alabama - america's health rankings

104
AMERICA’S HEALTH RANKINGS ® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org State Nation For source details and methodology visit www.AmericasHealthRankings.org. FLU VACCINATION PERCENTAGE OF ADULTS AGES 65+ PERCENTAGE OF ADULTS AGES 60+ 100 80 60 40 20 0 30 25 20 15 10 5 0 2013 2014 2015 2016 2017 2018 2019 2020 EDITION YEAR 2013 2014 2015 2016 2017 2018 2019 2020 EDITION YEAR FOOD INSECURITY Summary Trends Risk of Social Isolation Social isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter- ventions that alleviate isolation and loneliness in older adults. Highlights: Risk of Social Isolation by County <= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties Source: U.S. Census Bureau, American Community Survey, 2014-2018 Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty State Value (%) UNITED HEALTH FOUNDATION | AMERICA’S HEALTH RANKINGS ® SENIOR DATA 2020 UPDATE Alabama Alabama Strengths: • Low prevalence of excessive drinking • Low prevalence of severe housing problems • High community support expenditure Challenges: • Low prevalence of exercise • High early death rate • High prevalence of food insecurity 12% 17% 18% 15% 10% 8% in the past year from 19.3% to 17.0% of adults ages 60+ in the past four years from 64.1% to 58.0% of adults ages 65+ since 2013 from 56.4% to 61.0% of adults ages 65+ in the past five years from 39.8% to 46.5% of Medicare enrollees ages 65-74 since 2014 from 26.9% to 31.8% of adults ages 65+ since 2014 from 23.6% to 20.0% of adults ages 65+ FOOD INSECURITY MULTIPLE CHRONIC CONDITIONS OBESITY TEETH EXTRACTIONS FLU VACCINATION ABLE-BODIED SENIORS 40.9 41.3 17.4 11.4 4.1 10.3 State Health Department Website: alabamapublichealth.gov

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Page 1: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Alabama

Ala

bam

a

Strengths:• Low prevalence of excessive drinking• Low prevalence of severe housing problems• High community support expenditure

Challenges: • Low prevalence of exercise• High early death rate• High prevalence of food insecurity

12% 17%

18%

15%

10%

8%

in the past year from 19.3% to 17.0% of adults ages 60+

in the past four years from 64.1% to 58.0% of adults ages 65+

since 2013 from 56.4% to 61.0% of adults ages 65+

in the past five years from 39.8% to 46.5% of Medicare enrollees ages 65-74

since 2014 from 26.9% to 31.8% of adults ages 65+

since 2014 from 23.6% to 20.0% of adults ages 65+

FOOD INSECURITY MULTIPLE CHRONIC CONDITIONS

OBESITY

TEETH EXTRACTIONS

FLU VACCINATION

ABLE-BODIED SENIORS

40.941.317.411.44.1

10.3

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: alabamapublichealth.gov

Page 2: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.633 44++ 28.2 40+ -1.489 46+ 11.2 49+ 33.7 41+ 25.1 48+ 10.1 43+++++ 0.430 8+++++ 4.6 6++ 9.7 33

+ -0.664 46+ -0.784 45+ 17.0 43+ 10.3 41+++ 65.8 27+ -0.460 43+++++ 84 9++ 11.1 32+ 89.0 46++ 25.4 39++ 63.1 39+ 520 44

++ 0.060 34++ -0.183 39++ 8.1 36++ 13.4 37++++ 0.5 15++++ 14.3 15

++ -0.339 37++ -0.564 39++ 6.0 39+++++ 96.1 4+ 7.7 41+ 61 49++ -0.144 33+++ 73.8 23++ -0.193 33++++ 58.0 16++ 71.7 35+ 39.5 42+ -0.308 41++ 47.4 31+++ 16.0 23+++ 52.4 24+ 3,721 47

+ -0.473 45

+ -1.335 48+ -1.533 47+ 61.0 44+ 10.1 46+ 21.1 45+ 31.1 49+ -1.121 49+ 30.8 44+ 46.5 49++ 31.8 37+ 20.0 44+ -1.368 46+ 2,375 47+++ 19.3 30

+ -0.688 —

Alabama

Page 3: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Alaska

Ala

ska

Strengths:• Low prevalence of multiple chronic conditions • Low percentage of hospital readmissions• Low prevalence of physical inactivity

Challenges: • Low prevalence of cancer screenings• High prevalence of smoking• High prevalence of falls

39.138.513.37.35.25.4

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dhss.alaska.gov

20% 8%

23%

10%

9%

40%

in the past year from 23.3% to 28.0% of adults ages 65+

in the past year from 7.4% to 6.7% of adults ages 65+

in the past four years from 8.9% to 12.5% of adults ages 60+

in the past two years from 213 to 197 aides per 1,000 adults ages 65+ with a disability

since 2013 from 40.2% to 49.4% of adults ages 65+

in the past two years from 1,800 to 1,621 deaths per 100,000 adults ages 65-74

INSUFFICIENT SLEEP HOME HEALTH CARE WORKERS

HIGH HEALTH STATUS

EARLY DEATHS

POVERTY

FOOD INSECURITY

Page 4: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.267 35++ 28.0 37+++++ 0.744 10+++++ 21.0 6+++++ 23.5 4++ 31.9 35+++++ 15.7 10+ -1.739 50+ 9.7 47+ 12.8 47

++++ 0.479 19+++++ 0.842 9+++ 12.5 24+++++ 6.7 5++++ 90.1 14+++++ 0.644 10+++++ $152 2+++++ ‡ ‡+++++ 10 6++++ 35.0 14+++ 65.0 30+ 885 50

+ -0.216 43++ -0.083 36+++++ 6.4 10+++ 47.1 29+ 6.7 45+ 20.5 46

+ -0.496 41+ -0.718 41++ 5.9 38+ 85.0 50++ 9.2 37+++++ 197 10+ -1.234 49+ 66.1 48+ -0.797 46+ 49.0 42+ 64.2 49++++ 48.0 19++++ 0.463 16+ 22.5 50+++++ 14.0 1+++ 52.8 22+++++ 1,560 7

++ -0.073 32

+++ 0.158 26+++ 0.285 23+ 62.6 41++ 8.0 32++++ 15.8 12+++++ 49.4 5+++ 0.166 25+ 30.7 42+++++ 23.7 2++++ 27.2 15++ 15.7 33+++ -0.114 26++++ 1,621 15+ 23.1 43

+++ -0.015 —

Alaska

‡ Indicates data not available.

