The State of Health in America


February 3, 2016


The state of health in America is a popular topic, especially as the 2016 presidential election dominates the national news cycle. The health of the average American is as important on the list of talking points as the more contentious topics of health care, health services, and affordable health insurance coverage.

Using nationwide health data collected from the Centers for Disease Control, we crafted a broad look at the state of health across the United States. We examined specific diseases and infections, mapped the nation’s sickest cities, and analyzed the prevalence of emergency room visits across the country. The causes of illness for American citizens may not come as a surprise, but this in-depth look at the powerful impact of the state of health care and health services in the United States will get you thinking.

01-Diseases (5)

Some states experience high prevalence of multiple diseases, despite the difference in each one’s cause. For example, Maine, Alaska, Tennessee, and Ohio all make the top five for either viral or bacterial infections such as chickenpox, salmonella poisoning, pneumococcal disease, and the flu. It’s clear from each disease’s prevalence map that these correlations aren’t regional, but a deeper look at the state-by-state approach to health care and health education could unlock some of the reasons these states have such high rates of disease reporting.

First of all, vaccines exist for many viral and bacterial infections that, if left untreated, can cause serious illnesses and even death. Chickenpox, pneumococcal infections, and the flu can all be more effectively prevented when patients keep their vaccinations up to date. But in the four states with a high prevalence of at least one of these diseases, vaccination exemptions are available to patients with either religious or philosophical objections, and sometimes both. Because the U.S. allows each state to regulate its own immunization exemption requirements, states including Maine and Ohio allow religious and philosophical exemptions. In turn, Maine is the state with the highest chickenpox incidence and the fifth-highest pneumococcal incidence. Ohio is the fourth-highest state for chickenpox and the third-highest for pneumococcal infection.

By contrast, Mississippi is one of the few states that prohibit both religious and philosophical immunization exemptions. Where Maine reports an average of 132.3 cases of chickenpox per 1 million residents, Mississippi reports two cases. And Mississippi reports an average of 18.7 cases of pneumococcal per 1 million residents, while Maine reports 66.16 cases on average. It seems clear that mandatory immunization makes a big difference in lowering the prevalence and spread of disease. This is especially true for children entering schools where viral contagions and bacteria can spread quickly.

The accessibility of effective and reliable health care plans also plays a role in reducing the prevalence of disease around the country. States including Alaska, Tennessee, and Ohio all have high prevalence of viral and bacterial diseases, and they also all earn low state-by-state health care rankings. Alaska and Ohio feature ratings of 32 and 33 on their in-state health care systems, placing them in the bottom and third quartile nationally. Tennessee drops to a rating of 43 out of 51, placing it in the nation’s lowest quartile. Limited access to health care, emergency medical care, and accessible general treatments could significantly contribute to the prevalence of viral and bacterial infections. Alaska has the highest prevalence of pneumococcal infection in the country and the second-highest prevalence of the flu. Tennessee ranks fourth-highest for pneumococcal infection and fifth-highest in the nation’s flu prevalence. Regular doctor visits, up-to-date vaccinations, and access to emergency care could considerably decrease infections like these.

Finally, the last map displaying the prevalence of chlamydia across the United States can be taken in direct parallel with state-by-state sex education mandates. Each state establishes its own requirements for sex education in great detail. Where some states mandate sex education and HIV education, some states with those mandates are not required to provide unbiased or medically accurate information. In other states still, parents have the right to opt out of certain aspects of or even all of HIV and sex education programs on behalf of their children.

North Carolina has the top prevalence of chlamydia in the country, and while medically accurate and age-appropriate sex education and HIV education are mandated, unbiased information free of religious influence is not a requirement. South Carolina, which ranks second-highest for chlamydia, is a similar case. Although South Carolina’s mandate does not include medical accuracy, it empowers parents to opt out of sex education altogether on behalf of their children.

Arkansas ranks third in prevalence of chlamydia, and there is absolutely no sex education required at all in the state. Delaware, which ranks fourth, mandates sex education and HIV education but does not require that education be unbiased, medically accurate, age-appropriate, culturally appropriate, or free of religious influence. Virginia has the fifth-highest prevalence of chlamydia in the country and only mandates that if and when sex education is provided, information is age appropriate. Again, parents can opt out of any sex education programs for their children in Virginia.

The incidence rate of chlamydia is increasing across the United States overall, but it is clear that in states where young people are not educated about safe sex, and more specifically about sexually transmitted diseases like chlamydia, the incidence of those diseases is considerably higher.

04-ER-Visits (3)

The steady decline of the percent of American adults who report one emergency room visit has continued uninterrupted since 2010. By 2009, 21.4 percent of adults reported at least one visit to the emergency room. But between 2010 and 2013, that rate dropped to fewer than 19 percent in a consistent decline from year to year. Considering the great percentage of emergency room visits that occur due to unintentional injuries, chances are slim that Americans have become more health- or safety-conscious. The overall change between 2010 and 2013 may not be great, but even so, it’s probably safe to assume that the steadily declining rate of ER visits can be attributed to more accessible health care and health services.

