Since 1990, the infant mortality rate has decreased from 10.3 to 7.2 deaths per 1,000 live births, the rate of uninsured population has increased from 7.7 percent to 11.4 percent and the prevalence of smoking has declined from 29.3 percent to 25.4 percent of the population, a slower decline than other states.

To learn more about health and health initiatives in Pennsylvania, visit the Pennsylvania state department of health Web site at: www.dsf.health.state.pa.us/

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Rhode Island

Rhode Island is 14^th this year; it was 13^th in 2003. Its strengths are high access to adequate prenatal care with 85.8 percent of pregnant women receiving adequate prenatal care, a low rate of uninsured population at 10.2 percent and a low prevalence of obesity at 18.4 percent of the population. Challenges include a high number of limited activity days per month at 2.3 days in the previous 30 days, a high rate of cancer deaths at 207.5 deaths per 100,000 population and a high percentage of children in poverty at 17.1 percent of persons under age 18. Although both prenatal care and premature death rates indicate some health disparities within the state, the amount is less than in most other states.  Rhode Island is 12^th for the combined measures of risk factors, higher than its 18^th for the combined measures of outcomes. This indicates that the state, with continued emphasis on reducing risk factors, may improve its relative healthiness in the future.

In the past year, the infant mortality rate decreased from 6.5 to 5.9 deaths per 1,000 live births, per capita public health spending increased from $62 to $72 per person and the percentage of children in poverty increased from 11.0 percent to 17.1 percent of persons under age 18.

Since 1990, the prevalence of smoking has declined from 34.4 percent to 22.4 percent of the population, the prevalence of obesity has increased from 11.1 percent to 18.4 percent of the population and the total mortality rate has declined from 873.0 to 819.3 deaths per 100,000 population.

To learn more about health and health initiatives in Rhode Island, visit the Rhode Island state department of health Web site at: www.health.state.ri.us/

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South Carolina

South Carolina is 47^th this year; it was 48^th in 2003. The state's primary strength is strong support for public health with 8.0 percent of the state health budget allocated to public health. Among its challenges are ranking 50^th for a low high school graduation rate with 49.2 percent of incoming ninth graders who graduate within four years and a high violent crime rate at 822 offenses per 100,000 population. South Carolina also ranks among the bottom 10 states for a high prevalence of smoking, a high rate of motor vehicle deaths, a high incidence of infectious disease, a high number of limited activity days per month, a high infant mortality rate and a high premature death rate. The state has heath disparities between races; only 63.7 percent of pregnant black women receive adequate prenatal care compared to 76.9 percent of pregnant white women. The state ranks low in both the combined measures of risk factors and of outcomes (46^th and 42^nd, respectively), indicating the state is unlikely to change its relative healthiness in the near future.

In the past year, the prevalence of obesity decreased from 25.8 percent to 24.5 percent of the population, the percentage of children in poverty declined from 23.0 percent to 17.4 percent of persons under age 18 and the rate of uninsured population increased from 12.5 percent to 14.4 percent.

Since 1990, access to adequate prenatal care has increased from 56.7 percent to 72.3 percent of pregnant women receiving adequate prenatal care, and the rate of cancer deaths has increased from 189.4 to 205.9 deaths per 100,000 population.  The prevalence of smoking has declined from 27.1 percent to 25.5 percent of the population, a slower decline than other states.

To learn more about health and health initiatives in South Carolina, visit the South Carolina state department of health Web site at: www.scdhec.net/

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South Dakota

South Dakota is 19^th this year; it was 15^th in 2003. Its strengths include a low incidence of infectious disease at 4.8 cases per 100,000 population, a low violent crime rate at 177 offenses per 100,000 population, a low total mortality rate at 756.4 deaths per 100,000 population, a high rate of high school graduation with 77.8 percent of incoming ninth graders who graduate within four years and a low number of limited activity days per month at 1.5 days in the previous 30 days. Challenges continue to include a high rate of motor vehicle deaths at 2.4 deaths per 100,000,000 miles driven, a high occupational fatalities rate at 9.9 deaths per 100,000 workers and low access to adequate prenatal care with 69.1 percent of pregnant women receiving adequate prenatal care. South Dakota is 22^nd for the combined measures of risk factors and 16^th for the combined measures of outcomes, indicating that the state's relative healthiness is unlikely to change much in future years unless risk factors are more aggressively addressed.  Health disparities within the state are also present, as only 42.1 percent of pregnant American Indian women receive adequate prenatal care compared to 75.0 percent of pregnant white women.