Page 5: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Arizona

Ari

zona

Strengths:• High coverage of smokefree laws• High percentage of hospice care use• Low prevalence of falls

Challenges: • High suicide rate• Low prevalence of cancer screenings• High prevalence of excessive drinking

34.337.012.610.84.29.0

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: azdhs.gov

18% 16%

15%

11%

36%

20%

in the past year from 7.4% to 8.7% of adults ages 65+

in the past year from 11.1% to 7.1% of residents

in the past year from 129 to 155 aides per 1,000 adults ages 65+ with a disability

in the past five years from 60.0% to 50.6% of adults ages 65+

in the past two years from 28.2% to 24.0% of adults ages 65+

in the past five years from 31.7% to 35.2% of Medicare enrollees ages 65+

EXCESSIVE DRINKING FLU VACCINATION

FALLS

MULTIPLE CHRONIC CONDITIONS

LOW-CARE NURSING HOME RESIDENTS

HOME HEALTH CARE WORKERS

Page 6: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.180 18++++ 24.6 16++++ 0.333 17++++ 19.5 16++++ 26.4 13+++ 33.4 30+++ 13.7 23++ -0.295 34++ 8.7 40++++ 8.6 19

++ 0.023 31++ -0.154 32++ 14.7 35+++ 8.6 22++ 56.5 37++++ 0.397 18++ $27 36++++ 7.1 14++++ 32 17++ 25.0 40+++++ 75.6 8+ 475 41

++ 0.000 37+++ 0.043 28+ 9.7 49+++++ 100.0 1+++ 1.1 28+ 18.5 42

+++ 0.182 21++ -0.188 32++ 5.0 32++ 92.7 37+++ 11.1 30++++ 155 18++ -0.440 38++ 69.8 39++ -0.060 32++ 50.6 40+++ 74.0 23+++ 46.7 22+++++ 1.173 6+++++ 59.2 2+++++ 15.0 7++++ 54.8 17+++++ 1,569 8

+++ 0.104 26

++++ 0.379 18+++ 0.228 26+++ 66.4 24+++ 7.6 28++ 18.0 32++++ 45.3 14+++++ 0.830 5+++++ 24.0 5++++ 35.2 20+++++ 26.1 9++++ 11.6 12+++ -0.220 28++++ 1,589 11+ 25.5 45

+++ 0.173 —

Arizona

Page 7: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Arkansas

Ark

ansa

s

Strengths:• Low prevalence of excessive drinking• Low prevalence of insufficient sleep• High number of geriatricians per capita

Challenges: • Low prevalence of exercise• Low percentage of able-bodied seniors• High prevalence of food insecurity

41.9 40.116.811.33.510.2

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: healthy.arkansas.gov

31% 17%

16%

11%

40%

16%

in the past year from 3.6% to 4.7% of adults ages 65+

in the past four years from 26.1% to 15.7% of adults ages 60+

since 2013 from 17.3% to 14.5% of residents

in the past year from 57.3% to 47.6% of adults ages 65+

in the past two years from 35.2% to 29.6% of adults ages 65+

in the past three years from 19.7 to 21.8 deaths per 100,000 adults ages 65+

EXCESSIVE DRINKING FLU VACCINATION

FALLS

SUICIDE

FOOD INSECURITY

LOW-CARE NURSING HOME RESIDENTS

Page 8: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.365 37++++ 24.1 12+ -1.206 45+ 11.8 46+ 36.9 46+ 28.3 43++++ 14.3 18+++++ 0.282 9+++++ 4.7 7++ 10.1 38

+ -0.748 47+ -0.786 46++ 15.7 39++ 10.2 38+ 40.4 48+ -0.630 47++++ $49 17+ 14.5 43+ 83 43++ 28.9 32+ 58.4 49+ 544 47

++ 0.158 31++ -0.060 33++++ 7.1 19++ 0.5 40++++ 0.6 20++++ 14.3 15

++ -0.253 36++++ 0.164 19+++ 4.4 23++++ 94.3 17++++ 16.0 13++ 105 38++ -0.674 40++ 70.6 36+ -0.570 41+ 47.6 45++++ 75.0 16+ 39.0 44++ -0.250 36+++ 50.0 21+++ 16.0 23++ 42.7 38+ 3,068 42

+ -0.393 42

+ -1.069 45+ -1.375 46+ 58.1 49+ 8.9 42+ 21.0 44+ 32.7 48+ -0.610 43++ 29.6 38+++ 39.1 28++ 30.1 31+ 21.6 46+ -1.374 47+ 2,286 45++ 21.8 40

+ -0.562 —

Arkansas

Page 9: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

California

Cal

iforn

ia

Strengths:• High early death rate• High prevalence of exercise• High home health care worker rate

Challenges: • High prevalence of insufficient sleep• High prevalence of severe housing problems• High prevalence of falls

34.939.416.89.36.610.3

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: cdph.ca.gov

26% 10%

11%

14%

20%

243%

in the past year from 8.8% to 6.5% of adults ages 65+

since 2014 from 17.2% to 13.8% of adults ages 60+

in the past two years from 91 to 312 aides per 1,000 adults ages 65+ with a disability

in the past year from 76.8% to 68.9% of adults ages 65+

in the past year from 15.4% to 17.1% of adults ages 65+

since 2013 from 21.2% to 24.2% of adults ages 65+

EXCESSIVE DRINKING PNEUMONIA VACCINATION

FREQUENT PHYSICAL DISTRESS

OBESITY

FOOD INSECURITY

HOME HEALTH CARE WORKERS

Page 10: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.946 4+ 29.0 42+++++ 1.267 5+++++ 22.5 2+++++ 22.7 3+++++ 39.5 9+++++ 16.2 7+++++ 1.104 2++++ 6.5 16+++++ 5.8 2

+ -0.503 44+ -0.590 42++ 13.8 32+ 10.5 43+ 42.5 47++ -0.415 40++ $29 35+++ 9.3 26++ 75 39+ 23.3 42++ 63.8 37++ 447 37

+ -0.578 50++ -0.223 40+ 12.8 50+++++ 100.0 1+++++ 0.0 1+ 26.9 49

++++ 0.411 14++++ 0.470 13+++ 4.9 30+++ 93.6 27++++ 14.6 14+++++ 312 3++++ 0.428 11+++++ 78.9 5+++ -0.040 30+++ 54.9 26+ 68.9 41++++ 50.9 14++++ 0.335 20++ 45.2 38+++ 16.0 23++++ 55.8 14++++ 1,878 14

+++ 0.117 24

+++ 0.318 21+++ 0.193 28+++ 66.5 23++ 8.2 34+++ 17.1 23++++ 44.4 18++++ 0.289 17+ 30.4 41+++ 37.2 23+++++ 24.2 4+++++ 7.3 2+++++ 0.626 7+++++ 1,485 4++++ 16.7 20

+++ 0.167 —

California

Page 11: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Colorado

Col

orad

o

Strengths:• Low prevalence of food insecurity• High prevalence of exercise• High prevalence of high health status

Challenges: • High suicide rate• Low prevalence of cancer screenings• High percentage of low-care nursing home residents

32.237.711.69.34.37.5

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: colorado.gov/cdphe

826% 5%

14%

6%

10%

15%

in the past year from 10.8% to 100.0% of the population

since 2014 from 78.4% to 70.9% of seniors receiving recommended screenings

since 2013 from 65.9% to 55.9% of adults ages 65+

since 2013 from 65.9% to 68.9% of adults ages 65+

since 2013 from 44.9% to 51.1% of adults ages 65+

in the past four years from 1,508 to 1,419 deaths per 100,000 adults ages 65-74

NON-SMOKING REGULATION ABLE-BODIED SENIORS

HIGH HEALTH STATUS

EARLY DEATHS

CANCER SCREENINGS

FLU VACCINATION

Page 12: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.999 2+++++ 22.3 4+++++ 1.386 2+++++ 24.5 1+++++ 20.3 1++++ 37.3 14++++ 14.8 11+++++ 0.254 10+++ 7.5 24+++++ 7.8 8

+++++ 0.801 6+++++ 1.170 3+++++ 6.6 1+++++ 7.4 10+++ 65.4 28++++ 0.564 13+++ $33 30+ 13.1 41+++++ 8 5+++ 31.7 25++++ 72.7 11++ 397 31

++++ 0.696 11+++++ 0.770 10++++ 6.7 14+++++ 100.0 1+++ 0.8 26++ 16.5 31

+++++ 0.681 4++++ 0.498 11+++++ 3.6 10+++ 93.8 24++++ 16.7 12++++ 149 19++++ 0.324 14++ 70.9 35+++++ 1.047 3+++ 55.9 22+++++ 77.5 3+++++ 55.0 4+++++ 1.220 5++++ 53.2 11+++++ 15.0 7+++++ 60.9 8+++++ 1,301 3

