Hawaii is once again the healthiest state in the United States, according to the latest America’s Health Rankings. This is despite the fact that the state’s diabetes rate has doubled in the past 15 years.

“Our state is facing an epidemic of obesity and diabetes type 2 that is preventable, and costly to our health and pocket books,” Virginia Pressler, Hawaii’s director of health, said in a press release for a recent chronic disease symposium

But Hawaii as a whole still has a lower prevalence of obesity compared to other states, as well as fewer preventable hospitalizations, and better mental health.

The report was published by the United Health Foundation, the nonprofit arm of UnitedHealth Group. 

This is the fourth time Hawaii has ranked as the healthiest state. At the other end of the scale, Louisiana claimed the unfortunate distinction of being the least healthy state in the nation, a spot held by Mississippi in recent years.

States were rated not only by disease rates but also on how local healthcare systems and state governments care for their patients and citizens.

When compared to other nations, the United States ranks 33rd — just behind the Czech Republic — despite spending $3 trillion annually on healthcare. 

“It is pretty clear we are not getting the full return on our investment,” Dr. Reed Tuckson, senior medical advisor at UnitedHealth, told Healthline.

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The Health of a Nation

States were rated on four key factors: personal behaviors, the health of the community and environment around them, policy (including public health funding), and the quality of clinical care available.

“Hawaii does well almost across the board in almost all these domains,” Tuckson said.

Only 6 percent of Hawaii residents are uninsured, and the state spends $204 per person on public health.

Nationwide, health is improving. The report reveals that 5 percent fewer people in the United States smoke, and they tend to be more active than in years past. The rate of preventable hospitalizations is down by 8 percent, and trends show cardiovascular-related deaths and infant mortality continue their steady decline.

Of course, there is plenty of room for improvement.

More than 1 in 5 children in the United States now lives in poverty.

Drug deaths increased by 4 percent, now accounting for more than 13 deaths per 100,000 people. Obesity is up, now affecting nearly 30 percent of the population, more than doubling since 1990. Today, 10 percent of Americans have diabetes.

“These are things of great concern,” Tuckson said. “We are living longer, but we’re living sicker.”

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A Call to Action

Native Hawaiians — like other Pacific Islanders — have higher cancer death rates, triple the rate of type 2 diabetes, and nearly twice the likelihood of being obese than their non-Hispanic white counterparts. Tuckson says health data like this can be a starting point for turning those numbers around.

He urges people concerned about their health to read the state and regional reports and contact their local health departments. Together, he said, communities can identify health risks and begin to address them.

“Public health campaigns can and do work,” he said.

Tuckson says the United States needs to change its healthcare spending priorities, spending less on gadgets and pills and more on prevention. Such a shift would help close the rift between those who can afford the resources to be healthy and those who cannot.

“We are two nations,” he said. “We cannot afford to medicalize ourselves out of this problem.”

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