The 2013 edition of America' s Health Rankings came out yesterday. Once again, Mississippi finished 50th. At least you can't fault our consistency.

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America’s Health Rankings
©2013 United Health Foundation

The 2013 edition of America’s Health Rankings were released yesterday, and as in nine of the past 10 years, Mississippi came in dead last — no pun intended.

For over two decades, the United Health Foundation has compiled the annual rankings as a comprehensive assessment of public health in all 50 states. Mississippi has never finished higher than 48th — and that was only twice.

The full rankings can be found here, as well as an explanation of the methodology here and the 27 indicators used here. To get a complete picture of what’s happening in Mississippi, I also looked at the intrastate data from the newest set of County Health Rankings, produced by the Robert Wood Johnson Foundation and the University of Wisconsin’s Population Health Institute.

Here’s what stuck:

1. Nowhere to go but up…

In addition to ranking 50th overall, Mississippi ranked last in each of the following indicators: infectious disease, adolescent immunization, low birthweight, infant mortality, cardiovascular deaths, and premature deaths. Mississippi ranks 45th or below in 15 of the 27 health measures, including obesity (49th), cancer deaths (49th), physical activity (48th), diabetes (49th), and access to primary care physicians and dentists (49th).

The report aggregates all of the metrics into a single health index and ranks the states accordingly. Mississippi’s health score is nearly a full standard deviation below the national mean, and nearly two standard deviations below Hawaii, the healthiest state.

In real terms, that means that Mississippians live significantly shorter, unhealthier lives than our fellow Americans. Two statistics offer the starkest assessment of the toll Mississippians pay for our poor health: premature death and infant mortality.

Premature death measures how many potential years of life are lost by a state’s residents who die before the age of 75. For instance, if a person dies at age 50, he or she would add 25 years to the premature death statistic, while a deceased 25-year-old would add 50 years.

For every 100,000 people, Mississippi loses 10,821 years of potential life. That’s twice as many years lost as Minnesota, which tops the rankings, and over two-thirds more than the U.S. average of 6,981.

Premature Death by state, based on CDC data and accessible at http://www.americashealthrankings.org/ALL/YPLL/2013
Premature death by state, based on CDC data and accessible at America’s Health Rankings

No part of Mississippi is immune from premature mortality. Only one county in Mississippi, Lamar, approaches the national average, while most Delta counties double it. Quitman County’s residents have lost nearly 18,000 years of potential life — a morbid figure that exceeds any other part of the developed world.

Premature death takes into account infant mortality. One baby out of every 100 (or 9.9 per 1,000) dies in Mississippi during the first year of life, often as a result of poor maternal health, insufficient prenatal care, and limited access to quality healthcare. That places Mississippi closer to China and Mexico (13 deaths per 1,000 live births) than the U.S. average (6 per 1,000), which ranks 40th in the world. Mississippi’s infant mortality rate stands alone even among our neighbors: Alabama (8.5), Tennessee (8), Louisiana (8.2), and Arkansas (7.5).

Infant mortality rates from the National Center for Health Statistics accessible at http://www.americashealthrankings.org/ALL/IMR/2013
Infant mortality by state, based on data from the National Center for Health Statistics and accessible at America’s Health Rankings

2. …but it could be worse

Mississippi did have several bright spots, though they were few and far between. Mississippi’s rate of binge drinking (5th) and drug deaths (18th) are low by national standards. Violent crime has also decreased significantly over the past 20 years, to the 15th-lowest rate in the country.

Meanwhile, Mississippi has the 3rd-best rate of immunization among children (aged 19-35 months), despite ranking last in the number of 13- to 17-year-olds with vaccinations. Mississippi is one of only two states that does not allow religious or philosophical exemptions to immunization requirements.

However, these few positive indicators don’t seem to offer a pattern of success that will meaningfully improve Mississippians’ health outcomes in the near term.

3. We’re all in it together

The report calculated health disparities based on educational attainment, which has a strong positive correlation with health but also serves as a proxy other important factors such as income and vocation.

The good news is that Mississippi has the 3rd-smallest disparity (21.5 percent) in the reported health statuses of those who graduated high school and those who didn’t. The reason — and here’s the bad news — is that even educated Mississippians have lots of health problems.

The fact is, every single one of us is less healthy for living in Mississippi. Mississippians with a college degree (thus, likely, higher incomes and less physically demanding jobs) have higher rates of obesity, smoking, diabetes, and physical inactivity than their counterparts nationally. Mississippi’s college grads are also less likely to report their health as “good” or “excellent” than degree-holders in other states.

4. A familiar pattern

2013 Health Outcomes - Mississippi
Health outcomes by county, accessible at County Health Rankings

Regular readers should instantly recognize the similarity between this map of health outcomes and maps we’ve posted recently about opportunity and migration.

Mississippi is a deeply unequal state, increasingly divided by geographic boundaries that reinforce racial, social, and economic disparities. The Memphis and Jackson suburbs, the college towns, and the Coast are relatively prosperous and healthy, while much of the rest of the state is ensnared in a vicious cycle. Residents with the means and physical ability to leave Mississippi’s declining areas will continue to do so, but few are moving in to replace them. What — and who — is left behind will look less and less like the rest of the state and the country, not to mention the rest of the developed world.

The solutions aren’t always clear, but it is apparent that we cannot address these interlocking issues in isolation. Health, education, and economic opportunity are all part of the same basic challenge: How can we make sure all Mississippians have the ability to lead a comfortable, fulfilling life — no matter where they’re born, what they look like, or who their parents are?

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