+++++ 0.808 2

+++++ 1.048 2+++++ 1.168 5+++++ 68.9 8++++ 6.9 17+++++ 14.3 6+++++ 51.1 3+++++ 1.276 2++++ 25.9 16+++++ 27.5 5+++++ 21.8 2+++++ 10.0 7++++ 0.352 15+++++ 1,419 1+ 22.4 41

+++++ 0.868 —

Colorado

Page 13: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Connecticut

Con

nect

icut

Strengths:• Low prevalence of avoided care due to cost• Low early death rate• Low prevalence of falls

Challenges: • High percentage of hospital readmissions• Low coverage of smokefree laws• High percentage of low-care nursing home residents

30.639.113.611.77.17.3

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: portal.ct.gov/dph

29% 9%

7%

38%

22%

12%

since 2013 from 8.5% to 6.0% of adults ages 65+

in the past two years from 6.5% to 7.9% of adults ages 65+

in the past year from 62.6% to 55.3% of adults ages 65+

in the past year from 46.2% to 50.4% of adults ages 65+

since 2013 from 1,535 to 1,430 deaths per 100,000 adults ages 65-74

in the past three years from 6.9 to 9.5 deaths per 100,000 adults ages 65-74

SMOKING HIGH HEALTH STATUS

EARLY DEATH

DRUG DEATHS

POVERTY

FLU VACCINATION

Page 14: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.681 6+++ 25.2 21+++++ 0.754 9++++ 19.7 13++++ 26.9 15+++++ 40.6 6+++++ 15.8 9+++++ 0.607 4++ 8.2 35+++++ 6.0 3

+++ 0.413 21++++ 0.514 17+++ 13.4 30++++ 7.9 13+++++ 100.0 1+++ 0.116 27+++ $35 28++ 12.3 37+++ 40 21+++ 30.7 27++++ 67.5 18+++++ 207 5

++ -0.044 38++ -0.040 32+++ 7.2 22+ 0.0 42+++++ 0.1 8++ 18.1 40

++++ 0.462 12+++++ 1.134 2+++++ 3.1 2+++++ 95.4 8+++++ 23.4 4++++ 192 11+++ 0.168 23++++ 76.0 15+++ -0.020 28+++ 55.3 25++ 72.4 34+++ 44.7 29+++ 0.083 29+++ 48.6 28+ 17.0 45++++ 56.1 13++++ 2,119 19

++++ 0.437 13

+++++ 1.047 3+++++ 1.265 3+++++ 70.6 1+++++ 6.3 10+++++ 15.2 9+++++ 50.4 4+++++ 0.854 4+++++ 22.9 3+++ 39.2 29+++++ 26.3 10+++++ 9.4 6+++++ 0.996 3+++++ 1,430 2+++++ 13.2 10

+++++ 0.589 —

Connecticut

Page 15: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Delaware

Del

awar

e

Strengths:• Low percentage of seniors living in poverty• Low prevalence of avoided care due to cost• High percentage of able-bodied seniors

Challenges: • High prevalence of physical inactivity• High prevalence of multiple chronic conditions • Low number of geriatricians per capita

30.536.011.910.85.36.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dhss.delaware.gov

19% 11%

18%

25%

28%

45%

in the past four years from 10.5% to 8.5% of adults ages 65+

in the past year from 8.5% to 6.1% of adults ages 65+

in the past year from 5.8% to 3.2% of adults ages 65+

in the past year from 65.2% to 58.3% of adults ages 65+

in the past year from 38.3% to 45.2% of adults ages 65+

since 2014 from 26.0% to 32.5% of adults ages 65+

SMOKING FLU VACCINATION

HIGH HEALTH STATUS

OBESITY

POVERTY

AVOIDED CARE DUE TO COST

Page 16: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.080 28++++ 25.0 18++ -0.393 34+++ 17.0 28++ 32.5 36++ 32.9 32++ 12.6 33+++ 0.045 21+++ 7.5 24++++ 8.5 17

+++++ 0.655 9+++++ 1.184 2++++ 10.6 12+++++ 6.1 2++++ 84.1 17+++ 0.225 23++++ $54 15+++ 10.0 28+++++ 6 4+++ 32.0 23+ 61.9 42++ 424 35

++++ 0.546 14++++ 0.460 17++ 8.3 40+++++ 100.0 1+++++ 0.1 8++++ 14.8 20

++++ 0.357 17++++ 0.266 15+++++ 3.2 3+++ 93.7 25++ 9.4 36+++ 120 28+++ 0.156 24++++ 75.5 17+++ 0.040 27++++ 58.3 15+++ 73.0 29++ 41.3 38++++ 0.650 12+++++ 57.9 3+++ 16.0 23+++++ 62.8 4++ 2,743 34

++++ 0.365 16

+++ 0.293 23++++ 0.688 12+++++ 69.1 6++++ 6.8 14++++ 16.7 19++++ 45.2 16++ -0.262 36++++ 26.1 19++ 42.1 40+ 32.5 42+++ 14.6 30+++++ 0.612 8++++ 1,671 20+++++ 11.7 6

++++ 0.347 —

Delaware

Page 17: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Florida

Flor

ida

Strengths:• High community support expenditure• Low prevalence of falls• High percentage of hospice care use

Challenges: • High prevalence of multiple chronic conditions • Low home health care worker rate• High percentage of seniors living in poverty

33.139.813.212.84.610.3

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: floridahealth.gov

12% 15%

19%

10%

17%

32%

in the past year from 11.3% to 12.7% of adults ages 60+

in the past year from 8.7% to 7.2% of residents

in the past two years from 38 to 50 aides per 1,000 adults ages 65+ with a disability

in the past year from 62.2% to 52.8% of adults ages 65+

since 2013 from 23.4% to 27.8% of adults ages 65+

since 2013 from 9.1% to 8.2% of adults ages 65+

FOOD INSECURITY FLU VACCINATION

OBESITY

COGNITIVE DIFFICULTY

LOW-CARE NURSING HOME RESIDENTS

HOME HEALTH CARE WORKERS

Page 18: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ 0.049 21++ 27.6 33+++ 0.048 22+++ 18.1 21+++ 28.7 22+++ 35.5 26++ 12.5 34++++ 0.111 17+++ 7.7 28++++ 8.1 13

++ -0.076 33+++ -0.030 30+++ 12.7 27+ 10.6 44+++++ 100.0 1++ -0.146 33+++++ $142 3++++ 7.2 15++ 73 38+ 20.3 47+++ 65.9 25+++ 385 30

+ -0.318 47+ -0.240 41+++ 7.4 25+ 0.0 42++ 1.8 36+ 20.1 45

++ -0.073 32++ -0.422 37++ 5.2 34++ 93.5 31+++ 12.1 24+ 50 50++ -0.164 34+++++ 78.9 5+ -1.027 48++ 52.8 32+ 67.3 47+ 37.8 47++++ 0.368 19+++++ 57.9 3+ 17.0 45+++++ 62.8 4++ 2,717 33

++ -0.074 33

+++ 0.149 27+++ 0.295 22++++ 67.2 18++++ 6.8 14+++ 17.6 28+++ 41.7 28+++ 0.043 28++++ 25.4 11+ 46.7 50++++ 27.8 18++++ 12.5 18+++ 0.070 21++++ 1,628 16++ 20.4 34

