While the U.S. has made significant progress at improving health over the past three decades, longstanding issues and emerging challenges threaten those gains, a new report from America’s Health Rankings finds.

With the release of its 2019 report Dec. 5, America’s Health Rankings marked 30 years of documenting U.S. public health progress and challenges. Produced by United Health Foundation in partnership with APHA, the new report highlights health trends over both the past three decades and past year.

This year, America’s Health Rankings named Vermont the healthiest state and Mississippi the state with the greatest opportunity for improvement. Vermont was singled out for the lead honor because of its:

low incidence of chlamydia at 297.9 cases per 100,000, compared with 524.6 cases per 100,000 nationally;

low violent crime rate at 172 offenses per 100,000, compared with 381 offenses per 100,000 nationally; and

low percentage of uninsured population at 4.3%, compared with 8.8% nationally.

Over the 30 years of the report, Vermont has risen 19 places in the health rankings — the second greatest increase behind New York. Kansas has experienced the greatest ranking decrease during that time.

The “2019 Annual Report” shows recent health improvements across the U.S., including a reduction in smoking by 6% and the number of children in poverty by 2% in the past year, a reduction in infant mortality by 1,200 infant deaths over the past two years and an increase in the supply of mental health providers by 5% since the 2018 report.

However, premature death rates in the U.S. have risen over the past year, suicides have increased by 4% — with rates among teens and seniors on the rise — and drug-related deaths have increased 37% over three years.

Health challenges vary across the U.S. based on gender, age, race and ethnicity, education, income and geography. Examining differences among groups, the report highlights the disparities to help policymakers and community leaders tailor programs to certain populations.

“When we defined health 30 years ago, we really just measured mortality,” said Rhonda Randall, MD, executive vice president and chief medical officer at United Healthcare, at a Washington, D.C., event releasing the report. “Now we’re looking at it quite broadly, with 35 different measures of health in the annual report alone.”

APHA Executive Director Georges Benjamin, MD, said he sees the rankings as “a way to move the dial” on health improvements.

“Health isn’t something that happens by accident,” Benjamin said at the event. “We can collect and analyze the data to craft solutions for prevention — and to address some of the health inequities we see through policy and economic changes that can make a real difference.”

While the report’s national information is useful for all public health workers, the state data is particular relevant for those at the local and community levels. Judy Monroe, MD, president and CEO of the CDC Foundation, said she used America’s Health Rankings in her former role as state health officer in Indiana.

“It’s a celebration when you see improvement in your state,” Monroe said. “And where we were doing poorly, I took that to the legislature and the media and challenged my staff to look at the top five states and think about how we could improve.”

The “2019 Annual Report” looks at how U.S. health has changed over time and how the data informs the future of public health. Thirty years of public health work have reduced smoking by 45% and infant mortality by 43% across the U.S.

Meanwhile, mortality rates have risen. Obesity rates have increased by 166% since the first report in 1990, and diabetes by 148% — the highest prevalence in the history of the rankings. Cardiovascular death rates are increasing after decades of decline.

“We’ve got the data. Now we have to be serious about the action,” said Michael Fraser, MD, CEO of the Association of State and Territorial Health Officials. “All states are different, they have a unique leadership role to play in public health policy and they can all learn from each other.”

Visit the America’s Health Rankings website to see how your state fares in the new rankings and watch a recording of the report release event.