In the past year, the rate of motor vehicle deaths increased from 2.0 to 2.4 deaths per 100,000,000 miles driven, the prevalence of obesity increased from 21.2 percent to 22.9 percent of the population, the high school graduation rate increased from 71.9 percent to 77.8 percent of incoming ninth graders who graduate within four years and the percentage of children in poverty increased from 8.2 percent to 14.0 percent of persons under age 18.

Since 1990, the incidence of infectious disease has declined from 18.0 to 4.8 cases per 100,000 population, the infant mortality rate has decreased from 11.6 to 7.1 deaths per 1,000 live births and the violent crime rate has increased from 120 to 177 offenses per 100,000 population.

To learn more about health and health initiatives in South Dakota, visit the South Dakota state department of health Web site at: www.state.sd.us/doh/

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Tennessee

Tennessee is 48^th this year; it was 46^th in 2003. Its strengths are a low rate of uninsured population at 13.2 percent and moderate access to prenatal care with 77.1 percent of pregnant women receiving adequate prenatal care. Challenges include a high infant mortality rate at 9.2 deaths per 1,000 live births and a low high school graduation rate with 56.7 percent of incoming ninth graders who graduate within four years. The state also ranks in the bottom 10 states on seven of the other individual measures, including a high prevalence of smoking, a high prevalence of obesity, a high violent crime rate, a high rate of deaths from cardiovascular disease, a high rate of cancer deaths, a high total mortality rate and a high premature death rate. Tennessee is 44^th for the combined measures of risk factors and 46^th for the combined measures of outcomes, suggesting that the state's health is likely to remain at the same relative healthiness in the near future. Health disparity is present within the state, as illustrated by differences in premature death rates between black non-Hispanic individuals (14,538 years of potential life lost before age 75 per 100,000 population) and white non-Hispanic individuals (8,395 years lost).

In the past year, the prevalence of smoking decreased from 27.7 percent to 25.6 percent of the population, the rate of uninsured population increased from 10.8 percent to 13.2 percent and the number of limited activity days per month increased from 1.9 to 2.3 days in the previous 30 days.

Since 1990, the violent crime rate has increased from 534 to 717 offenses per 100,000 population, the prevalence of obesity has more than doubled from 11.8 percent to 25.0 percent of the population and the percentage of children in poverty has declined from 29.6 percent to 18.7 percent of persons under age 18.

To learn more about health and health initiatives in Tennessee, visit the Tennessee state department of health Web site at: www.state.tn.us/health/

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Texas

Texas is 35^th this year, unchanged from 2003. Its strengths continue to include strong support for public health with 16.9 percent of the state health budget allocated to public health, a low rate of cancer deaths at 200.0 deaths per 100,000 population and a low infant mortality rate at 6.2 deaths per 1,000 live births. Challenges include a high rate of uninsured population at 24.6 percent, a high percentage of children in poverty at 24.0 percent of persons under age 18 and a high incidence of infectious disease at 30.1 cases per 100,000 population. Health disparities in the state are evident, as illustrated by differences in premature death rates between black non-Hispanic individuals (12,341 years of potential life lost before age 75 per 100,000 population), white non-Hispanic individuals (7,358 years lost) and Hispanic individuals (6,655 years lost). Texas is 38^th for the combined measures of risk factors and 30^th for the combined measures of outcomes, indicating that, without more aggressively addressing risk factors, Texas will not improve in relative healthiness over the upcoming years.

In the past year, per capita spending for public health increased from $104 to $162 per person, the number of limited activity days per month increased from 1.9 to 2.2 days in the previous 30 days and the infant mortality rate increased from 5.8 to 6.2 deaths per 1,000 live births.

Since 1990, the prevalence of smoking has decreased from 30.6 percent to 22.1 percent of the population, access to adequate prenatal care has increased from 58.9 percent to 72.0 percent of pregnant women receiving adequate prenatal care and the rate of deaths from cardiovascular disease has decreased from 388.0 to 351.0 deaths per 100,000 population, a slower decline than other states.