++ -0.018 —

Florida

Page 19: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Georgia

Geo

rgia

Strengths:• Low prevalence of excessive drinking• High prevalence of cancer screenings• High percentage of hospice care use

Challenges: • Low percentage of volunteerism• High prevalence of avoided care due to cost• High prevalence of food insecurity

36.140.514.89.14.7

10.3

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dph.georgia.gov

20% 9%

8%

26%

9%

12%

in the past two years from 37.2% to 29.8% of adults ages 65+

in the past two years from 69.9% to 76.4% of seniors receiving recommended screenings

since 2014 from 60.1% to 52.6% of adults ages 65+

in the past five years from 37.8% to 41.2% of Medicare enrollees ages 65+

in the past two years from 39.4% to 36.2% of adults ages 65+

since 2013 from 11.2% to 8.3% of adults ages 65+

PHYSICAL INACTIVITY MULTIPLE CHRONIC CONDITIONS

HIGH HEALTH STATUS

COGNITIVE DIFFICULTY

CANCER SCREENINGS

FLU VACCINATION

Page 20: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.030 24++ 28.1 39++ -0.350 33++ 15.4 36+++ 29.8 29++ 32.9 32++ 12.8 31+++++ 0.514 6+++++ 5.3 8+++ 8.8 21

++ -0.417 40+ -0.540 41+ 16.0 42++ 10.2 38++++ 77.2 20+ -0.452 42+ $20 49+++ 8.4 23++ 59 31+ 19.7 49+++ 65.2 29+++ 327 24

+ -0.152 42+ -0.263 42++ 8.3 40++ 9.1 39++++ 0.5 15++ 16.9 33

++ -0.440 39+ -1.010 49+ 7.0 46++ 92.5 38++ 10.0 33+ 85 43+++ -0.054 30++++ 76.4 11++ -0.450 39++ 52.6 34++ 71.2 38++ 41.9 35++ -0.255 37++++ 50.7 18+++ 16.0 23+ 38.6 41++ 2,833 36

++ -0.285 39

+ -0.597 41++ -0.658 40+++ 66.0 30+ 9.4 44++ 19.6 39+ 36.2 41+ -0.545 42++ 30.1 40++ 41.2 36+++ 29.6 29++ 16.5 35++ -0.578 38++ 2,046 39+++ 17.6 27

++ -0.362 —

Georgia

Page 21: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Hawaii

Haw

aii

Strengths:• Low prevalence of falls• High prevalence of exercise• Low percentage of seniors living in poverty

Challenges: • High prevalence of insufficient sleep• High prevalence of severe housing problems• High prevalence of excessive drinking

33.537.815.510.07.18.0

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.hawaii.gov

27% 12%

20%

17%

25%

30%

in the past year from 4.1% to 3.0% of residents

since 2014 from 5.3% to 6.6% of adults ages 65+

in the past year from 9.3% to 6.5% of adults ages 65+

in the past year from 59.6% to 52.7% of adults ages 65+

in the past four years from 12.2% to 9.7% of adults ages 65+

in the past five years from 37.0% to 43.4% of adults ages 65+

LOW-CARE NURSING HOME RESIDENTS FLU VACCINATION

COGNITIVE DIFFICULTY

HIGH HEALTH STATUS

SMOKING

POVERTY

Page 22: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.395 12+ 38.9 50+++++ 1.337 4+++++ 22.2 3+++++ 23.5 4++++ 38.4 11+++++ 19.6 1++++ 0.075 18+ 9.6 46+++++ 6.6 4

++++ 0.559 13+++++ 1.398 1+++++ 9.2 5+++++ 6.5 4+++++ 100.0 1+ -0.561 46+++ $43 21+++++ 3.0 3+++ 42 22+ 20.5 46+ 56.5 50++++ 249 14

++++ 0.488 18+++++ 1.110 1+++++ 5.4 6+++++ 100.0 1+++++ 0.0 1+ 27.1 50

+++++ 0.699 2+++++ 0.518 9+++ 4.7 26+++++ 95.7 6+++++ 24.1 3++ 117 31++++ 0.184 19+++++ 78.2 7++ -0.340 36++ 52.7 33+ 65.3 48++++ 52.1 12+++++ 1.395 2++ 46.1 35+++++ 14.0 1+++++ 67.9 1+++++ 1,128 1

+++++ 0.543 10

+++++ 1.183 1+++++ 0.825 9++++ 68.3 13+++++ 6.2 8+++++ 14.9 8+++ 43.4 23+++++ 1.660 1+++++ 20.0 1++++ 34.1 17+++++ 17.4 1+++++ 6.2 1+++++ 0.946 5+++++ 1,464 3+++++ 13.0 9

+++++ 0.703 —

Hawaii

Page 23: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Idaho

Idah

o

Strengths:• Low percentage of hospital readmissions• Low prevalence of food insecurity• Low prevalence of multiple chronic conditions

Challenges: • High prevalence of falls• High suicide rate• Low number of geriatricians per capita

36.035.012.010.43.19.0

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: healthandwelfare.idaho.gov

76% 12%

21%

12%

18%

29%

in the past four years from 5.1% to 9.0% of adults ages 65+

in the past year from 4.4% to 3.6% of adults ages 65+

in the past year from 11.3% to 8.0% of residents

in the past year from 15.8% to 17.7% of adults ages 65+

in the past three years from 22.6 to 27.3 deaths per 100,000 adults ages 65+

since 2013 from 40.4% to 45.3% of adults ages 65+

EXCESSIVE DRINKING FREQUENT PHYSICAL DISTRESS

SUICIDE

HIGH HEALTH STATUS

AVOIDED CARE DUE TO COST

LOW-CARE NURSING HOME RESIDENTS

Page 24: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.366 14+++++ 23.7 9+++++ 0.822 8++++ 19.7 13+++++ 24.0 8++++ 37.0 17+++++ 16.1 8++ -0.580 40+ 9.0 44+++ 9.3 27

++++ 0.500 16++++ 0.706 13+++++ 8.0 2+++ 8.6 22++ 53.8 39+++ 0.124 26+ $23 43++++ 8.0 18+++++ 18 10+++ 30.5 28++ 63.1 39++++ 227 11

+++ 0.198 29+++ 0.047 27++++ 6.8 15++ 13.2 38++ 1.3 33+++ 15.1 25

+++ 0.178 22++ -0.134 31+++++ 3.6 10+ 91.3 44+ 4.3 49++++ 158 17+ -0.698 41+ 68.5 43++ -0.283 35+++ 53.0 30++ 70.5 39+++ 45.8 25+++++ 1.365 3++++ 51.9 14+++++ 14.0 1+++++ 61.2 7+++++ 1,391 4

++++ 0.338 18

++ -0.108 32+++ 0.238 25++ 64.7 37++++ 6.9 17+++ 17.7 29++++ 45.3 14++ -0.245 35+ 33.3 49+++++ 28.7 6+++ 29.0 25+++ 13.0 21++ -0.526 37+++ 1,674 21+ 27.3 47

++++ 0.226 —

Idaho

Page 25: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Illinois

Illin

ois

Strengths:• High coverage of smokefree laws• Low prevalence of falls• Low suicide rate

Challenges: • Low prevalence of cancer screenings• High prevalence of physical inactivity• High prevalence of obesity

