Teenage pregnancy rates have fallen, but smoking, obesity and child poverty remain large U.S. public health issues, results of a new assessment show.

The 16th annual America's Health Rankings report, released Monday, used state-by-state analyses to assess the nation's health. It shows that lifestyle factors, such as smoking and nutrition, are the biggest obstacles to improving public health. Minnesota was rated the healthiest state, and Mississippi the nation's most health-challenged state. The nation's health has improved 18.4% since 1990, according to United Health Foundation vice president Reed Tuckson. The percentage is arrived at by using 1990 as a baseline year and computing a weighted average of changes in health factors since then, says Tom Eckstein of Arundel Street Consulting in St. Paul, which compiled the statistics from a variety of government databases. United Health Foundation is a non-profit research group established by UnitedHealth Group, a private health insurance and health services company. The bad news is that the rate of improvement is slowing down. "In the 1990s, we were seeing a 1.5% increase year over year," Tuckson said. Since 2000, that number has slipped to a yearly average increase of 0.3%. Smoking and obesity largely are to blame, according to the report, which is conducted annually by United Health Foundation in partnership with the American Public Health Association and Partnership for Prevention. Although the smoking rate has declined 30% overall since 1990, 20.8% of Americans still smoke. "People are going to have to start making choices if our nation is going to reach its full potential," Tuckson said. "Smoking remains the most important risk factor for the prevention of disease and premature death." Equally troubling is the obesity rate, up from 11.6% in 1990 to 23.1% last year for those 18 and older, according to figures from the Centers for Disease Control and Prevention. Despite the prevalence of fad diets and emphasis on weight loss, 2.6% more people — or 1.5 million — can be classified as obese since last year alone, the CDC says. "The impact this will have on other diseases that are related to obesity, especially diabetes, which then is related to diseases like heart disease and kidney disease, is significant," Tuckson said. "What we can expect is that more people will be living with secondary disease. They will die sooner, and they will drive up health care costs." The report cites CDC data showing teen pregnancies fell 30% this year to 31.2 births per 1,000 teenage females, an accomplishment Tuckson attributes to community involvement and a broad range of strategies. This means fewer children will be born into poverty, especially significant since the report cites U.S. Census data showing child poverty rates have increased in 25 states since just last year. Tuckson said 28 countries have more expected years of healthy living than the United States, which has 69.3 years. Japan has the longest healthy life expectancy at 75 years, followed by France (72), Germany (71.8) and the U.K. (70.6). "What this is telling us is that we have not reached anywhere near our biological potential as human beings. We have a ways to go," Tuckson said. Although some states have work to do, everyone can learn from each other, Eckstein said. "Access to prenatal care is higher in Mississippi than it is in Minnesota. You have to look across the board. You can learn from somebody else." 2005 OVERALL HEALTH RANKINGS The United Health Foundation has released the 16th annual America’s Health Rankings report. Scores indicate the percentage a state is above the national average. Rank State Score 1 Minnesota 22.2 2 Vermont 21.3 3 New Hampshire 18.3 4 Utah 17.4 5 Hawaii 16.9 6 North Dakota 16.6 7 Connecticut 15.7 8 Maine 15.4 9 Mass. 15.2 10 Iowa 15.0 11 Nebraska 12.5 12 Rhode Island 11.2 13 Wisconsin 10.9 14 Washington 10.8 15 New Jersey 10.6 16 Idaho 10.4 17 Colorado 10.1 18 Oregon 8.4 19 South Dakota 6.7 19 Wyoming 6.7 21 Montana 5.9 22 California 5.8 23 Kansas 5.7 24 Virginia 5.5 25 Pennsylvania 2.1 26 Ohio 1.3 27 New York 1.0 28 Illinois 0.9 29 Michigan 0.1 30 Alaska -0.6 31 Arizona -1.5 32 Indiana -2.3 33 Delaware -3.4 34 Maryland -3.5 35 Missouri -3.8 36 North Carolina -5.6 37 Nevada -5.7 38 New Mexico -5.9 39 Texas -6.7 40 Florida -8.6 41 West Virginia -9.1 42 Kentucky -9.8 43 Georgia -10.1 44 Oklahoma -11.4 45 Alabama -12.7 46 Arkansas -15.6 47 South Carolina -15.7 48 Tennessee -16.8 49 Louisiana -18.3 50 Mississippi -19.4 Source: United Health Foundation

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