To learn more about health and health initiatives in Texas, visit the Texas state department of health Web site at: www.tdh.texas.gov/

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Utah

Utah is fifth this year; it was third in 2003. Utah has been in the top ten states

Since 1990. Its biggest strengths include a low prevalence of smoking at 11.9 percent of the population, a low rate of cancer deaths at 160.3 deaths per 100,000 population and a low rate of deaths from cardiovascular disease at 271.2 deaths per 100,000 population. It is also among the top 10 states for a low rate of motor vehicle deaths, a high rate of high school graduation, a low violent crime rate, a low number of limited activity days per month, a low total mortality rate, a low infant mortality rate and a low premature death rate. Its challenges include low access to adequate prenatal care with 60.6 percent of pregnant women receiving adequate prenatal care and low per capita public health spending at $19 per person. Access to adequate prenatal care also indicates health disparities within the state, with only 42.3 percent of pregnant American Indian women receiving adequate care compared to 61.5 percent of pregnant white women. Utah is eighth for the combined measures of risk factors and second for the combined measures of outcomes, indicating it will likely remain among the relatively healthy states in the future.

In the past year, the prevalence of obesity increased from 17.5 percent to 20.8 percent of the population, and the percent of state health budget allocated to public health declined from 6.6 percent to 3.5 percent.

Since 1990, the infant mortality rate has decreased from 8.7 to 5.3 deaths per 1,000 live births, the incidence of infectious disease has declined from 30.4 to 10.3 cases per 100,000 population and access to adequate prenatal care has declined from 72.4 percent to 60.6 percent of pregnant women receiving adequate prenatal care.

To learn more about health and health initiatives in Utah, visit the Utah state department of health Web site at: health.utah.gov/

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Vermont

Vermont is third this year; it was fourth in 2003. Strengths include a low rate of motor vehicle deaths at 0.7 deaths per 100,000,000 miles driven, a low violent crime rate at 107 offenses per 100,000 population and a low infant mortality rate at 4.3 deaths per 1,000 live births. Vermont also ranks in the top 10 states for a low prevalence of smoking, a low prevalence of obesity, a high rate of high school graduation, a low rate of uninsured population, a low incidence of infectious disease, a low percentage of children in poverty, high access to adequate prenatal care, a low total mortality rate and a low premature death rate. Challenges include a higher than average rate of cancer deaths at 207.3 deaths per 100,000 population. There are some health disparities within the state, as only 73.7 percent of pregnant black women receive adequate prenatal care compared to 85.9 percent of pregnant white women. Vermont is third for the combined measures of risk factors and fifth for the combined measures of outcomes, indicating it will likely remain among the relatively healthy states in the future.

In the past year, the rate of uninsured population decreased from 10.7 to 9.5 percent, the percentage of children in poverty declined from 12.2 percent to 10.9 percent of persons under age 18 and per capita public health spending increased from $44 to $60 per person. The rate of cancer deaths increased from 200.4 to 207.3 deaths per 100,000 population.

Since 1990, access to adequate prenatal care has increased from 62.6 percent to 85.8 percent of pregnant women receiving adequate prenatal care, the prevalence of smoking has declined from 30.7 percent to 19.5 percent of the population, the total mortality rate has declined from 889.2 to 775.9 deaths per 100,000 population and the premature death rate has declined from 7,842 to 6,130 years of potential life lost before age 75 per 100,000 population.

To learn more about health and health initiatives in Vermont, visit the Vermont state department of health Web site at: www.healthyvermonters.info/

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Virginia

Virginia is 20^th this year; it was 21^st in 2003. Its strengths include a low rate of motor vehicle deaths at 1.2 deaths per 100,000,000 miles driven, a low number of limited activity days per month at 1.8 days in the previous 30 days and high access to adequate prenatal care with 80.7 percent of pregnant women receiving adequate prenatal care. Challenges include low per capita public health spending at $20 per person and a higher than average infant mortality rate at 7.4 deaths per 1,000 live births. Health disparities within the state are present, as illustrated by the differences in premature death rates between black non-Hispanic individuals (11,625 years of potential life lost before age 75 per 100,000 population) and white non-Hispanic individuals (6,389 years lost). Virginia ranks 16^th for the combined measures of risk factors and 27^th for the combined measures of outcomes, indicating potential improvement in the relative healthiness of the state in the future.

In the past year, the prevalence of smoking decreased from 24.6 percent to 22.0 percent of the population, the prevalence of obesity declined from 23.7 percent to 21.7 percent of the population, the percentage of children in poverty increased from 8.4 percent to 13.5 percent of persons under age 18 and the percent of state health budget allocated to public health declined from 5.7 percent to 3.2 percent.