33.539.714.511.26.68.8

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dph.illinois.gov

20%

17%

15%

in the past year from 22.7% to 27.2% of adults ages 65+

in the past year from 29.4% to 34.4% of adults ages 65+ in fair or better health

in the past five years from 8.4% to 7.1% of adults ages 65+

INSUFFICIENT SLEEP

23% in the past two years from 31.6% to 24.4% of adults ages 65+

FALLSPHYSICAL INACTIVITY

COGNITIVE DIFFICULTY

63% since 2014 from 26.8% to 10.0% of residents

LOW-CARE NURSING HOME RESIDENTS

16% in the past two years from 15.3% to 12.9% of adults ages 60+

FOOD INSECURITY

Page 26: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.107 29+++ 27.2 29+++ -0.068 25++++ 19.7 13+ 34.4 43++++ 37.3 14+++ 13.0 27++ -0.220 33++++ 7.0 20++ 9.8 34

+++ 0.103 29++++ 0.366 20+++ 12.9 28+++ 8.8 27+++++ 100.0 1++ -0.162 34+++ $34 29+++ 10.0 28++ 67 35++ 27.8 34++ 64.7 31++ 404 32

+++ 0.208 27+++ 0.217 24+ 9.3 48+++++ 100.0 1++++ 0.2 13++ 17.3 35

++ -0.486 40+++ -0.126 29++ 5.3 36++ 93.5 31++++ 14.5 15+++ 138 24+ -1.032 45+ 67.3 45+ -0.653 43+++ 55.4 24+ 68.6 43+ 39.4 43++ -0.300 40+++ 49.7 22+++ 16.0 23+ 37.9 42++ 2,814 35

++ -0.096 35

+++ 0.148 28++ -0.040 33++++ 68.0 16+++ 7.9 30++ 18.4 35++ 38.6 37+++ 0.207 23+++++ 24.4 7+++ 38.2 26+ 32.5 42++++ 11.3 11++++ 0.404 14+++ 1,759 29+++++ 12.1 7

++ -0.035 —

Illinois

Page 27: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Indiana

Indi

ana

Strengths:• Low percentage of low-care nursing home residents• Low prevalence of severe housing problems• Low percentage of hospital readmissions

Challenges: • Low voter turnout• Low flu vaccination coverage• Low prevalence of exercise

36.539.513.710.84.37.5

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: in.gov/isdh

32% 15%

6%

23%

13%

14%

in the past two years from 18.2% to 12.3% of adults ages 60+

in the past four years from 7.0% to 7.9% of adults ages 65+

in the past year from 54.5% to 46.9% of adults ages 65+

in the past four years from 9.2% to 7.8% of adults ages 65+

in the past year from 17.3% to 18.4% of adults ages 65+

since 2013 from 26.6% to 32.6% of adults ages 65+

FOOD INSECURITY COGNITIVE DIFFICULTY

FREQUENT PHYSICAL DISTRESS

OBESITY

POVERTY

FLU VACCINATION

Page 28: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.320 36+++ 25.6 23++ -0.700 37+ 13.6 43+ 34.3 42++ 32.8 34++++ 14.3 18+++ -0.124 30+++++ 5.7 10++ 10.6 40

+++ 0.177 27+++ 0.288 24+++ 12.3 23++++ 7.9 13+ 51.5 43+++ 0.086 30+++ $36 25+++++ 5.2 7+++ 44 23++++ 35.2 12+ 59.2 48+++ 382 29

+++ 0.212 26++ -0.073 35+ 8.4 43++ 31.5 33+++++ 0.0 1+++++ 13.2 8

++ -0.171 34++++ 0.192 18++++ 3.8 15++++ 94.1 19+++ 11.4 28+++ 119 29+ -0.732 42++ 71.0 34+ -0.733 44+ 46.9 46++ 72.5 33++ 41.1 39++ 0.028 31+++ 48.9 27+++++ 15.0 7++ 42.9 37++ 3,003 40

+++ -0.044 30

++ -0.381 39++ -0.153 37++ 65.1 36+++ 7.4 27++ 18.4 35++ 39.3 34+ -0.540 41+++ 27.6 29++ 40.9 34+ 32.6 44+ 18.9 43++ -0.520 36+ 2,094 42++++ 15.4 15

++ -0.128 —

Indiana

Page 29: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Iowa

Iow

a

Strengths:• Low prevalence of insufficient sleep• Low prevalence of frequent mental distress• Low percentage of seniors living in poverty

Challenges: • Low number of geriatricians per capita• High prevalence of obesity• High percentage of low-care nursing home residents

31.536.711.011.94.57.1

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: idph.iowa.gov

19% 15%

17%

29%

11%

12%

in the past year from 10.2% to 12.1% of adults ages 60+

in the past year from 67.6 to 60.0 participants per 100 adults ages 60+ in poverty

since 2014 from 18.1% to 15.9% of residents

since 2013 from 70.2% to 59.7% of adults ages 65+

in the past two years from 31.7% to 26.2% of adults ages 65+

since 2014 from 17.3% to 12.2% of adults ages 65+

FOOD INSECURITY FLU VACCINATION

FALLS

TEETH EXTRACTIONS

SNAP REACH

LOW-CARE NURSING HOME RESIDENTS

Page 30: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.221 16+++++ 20.9 1++ -0.232 31++ 15.6 34++ 31.2 34+++ 35.1 27++++ 14.2 20++++ 0.165 15++++ 6.9 18++++ 8.6 19

+++++ 0.721 7++++ 0.568 16+++ 12.1 21+++++ 7.1 6++ 60.0 35+++++ 0.885 6+++ $42 22+ 15.9 45+++++ 12 7+++++ 36.9 6+++++ 77.4 3++++ 250 15

+++++ 0.926 4++++ 0.740 11++++ 7.1 19+++++ 100.0 1+++++ 0.1 8+++++ 12.1 5

+++++ 0.541 10+++ 0.030 26++++ 4.1 20+++++ 95.4 8+ 4.6 48+++ 140 23+++++ 0.584 8+++ 72.9 27+++++ 1.160 2+++++ 59.7 7+++++ 76.3 9+++++ 54.7 6+++++ 1.010 7+++++ 56.6 5+++++ 15.0 7++++ 57.3 12++++ 1,981 15

+++++ 0.567 9

++++ 0.510 12+++++ 1.195 4+++++ 68.9 8+++++ 4.6 1+++++ 14.2 4++++ 43.8 20++ 0.009 31+++ 26.2 21++++ 34.6 19+ 34.0 47++++ 12.2 15++++ 0.140 20++ 1,802 31++++ 14.6 14

+++++ 0.553 —

Iowa

Page 31: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Kansas

Kan

sas

Strengths:• Low prevalence of avoided care due to cost• High coverage of smokefree laws• Low prevalence of excessive drinking

Challenges: • Low number of geriatricians per capita• High percentage of low-care nursing home residents• Low percentage of able-bodied seniors

36.038.012.911.14.07.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: kdheks.gov

8% 17%

11%

23%

10%

18%

in the past year from 6.2% to 5.7% of adults ages 65+

in the past year from 20.3% to 18.2% of residents

since 2013 from 26.3% to 31.0% of adults ages 65+

since 2013 from 67.6% to 56.3% of adults ages 65+

in the past year from 6.5% to 7.2% of adults ages 65+

since 2014 from 18.8% to 14.5% of adults ages 65+

EXCESSIVE DRINKING FLU VACCINATION

FREQUENT MENTAL DISTRESS

TEETH EXTRACTIONS

LOW-CARE NURSING HOME RESIDENTS

OBESITY

Page 32: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.266 15++++ 24.2 14+++ -0.153 28++ 16.0 32+++ 29.1 23+++ 34.1 28+++ 13.5 24+++++ 0.592 5+++++ 5.7 10++++ 8.2 15

