Rapidly rising obesity rates and a startling increase in child mortality are holding back gains in Americans’ overall health, concludes an annual 50-state survey conducted by nonprofit public health groups Monday.

The survey has documented steady improvements in a host of health indicators across the country since 1990 in areas including deaths from infectious diseases, motor vehicle accidents, and violent crime. But experts now warn that gains seen up until 2000 have leveled off to near stagnation.

“We’re not really making progress year over year,” says Reed Tuckson, MD, vice president of the United Health Foundation, one of three groups releasing the study.

Tuckson cites a near-doubling in national obesity rates since 1990 as a major drag on what could otherwise be an improving health picture for Americans. While death from violent crimes, cancer, infectious diseases, and car accidents are down, those gains appear to be at least partially erased by a 23 perhaps obesity rate in the adult population.

Obesity is associated with a variety of health problems, including diabetes, pregnancy difficulties, and cardiovascular disease. A study published earlier this year in the Journal of the American Medical Association predicted that by next year obesity could overtake smoking as the leading preventable cause of death in the U.S.

Tuckson also says that experts are “startled” that infant mortality ticked upward in 2004 for the first time in 40 years. Rising poverty levels, less access to health insurance, and stagnant smoking rates appear to be playing a role, according to the report.

Seven of every 1,000 infants born in the U.S. now die before their first birthday, ranking the nation behind 27 other countries. More than 17 percent of American children now live in poverty, up 8 percent from the year before.

“It’s very clearly an issue of socioeconomic status,” says Georges Benjamin, MD, executive director of the American Public Health Association.

The report examines 18 areas to get an overall picture of the public’s health in the 50 states. Some — such as mortality rates and smoking figures — are direct measures of health, while others, including access to medical insurance and average education levels, are more indirectly associated with overall well-being.

Researchers take data from a variety of public and private sources, including the Centers for Disease Control and Prevention, U.S. Census Bureau, and the National Safety Council.

Ranking the States

Mississippi had the highest infant mortality rate in the nation at 10.2 deaths per 1,000 live births. That score, along with the nation’s highest obesity rate, helped put the state last among the states in overall public health.

Minnesota, New Hampshire, and Vermont ranked in the top three positions, owing largely to more robust state-run public health programs, higher education rates, and lower child poverty numbers.

Twenty-two states improved their scores from the previous year, while 28 declined. Nationally, public health quality, according to the report’s scoring scheme, improved an average of 1.5 percent per year between 1990 and 2000. But public health quality has improved at just 0.2 percent since then, Tuckson says.

The scores were highly divided geographically, with eight of the 10 lowest-scoring states falling in the southeastern part of the country. Meanwhile, Hawaii was the only non-northern state to score in the top 10.

Jonathan Fielding, MD, the director of public health for Los Angeles County, says that southern states generally have fewer resources to spend on public health programs. They also have the lowest education rates in the nation, according to the survey.

“We know that one of the most important determinants of health is whether or not someone has graduated from high school,” says Fielding, who is also chairman of the board at the Partnership for Prevention, a nonprofit health group.

Alaskaled the nation in public health resources, spending $716 for every citizen. But experts cautioned that the figure does not provide a clear picture of actual health spending for residents since much of the money is being spent on anti-bioterrorism and other homeland security programs.

The 2004 results for America's Health: State Health Rankings are listed below, with the top of the list being the healthiest. The scores represent how a state compares with the national norm. For example, a state with a score of 10 is 10 percent above the national average. A negative score means a state is below the national average.

Rank/State/Score:

1. Minnesota 25.0

2. New Hampshire 23.9

3. Vermont 22.8

4. Hawaii 17.7

5. Utah 17.6

6. Massachusetts 17.3

7. North Dakota 15.8

8. Connecticut 15.0

9. Wisconsin 14.4

10. Maine 13.7

11. Iowa 13.2

12. Nebraska 11.7

13. Colorado 11.6

14. Rhode Island 10.9

15. Washington 9.1

16. Kansas 7.3

17. New Jersey 7.2

18. Idaho 6.4

19. South Dakota 6.3

20. Virginia 5.9

21. Oregon 5.2

22. California 3.6

23. Arizona 3.0

24. Alaska 2.9

25. Pennsylvania 2.8

26. Montana 2.1

26. Ohio 2.1

28. Wyoming 2.0

29. Illinois 0.3

29. Michigan 0.3

31. New York 0.1

32. Delaware -0.1

32. Indiana -0.1

34. Maryland -2.0

35. Texas -2.7

36. Missouri -4.2

37. Nevada -5.8

38. New Mexico -6.6

39. Kentucky -7.1

40. Oklahoma -7.2

41. North Carolina -7.5

42. Florida -8.4

43. Alabama -10.4

43. West Virginia -10.4

45. Georgia -11.1

46. Arkansas -12.1

47. South Carolina -12.9

48. Tennessee -13.1

49. Mississippi -20.2

50. Louisiana -21.3

By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: America’s Health: State Health Rankings, Nov. 8, 2004. Reed Tuckson, MD, vice president, United Health Foundation. Georges Benjamin, MD, executive director, American Public Health Association. Jonathan Fielding, director of public health, Los Angeles County, Calif.