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How healthy is your state? IHME’s briefings provide insights

Published January 10, 2025

The US stands out globally for its excellence in the field of medicine. For example, lifesaving medical innovations such as antiretroviral therapy for HIV/AIDS, heart stents for treating people with blocked arteries, and vaccines against polio and measles, mumps, and rubella (MMR) were all developed in the US. Despite these profound medical advances, and the fact that the US spends more on health than any other country, the US is struggling to keep people healthy. When it comes to life expectancy, the US is falling farther and farther behind its peers, according to IHME’s new research. In 2021, the most recent year for which data are available, the US ranked 46th and 47th  in life expectancy worldwide for males and females, respectively, a decrease from 1990, when it ranked 19th for females and 35th for males globally. 

US global ranking in life expectancy, 1990–2021
Scatterplot showing declining US life expectancy between 1990 and 2020

Source: https://www.healthdata.org/sites/default/files/2024-12/01_auto_briefings_US.pdf

Troubling trends in states

IHME has published new briefings breaking down life expectancy trends at the state level, which indicate that many states are slipping in global life expectancy rankings, too. Looking at Mississippi and West Virginia, the states with the lowest life expectancy for males and females, respectively, in 2021, life expectancy rankings fell by more than 40 points over the past three decades. Similar trends are evident in even the healthiest US states. In Hawaii, which had the highest life expectancy ranking for males and females, the state’s ranking dropped by more than 15 points from 1990 to 2021.

Hawaii’s global ranking in life expectancy compared to US average, 1990–2021
scatterplot showing Hawaii's life expectancy is higher than the average in the US, though still declining since 1990

Source: https://www.healthdata.org/sites/default/files/2024-12/13_auto_briefings_HI.pdf

Unless US states make drastic changes addressing risk factors such as obesity and overweight, diabetes, high blood pressure, and smoking, IHME forecasts life expectancy rankings will continue to drop. These risk factors alone are the leading causes of poor health and early death in each state, the briefings show.

IHME forecasts show how states could reverse their worsening health performance. Both the healthiest and least healthy states in America stand to benefit from reducing people’s exposure to risk factors by 2050. Mississippi could boost its life expectancy rankings by roughly 40 points by 2050, while Hawaii could improve its rankings by more than 20 points over this same period.

Mississippi’s global ranking in life expectancy, 2022–2025, two scenarios
scatterplot showing how life expectancy in Mississippi could be improved if risk factors like smoking and obesity are addressed

Source: https://www.healthdata.org/sites/default/files/2024-12/26_auto_briefings_MS.pdf

Vast inequalities within and between states

The briefings go beyond the state level, examining life expectancy and well-being within counties. In 2019, the latest year for which estimates were available, life expectancy ranged from 92 years in Summit County, Colorado, to 65 years in Oglala Lakota County, South Dakota. Life expectancy in Summit County is comparable to life expectancy in Singapore, while life expectancy in Oglala County is similar to life expectancy in Yemen.

Even within the state of Colorado, with its impressively high life expectancy in the three counties that are home to the exclusive ski resorts of Aspen, Breckenridge, and Vail, life expectancy varies starkly across the state. In Otero County, located in the southeastern part of Colorado, life expectancy was 17 years lower than it was in Summit County. 

There are stark differences in life expectancy among Colorado counties
map of Colorado showing counties with the highest life expectancy of 93 years

Source: https://www.healthdata.org/sites/default/files/2024-12/07_auto_briefings_CO.pdf

Another metric explored in the briefings includes well-being, quantified in the Human Development Index (HDI). HDI captures lifespan, education, and income and provides insight into who and where are the worst off within a state. By targeting interventions to the people with the lowest well-being, states can improve their health performance. Take West Virginia, where people have some of the lowest levels of well-being in the US. The worst-off people in West Virginia live in the southwestern part of the state alongside the Kentucky and Virginia borders, while the better-off people tend to live in the northeastern part of the state close to Pennsylvania.

Well-being in West Virginia

IHME measures well-being across the states using a metric called the Human Development Index (HDI). This metric reflects lifespan, education, and income.

map of West Virginia showing the counties with lowest well-being levels in the south and highest well-being in the north of the state

Source: https://www.healthdata.org/sites/default/files/2024-12/50_auto_briefings_WV.pdf

Map reflects geographic subdivisions called Public Use Microdata Areas. These areas are designed to capture a minimum of 100,000 people.

In addition, the briefings show how well-being varies dramatically by race and ethnicity and sex due to racism and legacies of colonial violence. In the US as a whole, American Indian and Alaska Native people and Black males have the lowest well-being, but this can vary by state. For example, in Texas, Black and Latino males are the worst-off. 

Human Development Index by race and ethnicity and sex, United States
bar chart showing Asian females as the group in the US with the highest well-being and Black males with the lowest

Source: https://www.healthdata.org/sites/default/files/2024-12/01_auto_briefings_US.pdf

Chart reflects average Human Development Index measurement between 2008 and 2021. AIAN: American Indian and Alaska Native.

A second way to look at well-being is by looking at the makeup of the worst-off group in every state, which often reflects the most populous racial and ethnic groups. In Pennsylvania, a state where White people are largest racial and ethnic group, White and Black males make up the largest portion of the worst-off group. However, in California, where Latino people are the dominant racial and ethnic group, the worst-off segment of the population includes Latino males and females.

Makeup of lowest well-being group in California (hundred thousands of people)
pie chart showing the largest percentage of low well-being people in California were latino males and females

Source: https://www.healthdata.org/sites/default/files/2024-12/06_auto_briefings_CA.pdf

Numbers not shown in the pie chart are shown in the legend instead.

Notably, nationwide, researchers have observed a profound shift in the worst-off group over generations, with males becoming worse off over time and females becoming better off. Among younger age groups, the makeup of the lowest well-being group is predominantly male. Among older age groups, however, the worst-off group is predominantly female.

Solutions start early in life

America’s poor health outcomes have been decades in the making, and ameliorating them will not happen overnight. To ensure that everyone in the US can achieve health outcomes that are comparable to people in peer countries, interventions are needed in every stage of life, starting prior to conception and lasting through the end of life, especially for those who are worst-off. The US must also grapple with the root causes of inequality by improving education and addressing preventable risk factors, socioeconomic factors, and access to quality medical care.

Universal health coverage in the US is part of the solution to protect not only people’s health but also their financial well-being—medical debt can drive people into poverty.  Equally important is preventing health problems from occurring in the first place. Prevention programs need to be routinely evaluated to ensure effectiveness and modified accordingly. Further, making healthy foods such as fruits and vegetables more affordable and easier to find is a concrete action that policymakers can take to boost health and improve equity. Additional social support programs are needed to improve Americans’ well-being.

Education has a strong, beneficial effect on people’s health. State governments should ensure that everyone can access a high-quality, affordable education. Researchers have found that having 18 years of education is as good for your health as eating the recommended amount of vegetables, while not attending school at all is as bad for your health as smoking a pack of cigarettes every day for five years. 

chart showing -1.9% average mortality risk per year of education
Source: Education as protection against adult mortality | Institute for Health Metrics and Evaluation

As a nation and as individual states, we are not living up to our fullest potential. We are falling behind peer countries in life expectancy rankings. If current trends continue, our life expectancy rankings will fall even farther behind our peers, growing worse by the year. By taking aggressive action to improve people’s lives, America can change course for the better. 

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