+++ 0.201 26+++ 0.190 27+++ 12.5 24++++ 8.0 17+ 45.0 44++++ 0.357 19+++ $36 25+ 18.2 47++++ 34 18+++++ 36.0 10++++ 70.2 14++ 439 36

+++++ 0.708 10++++ 0.540 15++++ 7.0 18+++++ 100.0 1+ 2.6 41+++++ 13.1 7

+++ 0.169 23++++ 0.210 17+++++ 3.5 8++ 93.5 31++ 8.7 39+++ 147 21+++ 0.034 28+++ 71.3 30++++ 0.497 15+++ 56.3 21+++++ 76.2 10+++ 46.5 23+++ 0.263 23++++ 51.4 15+++ 16.0 23++ 47.9 31++++ 2,094 18

++++ 0.277 19

++ -0.119 33+++ 0.080 30++ 63.5 40+++ 7.2 23+++ 16.8 21+++ 42.8 24++ -0.205 34++ 28.6 34+++ 36.3 22++ 31.0 34+++ 14.5 29++ -0.344 32++ 1,930 37+++ 17.6 27

+++ 0.178 —

Kansas

Page 33: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Kentucky

Ken

tuck

y

Strengths:• Low prevalence of excessive drinking• High flu vaccination coverage• Low percentage of low-care nursing home residents

Challenges: • High prevalence of physical inactivity• High early death rate• High prevalence of frequent mental distress

41.340.616.811.04.1

10.8

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: chfs.ky.gov/agencies/dph

38% 14%

55%

12%

11%

24%

in the past four years from 4.0% to 5.5% of adults ages 65+

in the past year from 16.6% to 14.8% of adults ages 60+

in the past year from 7.4% to 5.6% of residents

in the past four years from 68.9% to 59.4% of adults ages 65+

in the past four years from 7.3% to 11.3% of adults ages 65+

in the past two years from 22.0% to 24.6% of adults ages 65+

EXCESSIVE DRINKING FLU VACCINATION

FREQUENT MENTAL DISTRESS

TEETH EXTRACTIONS

FOOD INSECURITY

LOW-CARE NURSING HOME RESIDENTS

Page 34: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -1.218 50+ 29.8 44+ -1.752 50+ 11.6 48+ 41.5 50+ 26.6 47+ 9.6 46+ -0.664 41+++++ 5.5 9+ 13.1 49

+ -0.424 41++ -0.512 39++ 14.8 37++ 10.2 38++ 60.4 34+ -0.687 48++ $26 37+++++ 5.6 10+ 87 45+ 18.9 50++ 63.5 38+++++ 212 7

++ -0.092 39+ -0.403 45++ 8.1 36++ 35.2 31+ 4.8 44++++ 13.9 11

+ -0.668 47+ -0.856 47+ 6.3 41+++ 94.0 21+ 6.3 46+ 69 47++ -0.190 35+++ 71.5 29+++ 0.090 25+++++ 59.4 10++ 72.6 32++ 41.6 37+ -0.958 49+ 41.6 45+++ 16.0 23+ 37.5 44+ 3,924 49

+ -0.657 48

+ -1.349 49+ -1.620 48+ 60.3 46+ 11.3 48+ 21.4 48+ 34.5 44+ -1.027 47+ 30.7 42+ 44.4 46++ 30.8 33+ 24.6 49+ -1.452 49+ 2,407 49++ 20.5 35

+ -0.830 —

Kentucky

Page 35: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Louisiana

Loui

sian

a

Strengths:• Low suicide rate• High percentage of hospice care use• Low prevalence of falls

Challenges: • High prevalence of food insecurity• High early death rate• High prevalence of smoking

39.142.316.310.85.912.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: ldh.la.gov

20% 13%

24%

72%

46%

16%

in the past year from 77.6 to 62.2 participants per 100 adults ages 60+ in poverty

since 2013 from 22.8% to 12.2% of residents

in the past year from 54.4% to 45.7% of adults ages 65+

in the past two years from 31.0% to 26.9% of adults ages 65+

since 2013 from 12.1% to 9.2% of adults ages 65+

in the past three years from 5.3 to 9.1 deaths per 100,000 adults ages 65-74

SNAP REACH FALLS

COGNITIVE DIFFICULTY

DRUG DEATHS

LOW-CARE NURSING HOME RESIDENTS

FLU VACCINATION

Page 36: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.995 48++ 27.9 36+ -1.041 44+ 13.5 44+ 34.7 44++ 30.8 38++ 11.2 40+ -1.284 49++ 8.6 39+ 12.0 46

+ -1.190 50+ -1.630 50+ 19.8 50+ 12.4 48++ 62.2 31+ -0.690 49++++ $51 16++ 12.2 35+ 93 48+ 22.0 44++ 64.3 33+ 538 45

++ -0.108 40+ -0.277 44++ 7.9 33++ 27.9 36+ 3.3 42+++ 15.9 30

+ -0.790 49+ -0.800 44+ 6.8 43++ 92.9 36+ 7.7 41++++ 160 15+ -0.884 43+++ 73.4 24+ -1.360 49+ 45.7 47+ 68.6 43+ 37.7 48+ -0.685 48+++ 49.7 22+++ 16.0 23+ 33.5 49+ 3,613 46

+ -0.887 50

+ -0.852 43+ -1.113 43+ 62.0 43++ 8.8 40+ 20.9 43+ 33.7 46++ -0.531 40+++ 26.9 25+ 45.1 47++ 31.8 37++ 17.7 40+ -0.974 42+ 2,273 44++++ 16.6 19

+ -0.878 —

Louisiana

Page 37: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Maine

Mai

ne

Strengths:• High voter turnout• High coverage of smokefree laws• High prevalence of cancer screenings

Challenges: • Low flu vaccination coverage• High suicide rate• High prevalence of food insecurity

33.537.711.613.05.18.8

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: maine.gov/dhhs

27% 13%

19%

8%

23%

19%

since 2013 from 12.2% to 15.5% of adults ages 60+

in the past year from 63.2% to 48.5% of adults ages 65+

since 2013 from 9.9% to 8.0% of adults ages 65+

in the past two years from 32.5% to 28.3% of adults ages 65+

in the past two years from 15.2% to 18.1% of adults ages 65+

since 2013 from 1,848 to 1,703 deaths per 100,000 adults ages 65-74

FOOD INSECURITY FALLS

TEETH EXTRACTIONS

EARLY DEATH

FLU VACCINATION

COGNITIVE DIFFICULTY

Page 38: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.463 10++++ 25.1 20++++ 0.722 11++++ 18.7 19+++ 28.6 21+++++ 40.6 6+++++ 18.1 4+++ 0.018 22+++ 7.6 27++++ 8.5 17

++++ 0.454 20++ -0.134 31++ 15.5 38+++ 9.1 30++++ 87.9 15+++++ 0.878 7++ $30 32+++++ 2.1 1+++ 46 24++++ 33.7 15+++++ 78.9 1+++++ 112 1

+++++ 0.880 6+++++ 0.893 6+++++ 5.9 7+++++ 100.0 1++ 1.5 34+++ 15.0 24

+++++ 0.795 1+++++ 0.876 3+++++ 3.4 6++++ 94.5 13+++++ 21.4 5++++ 184 13+++++ 0.740 6+++++ 79.0 4++++ 0.460 18+ 48.5 43+++++ 77.2 5+++++ 53.3 8++++ 0.770 11++++ 50.6 19+++++ 15.0 7+++++ 59.3 10++++ 2,245 20

