Friday, January 21, 2011

Some perspective on Vermont's ranking as healthiest state

According to the annual America’s Health Rankings, issued last month by the United Health Foundation Vermont is ranking first in the nation as the healthiest state. 
Although this article suggests that this must be read with caution, it also reveals some interesting numbers and facts - in comparison. For example, 58% of all adult Vermonters are either overweight or obese. And the state still ranks first in the U.S. 

By Tim Johnson, Burlington Free Press:

Vermont’s recent ranking as the healthiest state in the country might be cause for celebration, but on closer inspection, that distinction isn’t quite as wonderful as it looks.
The annual America’s Health Rankings, issued last month by the United Health Foundation, take 22 primary indicators into account — such as prevalence of obesity, health insurance and primary-care-physician coverage. For each indicator, states get a score based on how they compare with all the other states, and the sum of those weighted scores becomes the basis for the national health ranking.
Vermont came out No. 1 for 2010 and for 2009. Why isn’t this something to crow about?
Because the states Vermont surpasses aren’t doing so great to begin with — considering that the United States, as a rich, industrialized country, trails its peer nations in health quality. In other words, Vermont sits atop a country that’s an also-ran.
What’s more, one of the indicators — for which Vermont is No. 1 — is not a direct reflection of health quality at all. It’s the state’s high school graduation rate, listed at 88.6 percent. What does that have to do with Vermont’s healthiness?
“It is an indication of the individual’s ability to learn about, create and maintain a healthy lifestyle and to understand and access health care when required,” reads the methodological explanation.
As for the health indicators, Vermont gets its lowest ranking for binge drinking (No. 36) and scores in the middle third for smoking prevalence (No. 17), occupational fatalities (No. 18), immunization coverage (No. 27), poor mental health days and cancer deaths (both No. 19).
What pushes Vermont to the top overall are its showings for obesity prevalence (No. 5) , its low incidence of violent crime (No. 2) and infectious disease (No. 4), its primary-care coverage (No. 4), the share of its population covered by health insurance (No. 4), early prenatal care (No. 1) and infant mortality (No. 4).
Not all of those rankings are as impressive as they sound.
Take obesity: How much satisfaction can Vermont take in being less obese than the rest of an increasingly obese country? According to one recent survey, 58 percent of Vermont adults are overweight or obese. So what if that percentage is lower than for other states — it’s still higher than recommended.
What about primary care? Vermont has a documented shortage of full-time primary care doctors (the state has 476 full-time-equivalent physicians, according to data being developed for 2010, 25 fewer than needed.)
“There is a persistent and pervasive shortfall of internal medicine practitioners — that is, those who serve adults in primary care — in every region of Vermont,” said Elizabeth Cote, director of the Office of Primary Care at the University of Vermont College of Medicine.
“But we are doing well compared to other states,” Cote said. “Lots of effort goes into health care work force pipeline development, recruitment and retention.”
Consider infant mortality. The United States has a higher rate than 43 other countries in the world — higher than Taiwan, Singapore and most of Europe. In that context, Vermont’s high state ranking isn’t exactly cause for rejoicing. Moreover, the state’s population is so small that one death can change the rate dramatically, noted Breena Holmes, director of maternal and child health at the state Department of Health.
“We still have work to do,” she said, adding: “We do very well getting people into prenatal care.”
Read the full article here.

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