The United Health Foundation has released its latest health rankings report, and the findings paint a conflicting portrait of the U.S. health system.
While overall U.S. deaths increased 17% from 2019 to 2020, people also reported a 13% increase in high health status during the same time.
The report examined more than 80 measures from 30 data sources, with the goal of illuminating the strengths and pitfalls of this country’s health. It offers a look into disparities by age, gender, race, ethnicity, geography, education and income level. The report is available at AmericasHealthRankings.org, as is an interactive breakdown of the data.
The report found large disparities existing between groups. COVID-related death rates were highest among the American Indian/Alaska Native population as well as among males and seniors 85 and older. COVID-related deaths among the Hispanic, Black and Hawaiian/Pacific Islander populations also exceeded the national rate by 30 percentage points or more.
New York led as the state with the highest mortality rate at 29%, followed by New Jersey (27%) and Washington, D.C. (23%). COVID-19 was the third-leading cause of death in 2020.
Meanwhile, high health status was reported among Asian and white adults more than among American Indian/Alaska Native, Hispanic and Black adults. The highest rankings came from the West, Midwest and the Northeast regions, and from those with higher education levels. However, in total, more than half of all U.S. adults reported good or excellent health between 2019 and 2020. These rankings marked the reversal of a long-term downward trend.
“We begin to see how the COVID-19 pandemic has had both direct and indirect impacts on health and health trends,” Rhonda Randall, executive vice president and chief medical officer of UnitedHealthcare Employer and Individual, said in a statement in the report. “The report also demonstrates an urgent and ongoing need to further examine and discuss these findings and how to best address Americans’ most pressing health needs.”
The report found other peculiar contradictions that will take time to fully understand, the analysts said. Cancer decreased 7% from 2019 to 2020—though there is also evidence that screenings for cancer declined during that time. The number of adults with three or more chronic conditions also decreased during that time, with cancer decreasing the most (7%).
“Further analysis will be necessary as additional data become available,” the report said.
The U.S. ranked thirty-third of the 38 OECD countries for infant mortality in 2019. It also ranked low—29 of 38—for life expectancy at birth the same year. And the U.S. had the highest health spending of all.
The most concerning takeaway from the report is the reduction in life expectancy, said Georges Benjamin, M.D., executive director of the American Public Health Association, in a press webinar about the report’s findings. He noted that this reduction was not only because of the pandemic but also because of ongoing concerns like obesity and the opioid epidemic.
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“The report does a marvelous job of identifying where states can focus their efforts,” he said, such as addressing funding and infrastructure gaps. Figuring out the right system to put in place is an ongoing challenge, and he emphasized the need to break the classic tendency to “throw a lot of money at the problem when we first get it and never build the infrastructure for the long haul.”
Yet it’s hopeful to see an increase in public funding, Benjamin said.
Public health funding increased 33% between 2017 and 2020, in part due to COVID-19 response measures. D.C. had the highest health funding per person between 2019 and 2020, at $874, followed by $449 in Alaska and $265 in New Mexico.
States with the lowest rates per person included Nevada and Wisconsin (both $72), as well as Texas ($74) and Ohio ($75). The national rate was $116 per person. Time will tell how much the increase will persist and how much of it is merely plugging existing holes like staffing shortages in the wake of COVID-19, Benjamin noted.
Despite staffing shortages in the industry, the number of mental health providers increased 6% between 2020 and 2021, the report found, a 30% increase since 2017. The number of primary care providers also increased 4% in the same time period, an 18% increase since 2018. D.C. had the most providers, while Nevada had the fewest.
Fewer adults avoided seeing a doctor because of the cost between 2019 and 2020 (a 22% decrease). While decreases were significant among most racial and ethnic groups—and across all ages, genders, education and income levels—disparities still existed between states. Avoiding care due to cost was highest in Texas (15.2%) and lowest in Hawaii (6%). Avoiding care was also associated with low-income households, older adults and lower education levels.
At the same time, the U.S. saw its highest level of flu vaccinations in 2020 since 2012, with 47% of adults reporting receiving the flu vaccine.
The U.S. can no longer afford not to have the infrastructure in place to address things like social determinants that lead to inequities in public health, said Judy Monroe, M.D., president and CEO of the CDC Foundation, in the press webinar.
Every state task force should seize on the opportunity to leverage the report’s findings to improve their own systems. States should “look at who the exemplars are” and how they can attain their level of success using the report as a guide.