+++++ 0.604 7

+++ 0.191 25++++ 0.523 18+++ 66.2 28+++ 7.1 21++++ 16.3 16+++++ 46.6 10+++ 0.079 26++ 28.3 32++++ 34.0 16++++ 27.2 15+ 18.1 41+++ -0.250 30+++ 1,703 23+ 22.7 42

++++ 0.501 —

Maine

Page 39: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Maryland

Mar

ylan

d

Strengths:• Low prevalence of falls• Low percentage of seniors living in poverty• High percentage of volunteerism

Challenges: • Low voter turnout• Low percentage of hospice care use• High violent crime rate

31.340.113.610.36.57.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.maryland.gov

26% 8%

15%

20%

14%

16%

in the past year from 6.9% to 5.1% of residents

since 2013 from 9.2% to 7.9% of adults ages 65+

in the past two years from 86.0 to 100.0 participants per 100 adults ages 60+ in poverty

since 2014 from 82.8% to 76.4% of seniors receiving recommended screenings

in the past year from 66.8% to 56.5% of adults ages 65+

in the past two years from 28.6% to 23.0% of adults ages 65+

LOW-CARE NURSING HOME RESIDENTS CANCER SCREENINGS

FLU VACCINATION

FALLS

SMOKING

SNAP REACH

Page 40: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.453 11+++ 27.1 28++++ 0.411 15++++ 20.0 11++++ 28.0 18+++ 36.4 22+++ 14.0 21+++++ 0.680 3+++++ 5.7 10++++ 7.9 11

++++ 0.513 15+++++ 0.882 8++++ 11.7 19+++++ 7.3 8+++++ 100.0 1++++ 0.319 20+ $24 41+++++ 5.1 6++++ 36 19+++++ 38.2 4+ 61.4 44++ 469 40

++++ 0.530 16++++ 0.563 14+++ 7.7 30+++++ 100.0 1++++ 0.5 15++ 16.5 31

++++ 0.409 15+++++ 0.698 5++++ 3.9 16+++++ 96.5 2+++++ 21.2 7++ 111 34+++++ 0.520 9++++ 76.4 11++++ 0.507 14++++ 56.5 20++++ 75.7 11++++ 47.4 20++ 0.008 32++ 46.7 34+++ 16.0 23+++ 50.6 28+++ 2,583 29

++++ 0.472 12

+++++ 0.669 7+++++ 0.818 10+++++ 69.3 5++++ 7.0 19+++++ 14.2 4+++ 42.7 26+++++ 0.648 8+++++ 23.0 4++ 40.0 33++++ 27.9 19+++++ 10.8 10++++ 0.414 13+++ 1,703 23++++ 13.5 12

+++++ 0.521 —

Maryland

Page 41: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Massachusetts

Mas

sach

uset

ts

Strengths:• Low prevalence of avoided care due to cost• High prevalence of cancer screenings• Low suicide rate

Challenges: • High prevalence of excessive drinking• High percentage of hospital readmissions• High prevalence of frequent mental distress

32.238.813.711.88.29.0

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: mass.gov/orgs/department-of-public-health

46% 19%

13%

6%

13%

42%

in the past three years from 7.0% to 10.2% of adults ages 65+

in the past year from 10.5% to 9.1% of residents

in the past 2 years from 209 to 297 aides per 1,000 adults ages 65+ with a disability

since 2013 from 66.9% to 54.5% of adults ages 65+

since 2013 from 42.6% to 48.0% of adults ages 65+

since 2013 from 1,614 to 1,516 deaths per 100,000 adults ages 65-74

EXCESSIVE DRINKING FLU VACCINATION

HIGH HEALTH STATUS

EARLY DEATH

LOW-CARE NURSING HOME RESIDENTS

HOME HEALTH CARE WORKERS

Page 42: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.205 33+++ 27.2 29++++ 0.138 20+++ 17.0 28+++ 29.1 23++++ 36.7 20++++ 14.8 11+ -0.797 43+ 10.2 50+++ 9.0 25

+++ 0.342 23++++ 0.498 19++++ 11.4 16+++ 9.1 30+++++ 100.0 1+++ 0.166 25+++++ $265 1+++ 9.1 24++ 69 36++ 30.1 31++ 64.1 35+++ 338 25

+++++ 0.746 9+++++ 0.917 5+++++ 6.3 9+++++ 100.0 1++++ 0.2 13++ 17.7 37

+++++ 0.694 3+++++ 1.524 1+++++ 3.3 5+++++ 96.6 1+++++ 25.5 2+++++ 297 4+++++ 0.850 1+++++ 80.7 2++++ 0.377 20+++ 54.5 27+++ 73.4 27++++ 51.3 13++ -0.293 38++ 47.1 32+ 17.0 45+++ 51.1 26++ 2,699 32

++++ 0.344 17

+++++ 0.671 6++++ 0.648 14+++++ 68.8 10++ 8.3 36++++ 15.8 12+++++ 48.0 6++++ 0.480 12++++ 25.8 15+++ 38.0 25+++++ 25.9 8++++ 12.8 19+++++ 1.098 1+++++ 1,516 7+++++ 9.4 1

++++ 0.425 —

Massachusetts

Page 43: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Michigan

Mic

higa

n

Strengths:• High coverage of smokefree laws• High prevalence of cancer screenings• High percentage of hospice care use

Challenges: • High prevalence of avoided care due to cost• High prevalence of multiple chronic conditions • High prevalence of falls

34.938.714.311.65.28.3

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: michigan.gov/mdhhs

18% 14%

81%

14%

15%

20%

in the past four years from 15.3% to 12.6% of adults ages 60+

in the past three years from 7.8% to 9.0% of adults ages 65+

in the past year from 10.4% to 8.3% of residents

in the past year from 60.3% to 51.9% of adults ages 65+

since 2014 from 16.2% to 29.3% of adults ages 65+

since 2014 from 9.4% to 8.1% of adults ages 65+

FOOD INSECURITY FLU VACCINATION

FALLS

COGNITIVE DIFFICULTY

POVERTY

LOW-CARE NURSING HOME RESIDENTS

Page 44: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.046 26++ 27.7 34+++ -0.094 26+++ 17.0 28++++ 28.2 20+++ 36.3 23+ 11.1 41++++ 0.055 20+++ 7.1 21+++ 8.8 21

+++ 0.127 28+++ 0.140 28+++ 12.6 26+++ 9.0 28+++ 70.9 24+++ 0.251 21+++ $36 25++++ 8.3 20+++ 53 28++ 26.1 38+++++ 74.1 9++ 449 38

++++ 0.424 19+++ 0.343 22++ 8.0 34+++++ 100.0 1++ 2.2 38+++ 15.3 27

+++ 0.004 28++ -0.298 35+ 6.5 42++++ 95.1 11++++ 17.3 11++ 116 32++++ 0.182 20++++ 76.4 11++ -0.057 31++ 51.9 36+++ 74.2 22+++ 44.9 27+++ 0.128 28+++++ 53.7 10+++ 16.0 23++++ 54.8 17+ 3,247 44

+++ 0.088 27

++ -0.211 34++ 0.055 31++ 65.9 32+++ 7.1 21++ 18.5 37+++ 41.7 28++ -0.529 39++ 29.3 36+ 42.2 41++ 32.3 40++++ 11.9 14+++ -0.106 25++ 1,891 34++++ 15.4 15

+++ 0.013 —

Michigan

Page 45: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Minnesota

Min

neso

ta

Strengths:• Low prevalence of frequent physical distress• Low prevalence of insufficient sleep• Low prevalence of food insecurity

