Outcome s
7
# Years Of Life Lost
Number of years of life lost per capita from all causes prior to age 75. R ANK
7
CHANGE
DISPARITIES
GR ADE*
YES+
The premature death rate measures the loss of years of life due to death before age 75. Thus
the death of a 25-year-old would account for 50 years of life lost, while the death of a 60-yearold would account for 15 years. Washington State ranks 7th in this outcome with 5,957.3 years of life lost per 100,000 population. Minnesota ranks 1st with 5,219.5 years lost per 100,000 population, while Mississippi ranks 50th with 10,678 years lost per 100,000 population. Many of the Healthiest State Report Card measures affect the premature death rate. Strong community systems that Invest in Prevention, Increase Value in Health Services, Protect Against Injury and Disease, and support individuals who Avoid Addiction and Engage in Healthy Habits, all contribute to fewer premature deaths. Disparities in this outcome are present between all groups. Hispanics and Asian/Pacific Islanders have fewer years of life lost in Washington and nationally than do Caucasians. But rates for African Americans and American Indians/Alaska Natives are higher, although African Americans fare better here than nationally. Particularly disturbing is that premature death among American Indians/Alaska Natives occurs at twice the rate in Washington as it does for Caucasians, and at a far higher rate here than across the nation. Cigarette smoking is the single most preventable cause of premature death in the U.S.1 For more than a decade, we have known that premature deaths associated with smoking robs more than five million years from potential lifespans.2 As noted in the Smoking Rates measure, American Indian/Alaska Natives report a higher smoking rate than other racial and ethnic groups. In 2001, heart disease accounted for approximately 29 percent of deaths among U.S. residents—and 16.8 percent of those deaths occurred among persons over 65 years old.3 A Centers for Disease Control and Prevention analysis indicated that the proportion of premature heart disease deaths varied by state and was higher among African Americans, American Indian/Alaska Natives, Asian/Pacific Islanders and Hispanics.4
20
SOURCES: 2003-05 data, Centers for Disease Control and Prevention; Disparities: 2003-05 data, CDC. *We invite the reader to add their own knowledge and values to the information here to assign a grade (A - F).
13
# Leading Causes of Death Composite of four indices: All cardiovascular, all cancer, all injury and all infant deaths per capita. RANK
13
CHANGE
DISPARITIES
GR ADE*
YES
This outcome is the average of state ranks in four mortality rates, each either a single measure or a combination of measures. Washington state ranks 13th in the average of these four mortality rates. Washington state ranks 8th in infant mortality, 23rd in all injury deaths, 17th in cancer deaths and 14th in cardiovascular deaths.
Infant mortality rates are considered sentinel for accessibility and performance of certain public health and social services, and are related to several of our campaign measures including: Health Homes, Economic Well-Being, Insuring for Prevention, Use of Proven Preventive Care and Smoking. Cancer and cardiovascular deaths are Washington’s two leading causes of death, accounting for over half of all deaths. WHF’s measures, including Smoking, Physical Activity, Nutrition, Binge Drinking, Economic Well-Being, and High School Graduation Rates are associated with cancer and cardiovascular deaths. Deaths from all injuries include those from traffic crashes, gun violence, domestic violence, and all accidents. These are associated with our measure of Injury and Violence Prevention which includes indicators for violent crime, threats of school violence and seat belt use. Disparities are present in the infant mortality rate both nationally and in Washington state. For example, in 2005 the United Health Foundation reported Washington state African Americans and American Indian/Alaska Natives had infant mortality rates of 9.5 and 10.6 per 1,000 live births respectively, with Caucasians having 5.2 per 1,000.1 According to the Washington State Department of Health, colorectal cancer is higher in both African Americans and Caucasians, than Asian/Pacific Islanders on the state and national levels. Mortality rates from strokes are higher among African Americans and American Indian/ Alaska Natives than among Caucasians. Mortality for cardiovascular disease and coronary heart disease are also higher in African Americans while lower in Asian/Pacific Islanders than among Caucasians. Lastly, cardiovascular disease and coronary heart disease mortality was lower in Hispanics than among non-Hispanics.2
SOURCES: 2003-05 data, Centers for Disease Control and Prevention; Disparities: 2003-05 data, CDC. *We invite the reader to add their own knowledge and values to the information here to assign a grade (A - F).
