How healthy are we as a nation and state by state? The United Health Foundation recently released its health rankings for 2011. Among its findings:

- Obesity has increased 137%, from 11.6% of the adult population in 1990 to 27.5% in 2011, meaning that more than one in four Americans is now considered obese.

- Smoking: In the past year, the prevalence of smoking decreased from 17.9% to 17.3% of the adult population, the lowest in 22 years (down from a high of 29.5% in 1990). But tobacco use is still estimated to be responsible for one out of five deaths annually (approximately 443,000 deaths per year).

- Children living in poverty are challenged by lack of access to health care, limited availability of healthy foods, reduced choices for physical activity, limited access to appropriate educational opportunities, and stressful living conditions. The number of children in poverty has increased steadily for the last five years, from 17.4% in 2007 to 21.5% of children in 2011.

- The uninsured: the number of people living without health insurance coverage increased from 16% in 2010 to 16.2% in 2011 and has increased more than two full percentage points since 2001 (from 13.9% to 16.2%).

- Diabetes diagnosis is significantly higher than it was five years ago. According to the report, 8.7% of American adults have been told by a physician that they have diabetes. A recent report from the CDC estimates that the number of Americans with diabetes will range from one in five to one in three by 2050. This means a large number of people are either at risk for diabetes or unaware they have the disease and not being medically managed.

Overall, Vermont, New Hampshire, Connecticut, and Hawaii ranked as the healthiest states. However, among the 50 states, there are significant differences in the rankings by specific issue. For example, Alaska, Colorado, Vermont, and Utah have the lowest rates of diabetes.

Washington state's ranking slipped from 11th in 2010 to 15th in 2011. The report cites Washington's challenges as low immunization coverage, low use of early prenatal care, and a low high-school graduation rate. The state's strengths, on the other hand, include a low prevalence of smoking, a low rate of preventable hospitalizations, and a lower prevalence of diabetes than other states. It also points up significant disease disparities among the state's minority groups. For example, about 13% of non-Hispanic blacks have diabetes compared with just 6% of non-Hispanic Asians, 7% of Hispanics, and about 7% of non-Hispanic whites.

High school graduation in Washington is the lowest in seven years; only about 72% of incoming ninth-graders graduate in four years. In the past 10 years, obesity in the state has increased from about 19% to 26% of adults.

Professor Adam Drewnowski, director of the UW Center for Public Health Nutrition, stresses that the more local the health research, the better. "State-level rankings conceal very deep social and economic disparities at the local level. Every community ought to be encouraged to develop its own health database and bring it to the attention of local politicians; all politics is local, and all health research should be local too."

Global Health professor Ali Mokdad, head of the US County Performance team at the UW Institute of Health Metrics and Evaluation (IHME), agrees. "Washington state is doing well at the overall level, but there are large disparities within the state. For example, San Juan County has one of the lowest rates of diabetes in the whole country, but Yakima and Franklin Counties have high rates of diabetes."

Some of IHME's current projects relate directly to analyzing local health conditions. Says Dr. Mokdad, "One of our primary projects is the Monitoring Disparities and Chronic Conditions study. We're pulling together health records and surveys from thousands of people in King County to provide the most comprehensive analysis to date of the factors that are creating health disparities in local populations. We hope it will become a model for other counties to use nationwide, to show that you can build on the available data, survey a segment of the population, and generate a detailed picture of the factors that merit the most attention and resources. We also are engaged in a project called Tracking Disparities in the Effective Delivery of Health Services, funded by the National Institute on Aging. There we are going to be working with data from all 39 Washington counties to develop a cost-effective approach to tracking disease status, intervention delivery, and effective disease control."