When United Health Foundation released its annual rankings in December, Indiana found itself near the bottom of the list, at No. 41.
It landed nine spots away from the dead last ranking state: Mississippi, which has been anchored to that bedrock position since at least 2010.
At the top of the list was Hawaii, edging out Vermont, which had led the nation in good health the previous few years.
High smoking rates, obesity numbers and unhealthy habits helped Indiana sink.
Air pollution choked the state to a No. 49 spot. For physical inactivity, it sat at a low No. 41. And Indiana joins the bottom 10 states in weight, holding the spot as 43rd most obese.
Numbers can hurt.
U.S. Sen. Joe Donnelly, D-Ind., told The Times Editorial Board on Monday that Indiana often falls “in the 40s” in health rankings.
“Employers are not impressed when your state is No. 41, 42, 43 in health,” he said. “We want to have a good business climate by having the right tax climate, but we also have to have the right educational climate. We have to have the right health climate. All of those things are critical.”
Ken Severson, media relations coordinator for the Indiana State Department of Health, said the United Health Foundation rankings takes numerous indicators into consideration, including the economy, unemployment rates and high school education rates.
“And while the ISDH acknowledges those areas are very important for health outcomes, it clearly indicates this is a state of Indiana issue and goes above and beyond what the scope of ISDH controls,” he said.
The department monitors a variety of reports and data sources to see what is being done well and what needs improvement but does not put more stock into one set of findings over another, he said
“Each report is a tool in the public health messaging, and everyone can glean some information from each report,” Severson said.
In the United Health Foundation report, Mississippi finds itself near the bottom of the rankings for many health issues, and Indiana is not far away.
Yet the state demographics don't align.
Mississippi has about 3 million people, and Indiana has about 6.5 million, according to U.S. Census Bureau estimates. The racial makeup of Mississippi is about 60 percent white, 37 percent black and 3 percent Latino. Comparatively, Indiana has a population that is about 86 percent white, 9 percent black and the rest Latino.
Some research has drawn links between low incomes and poor health.
Mississippi has a median household income of $38,882, with 22.3 percent of residents living below the poverty level. Indiana has a median household income of $48,374, with 14.7 percent of residents living below the poverty level, according to data through the U.S. Census.
Where Mississippi ranks 49th in obesity, Indiana ranks 43rd. Where Mississippi ranks 49th in cases of diabetes, Indiana ranks 40th. Mississippi ranks No. 49 for cancer deaths, and Indiana ranks No. 42. The states tie at No. 44 for the number of smokers.
Mississippi ranks 50th in the nation in infant mortality. Indiana sits at No. 45.
Indiana State Health Commissioner Dr. William VanNess II last year declared that lowering the infant mortality rate is one of the Indiana State Department of Health's top three initiatives.
Rankings, such as the those compiled by the United Health Foundation, is just one factor when the health department sharpens its focus on issues.
“Programs and initiatives are data driven as well as by funding opportunities from both the state and federal level,” Severson said. “These decisions are not solely based on rankings, as the rankings contain numerous outside indicators and funding is usually topic-based.”
When it comes to public health funding, the United Health Foundation ranks Mississippi at No. 32; whereas Indiana sits at 48. In terms of lack of health insurance, Mississippi ranks 34th, and Indiana ranks 16th.
Indiana opted against expanding Medicaid under the Affordable Care Act.
“Every state around us now has the Medicaid expansion,” Donnelly said. “We're the only one that doesn't. I know the governor is meeting with Secretary (Kathleen) Sebelius. I don't have a crystal ball, but I think it would be in both their interests to work out some type of hybrid.
“By all rights, if they both sit down and both look at this as a chance to solve a problem, this shouldn't be hard,” Donnelly said. “Hopefully at that time, we'll be able to move our numbers forward in those areas.”