21
Outcome s
30.5
# Limits on Normal Living
Number of days in the previous 30 when an adult reported daily activities limited because of physical or mental difficulties. R ANK
30.5
CHANGE
DISPARITIES
GR ADE*
YES
This measure is a general indication of the adult populations’ ability to function on a
day–to–day basis. Washington state is tied for a rank of 30th in this outcome with Rhode Island, with 4.1 days per 30 days reported as limited activity days among adults. However, because of many ties, this rate places Washington slightly above the national mean of 4.2 days. Days of limited normal living considers overall health and function in terms of daily living. Essentially all WHF’s Healthiest State Campaign measures potentially influence this outcome. For instance, individuals Engaging in Healthy Habits can decrease their limits on normal living. On a community level, Investing in Prevention can also reduce limits on normal living. The related measure of “activity limitation” for children ages 5-17 years old is a child’s inability to participate fully in age-appropriate activities such as school. Limitations include chronic physical, mental, emotional or behavioral conditions. In 2003, approximately 8 percent of children nationally were reported to have activity limitations.1
8 22
SOURCES: 2006 data, Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention; Disparities: 2006 data, Centers for Disease Control and Prevention, National Health Interview. *We invite the reader to add their own knowledge and values to the information here to assign a grade (A - F).
21
Emotional Well-Being # Average number of days reported by adults as mentally unhealthy. RANK
CHANGE
21
DISPARITIES
GR ADE*
YES
Washington State ranks 21 in this widely collected measure of self-reported Emotional st
Well-Being. Poor mental health includes stress, depression and problems with emotions.
Emotional Well-Being is related to several Healthiest State Report Card measures including: Avoiding Addictions, Engaging in Healthy Habits, Promoting Community Health and Increasing Value in Health Services. These areas each have a connection to depression and/or stress. Nationally, only 58.7 percent of children (ages 1-17), with current emotional, developmental, or behavioral problems requiring treatment or counseling, received mental health care during the past 12 months. Data on mental illness disparities by race and ethnicity is conflicting and problematic. The table below displays the most recent available results from the federal Behavioral Risk Factor Surveillance System, among the most frequently cited national sources. It indicates limited disparities between racial and ethnic groups in our state, with our state rates elevated over reported national averages. However, problems with sample size and response rates in more than 40 percent of states for African Americans and even higher proportions for other racial and ethnic groups make much of the state level data that contribute to national ranks suspect.1
SOURCES: 2006 data, Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention. Disparities: 2004 data, BRFSS reported by the Henry J. Kaiser Foundation, State Health Facts. *We invite the reader to add their own knowledge and values to the information here to assign a grade (A - F).
23
Outcome s
22
# Infectious Disease Rate Rate of three infectious diseases: HIV/AIDS, Hepatitis A-C, and tuberculosis. R ANK
CHANGE
22
DISPARITIES
GR ADE*
YES++
Washington state ranks 22
in this outcome once again this year, posting no change in our rank since 2006. However our rate of reported illnesses of HIV/AIDS, Hepatitis A-C and tuberculosis decreased from 14.6 cases per 100,000 population to 13.3. North Dakota continues reporting the lowest infectious disease rates at 3.8 cases per 100,000 population. This outcome is an indication of the toll that infectious disease is placing on the population. nd
The Healthiest State Report Card measures that most directly influence this outcome are: Economic Well-Being, High School Graduation Rates, Public Health System Investments, and Insuring for Prevention. The table below reveals an alarming disparity in HIV cases by race both within our state and nationally. In Washington where racial and ethnic disparities in reported HIV cases are less pronounced than nationally, Hispanic cases are roughly one-third higher than Caucasians, American Indian/Alaska Native cases, two-thirds higher and African American cases five times higher than Caucasians. According to our Washington State Department of Health’s Health of Washington State Report (2004): In Washington state, infectious disease rates reveal racial, ethnic, and socioeconomic disparities, which are influenced by different factors. Individuals who are foreign-born are disproportionately affected with tuberculosis, particularly Asian/Pacific Islanders, who have the highest rates. Infectious disease rates are also higher in Hispanics than in non-Hispanics. Hepatitis A rates are also higher in Hispanics than non-Hispanics. This situation may be associated with travel to and living with people from developing countries where Hepatitis A is common. HIV/AIDS rates are higher in African-Americans than any other racial group, and while the majority of cases are from the United States, African-born blacks who were likely infected before coming to this country comprise an increasing proportion of Washington cases. In general, infectious disease rates are higher in African-Americans, American Indian/Alaska Natives, and those of Hispanic ethnicity than in Caucasians and nonHispanics—although for some diseases, it is difficult to interpret racial differences because of incomplete data. In most cases, higher disease rates are associated with lower educational levels and higher levels of poverty. Situations such as unstable or crowded living conditions (such as homeless shelters), poor hygiene, and drug use contribute to higher disease rates.1
24
SOURCES: United Health Foundation, America’s Health Rankings 2007 Edition, 2004-06 data, Centers for Disease Control and Prevention; Disparities: 2006 data, Henry J. Kaiser Foundation, State Health Facts, reporting based on CDC. *We invite the reader to add their own knowledge and values to the information here to assign a grade (A - F).