Since 1990, access to adequate prenatal care has increased from 73.0 percent to 80.7 percent of pregnant women receiving adequate prenatal care, the infant mortality rate has decreased from 10.6 to 7.4 deaths per 1,000 live births and the prevalence of obesity has increased from 9.9 percent to 21.7 percent of the population.

To learn more about health and health initiatives in Virginia, visit the Virginia state department of health Web site at: www.vdh.state.va.us/

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Washington

Washington is 15^th this year; it was 11^th in 2003. It is among the top 10 states for a low prevalence of smoking at 19.5 percent of the population, a low rate of motor vehicle deaths at 1.1 deaths per 100,000,000 miles driven, a low infant mortality rate at 5.3 deaths per 1,000 live births and a low premature death rate with 6,216 years of potential life lost before age 75 per 100,000 population. Challenges include low support for public health with 2.0 percent of the state health budget allocated to public health and a high percentage of children in poverty at 19.1 percent of persons under age 18. There are health disparities within the state, as shown by the access to adequate prenatal care: 62.0 percent of pregnant black women receive adequate prenatal care compared to 74.1 percent of pregnant white women. The state is 18^th for the combined measures of risk factors, lower than its 11^th for the combined measures of outcomes. This indicates that the state may not improve its relative healthiness in the near future unless the risk factors are more aggressively addressed.

In the past year, the percentage of children in poverty increased from 13.7 percent to 19.1 percent of persons under age 18, the number of limited activity days per month increased from 1.9 to 2.2 days in the previous 30 days and the prevalence of smoking decreased from 21.5 percent to 19.5 percent of the population.

Since 1990, the infant mortality rate has decreased from 9.7 to 5.3 deaths per 1,000 live births, the incidence of infectious disease has decreased from 84.1 to 16.9 cases per 100,000 population, the rate of uninsured population has increased from 10.4 percent to 15.5 percent and the percentage of children in poverty has increased from 11.8 percent to 19.1 percent of persons under age 18.

To learn more about health and health initiatives in Washington, visit the Washington state department of health Web site at: www.doh.wa.gov/

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West Virginia

West Virginia is tied with Alabama for 43^rd this year; it was 44^th in 2003. Strengths continue to include a low violent crime rate at 234 offenses per 100,000 population, a low incidence of infectious disease at 10.3 cases per 100,000 population and high access to adequate prenatal care with 79.3 percent of pregnant women receiving adequate prenatal care. The state faces challenges in many areas as it ranks among the bottom five states in seven of the 18 individual measures, including a high total mortality rate at 1,006.1 deaths per 100,000 population, a high prevalence of smoking at 27.3 percent of the population, a high rate of cancer deaths at 228.1 deaths per 100,000 population, a high number of limited activity days per month at 3.4 days in the previous 30 days, a high prevalence of obesity at 27.7 percent of the population, a high percentage of children in poverty with 26.7 percent of persons under age 18 and a high rate of deaths from cardiovascular disease at 393.3 deaths per 100,000 population. Access to adequate prenatal care, although a strength, is not equal across all racial groups; only 66.3 percent of pregnant black women receive adequate prenatal care compared to 79.7 percent of pregnant white women.

In the past year, the rate of motor vehicle deaths decreased from 2.2 to 1.9 deaths per 100,000,000 miles driven, the high school graduation rate declined from 73.4 percent to 71.2 percent of incoming ninth graders who graduate within four years and the percentage of children in poverty increased from 22.2 percent to 26.7 percent of persons under age 18.

Since 1990, access to adequate prenatal care has increased from 62.1 percent to 79.3 percent of pregnant women receiving adequate prenatal care, and the rate of cancer deaths has increased from 208.7 to 228.1 deaths per 100,000 population.

To learn more about health and health initiatives in West Virginia, visit the West Virginia state department of health Web site at: www.wvdhhr.org/

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Wisconsin

Wisconsin is ninth this year, returning to the top 10 states; it was 14^th in 2003. Its strengths are a low violent crime rate at 225 offenses per 100,000 population, a strong high school graduation rate with 79.0 percent of incoming ninth graders who graduate within four years, a low rate of uninsured population at 10.9 percent, a low incidence of infectious disease at 7.5 cases per 100,000 population and a low number of limited activity days per month at 1.7 days in the previous 30 days. Wisconsin's biggest challenges are a moderate percentage of children in poverty at 15.4 percent of persons under age 18, a moderate prevalence of smoking at 22.0 percent of the population and a moderate infant mortality rate at 6.6 deaths per 1,000 live birt