The Affordable Care Act was signed into law in 2010, and after much political contention was upheld by the Supreme Court in the years that followed the law’s passing. Colloquially known as Obamacare, the Patient Protection and Affordable Care Act was designed to put in place comprehensive health care reforms that made health insurance and health care services more readily available and, most important, affordable, for all Americans.

The small overall difference in the percent of adults who report emergency room visits between 2010 and 2013 may be attributable to the challenges to Obamacare that have slowed the progress of its incremental rollout as a national program. The Affordable Care Act was also designed to take place over a four-year implementation process, during which features and coverages were planned to increase and develop responsibly. This rollout plan could be the explanation that draws together the slow but steady decrease in emergency room visits as planned, consistent progress.

07-HIV (3)

After 30 years of dedicated medical effort, the cure for AIDS and HIV still eludes us. Reported cases of HIV infection the United States can’t be neatly attributed to any specific cause, but we can identify a few contributing factors. Because HIV is sexually transmitted, it’s no great surprise that cities with a more liberal, open-minded approach to sex and sexuality land on the top 10 list of the U.S. cities with highest HIV prevalence. San Francisco, the veritable hub of the Summer of Love in 1969 and a city with a vibrant and welcoming LGBTQ scene, places at No. 2 in the country. Florida plays host to college-aged, party-loving, and often reckless spring breakers year after year, and it also features three separate cities on the top 10 list of HIV prevalence. In states such as New Jersey, Louisiana, and Mississippi, contraceptive access is limited or restricted for minors who may then engage in sexual activity in unsafe ways if they choose to engage at all.

The transmission of HIV is largely preventable, and with access to effective treatment methods, its spread could be seriously curtailed. However, the director of the Centers for Disease Control and Prevention, Dr. Thomas R. Frieden, suggested recently that we are still losing the war on HIV/AIDS, and that the hundreds of thousands of HIV-positive Americans who don’t receive care or treatment for the disease account for most new cases of HIV transmission. In recent years, medical researchers and health professionals have made enormous progress in developing treatment systems that allow HIV-infected individuals to live long, healthy lives without unwanted transmission of the virus. Improving or even overriding individual state legislations that limit the accessibility of these crucial HIV testing and treatment options could be one key step in winning the war on AIDS.

06-Cancer (1)

Speculating about contributors to the spread of cancer is something of a national hobby. Because cancer is a dangerous and often fatal disease that is not contagious and is sometimes completely unpredictable, health professionals work hard to determine what elements of our natural environments might contribute to the disease’s prevalence. Researchers analyze everything from diet to physical environment to develop strategies that supposedly cut out carcinogenic substances from our daily lives. These findings are not always accepted by the medical profession overall, and so it is difficult to determine whether or not their suggestions help to decrease prevalence of new cancer cases.

The medical profession mostly agree that new cases of cancer frequently can be linked to hereditary connections. Oftentimes, doctors will suggest preventative measures to eliminate the future possibility of cancer appearing in the body. For patients who are aware of their inherited predisposition to cancer or who acknowledge their high risk levels, frequent and ongoing health care is a hugely important factor in their lifestyle planning. The prevalence of cancer in the U.S. is grouped regionally on the map in the Northeast, but the Northeast also boasts the lowest mortality rate from cancer. If health care centers and medical facilities with specific cancer care capabilities may be the key to beating the disease, then it’s no surprise that those with a predisposition to the disease find themselves in the region of the U.S. where these care centers are most popular and accessible.

05-Diabetes (2)

On average, 9 out of 100 Americans have been diagnosed with some form of diabetes. The United States has come to be known for its widespread obesity epidemic for more than a decade, and it’s no secret that health and physical wellbeing are important factors in preventing new cases of diabetes. Type 2 diabetes is the most common form of diabetes, and although it can be hereditary, it can also often be prevented or at least postponed in its most extreme form. The concentration of American cities with the highest prevalence of diabetes cases is grouped in the South and the Southeast regions, which may have something to do with a typical lifestyle in more rural parts of the country. The American South is world-famous for its culinary delicacies, which are often deep-fried, fatty, and high in calories.

This part of the country also tends to necessitate driving long distances rather than walking as a mode of transportation. Many hours spent sitting in cars, improper diets, and the popularity of fast food joints along American highways all contribute to the temptation of an unhealthy lifestyle. Healthy eating and regular exercise seem simple, but they can also be effective choices when it comes to staving off the more dramatic measures required to treat Type 2 diabetes and care for seriously ill patients.


Overall, it is clear that accessibility to health care and the effectiveness of health services around the country play an important role in determining the health of American citizens. State by state or city by city, the state of health in America closely correlates with the availability of health care options and accurate education so that Americans can protect themselves from preventable diseases and infections and keep their families healthy.

Keeping Americans out of emergency rooms could be as simple as taking further precautions when it comes to dangerous situations where accidents happen. A solution for even more dramatic reductions in emergency room visits in America could be as simple as supporting health care reform that protects all Americans. When it comes to health, these are just some of the ways you can educate and protect yourself against unwanted illnesses within the context of your state’s health rules and regulations.



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