Challenges: • High prevalence of excessive drinking• Low community support expenditure• Low prevalence of seniors with a dedicated health care provider

31.235.211.510.85.37.2

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.state.mn.us

16% 13%

13%

23%

17%

10%

in the past year from 3.8% to 4.4% of adults ages 65+

in the past year from 15.4% to 12.8% of residents

in the past five years from 66.0% to 59.1% of adults ages 65+

in the past five years from 27.6% to 31.2% of Medicare enrollees ages 65+

in the past three years from 10.2% to 8.9% of adults ages 60+

since 2014 from 12.0% to 9.3% of adults ages 65+

AVOIDED CARE DUE TO COST FOOD INSECURITY

MULTIPLE CHRONIC CONDITIONS

TEETH EXTRACTIONS

LOW-CARE NURSING HOME RESIDENTS

FLU VACCINATION

Page 46: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.490 9+++++ 22.0 3++++ 0.594 12++++ 19.3 17++++ 26.6 14+++++ 39.6 8++++ 14.4 16+++ -0.108 29++ 8.3 37++++ 8.3 16

+++++ 0.959 2+++++ 0.822 10+++++ 8.9 4++++ 7.6 11++ 53.3 40+++++ 1.114 2+ $23 43++ 12.8 38+++++ 4 3+++++ 43.3 2+++++ 78.7 2+++++ 220 10

+++++ 0.944 3+++++ 0.857 7++++ 6.6 11+++++ 100.0 1+++++ 0.1 8+++++ 13.4 9

+++++ 0.583 8++++ 0.476 12+++ 4.4 23++ 91.9 40++++ 14.0 19+++++ 371 2+++++ 0.768 4+++++ 77.1 8+++++ 0.807 6++++ 59.1 11++ 72.7 31+++++ 55.1 3++++ 0.505 14++++ 52.7 12+++++ 15.0 7+++++ 61.9 6+ 3,434 45

+++++ 0.732 4

+++++ 0.936 4+++++ 1.330 2+++++ 69.1 6+++++ 5.2 3+++++ 14.0 2+++++ 47.7 8+++++ 0.543 10++++ 26.1 19++++ 31.2 11+++ 30.0 30+++++ 9.3 4+++++ 0.932 6+++++ 1,488 6+++++ 12.4 8

+++++ 0.783 —

Minnesota

Page 47: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Mississippi

Mis

siss

ippi

Strengths:• Low prevalence of excessive drinking• High flu vaccination coverage• Low violent crime rate

Challenges: • High percentage of seniors living in poverty• High early death rate• Low prevalence of exercise

42.142.618.811.34.812.7

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: msdh.ms.gov

14% 12%

32%

10%

27%

8%

in the past four years from 67.6 to 57.9 participants per 100 adults ages 60+ in poverty

in the past two years from 24.3% to 17.7% of adults ages 60+

since 2013 from 65.4% to 60.0% of adults ages 65+

since 2013 from 54.0% to 60.4% of adults ages 65+

in the past four years from 7.4% to 9.8% of adults ages 65+

in the past two years from 31.5% to 28.2% of adults ages 65+

SNAP REACH ABLE-BODIED SENIORS

FREQUENT MENTAL DISTRESS

FALLS

FOOD INSECURITY

FLU VACCINATION

Page 48: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.729 45++ 28.0 37+ -1.532 48+ 10.9 50+ 37.1 47+ 27.6 44++ 11.4 39++++ 0.192 13+++++ 3.9 3+ 11.1 43

+ -0.965 48+ -1.428 49+ 17.7 45+ 12.4 48++ 57.9 36+ -0.859 50++ $25 39++ 11.8 34+ 97 50+ 20.2 48+++ 65.8 26++++ 234 13

+ -0.286 45+ -0.507 48+++ 7.7 30++ 31.1 34+ 6.7 45+++ 15.8 29

+ -0.839 50+ -0.808 46++ 6.1 40+++ 93.6 27+ 6.7 45+ 72 46+ -1.092 48+ 67.3 45+ -0.753 45+++++ 60.0 6+ 68.7 42+ 29.2 50+ -0.618 47++ 44.5 40+++ 16.0 23++ 44.9 34+ 3,770 48

+ -0.778 49

+ -1.250 47+ -1.698 49+ 60.4 45+ 9.8 45+ 22.2 49+ 28.8 50+ -0.812 45++ 28.2 31+ 42.6 43+ 32.8 46+ 23.0 48+ -1.228 45+ 2,486 50+++ 17.4 26

+ -0.896 —

Mississippi

Page 49: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Missouri

Mis

sour

i

Strengths:• Low prevalence of insufficient sleep• High flu vaccination coverage• Low prevalence of frequent mental distress

Challenges: • Low prevalence of exercise• High percentage of low-care nursing home residents• High early death rate

36.839.814.011.44.28.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.mo.gov

57% 12%

9%

24%

38%

8%

in the past year from 5.6% to 8.8% of adults ages 65+

in the past four years from 19.1% to 11.8% of adults ages 60+

in the past year from 57.0 to 61.4 participants per 100 adults ages 60+ in poverty

in the past five years from 69.5% to 61.2% of adults ages 65+

in the past year from 20.1% to 18.2% of adults ages 65+

since 2014 from 24.9% to 18.8% of adults ages 65+

EXCESSIVE DRINKING FLU VACCINATION

FREQUENT PHYSICAL DISTRESS

TEETH EXTRACTIONS

FOOD INSECURITY

SNAP REACH

Page 50: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.485 40+++++ 22.6 5+ -0.906 41++ 15.1 37++ 30.7 33+ 26.9 46+ 9.6 46+ -0.679 42+ 8.8 42++ 9.8 34

++ -0.028 32+++ 0.364 21++++ 11.8 20++++ 8.2 19++ 61.4 33++ -0.333 37++++ $46 19+ 24.0 49++ 65 34++ 26.7 37+++ 65.6 27+ 502 43

+++ 0.294 24+++ 0.073 26+++ 7.5 28++ 29.1 35++++ 0.5 15+++++ 13.8 10

+++ 0.046 27++++ 0.214 16+++ 4.7 26++++ 94.2 18+++ 13.1 21+++++ 198 9++++ 0.220 17+++ 73.3 25++++ 0.493 16+++++ 61.2 5++++ 74.4 20+++ 43.9 30++ -0.295 39++++ 50.3 20+++ 16.0 23+ 37.8 43++ 2,851 37

++ -0.087 34

++ -0.338 38++ -0.145 36++ 63.6 38++++ 6.7 13++ 18.2 33++ 39.1 35++ -0.335 38+++ 27.1 26++ 39.7 32++ 31.3 35+ 18.8 42++ -0.728 40++ 2,053 40++ 19.4 31

++ -0.150 —

Missouri

Page 51: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Montana

Mon

tana

Strengths:• Low prevalence of multiple chronic conditions • Low percentage of hospital readmissions• Low prevalence of food insecurity

Challenges: • Low prevalence of seniors with a dedicated health care provider• High prevalence of falls• High prevalence of excessive drinking

34.336.710.612.04.18.4

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dphhs.mt.gov

20% 7%

19%

6%

9%

5%

in the past four years from 8.3% to 10.0% of adults ages 65+

in the past two years from 98 to 107 aides per 1,000 adults ages 65+ with a disability

in the past year from 60.7% to 57.4% of adults ages 65+

in the past five years from 63.6% to 68.1% of adults ages 65+

since 2013 from 39.8% to 47.5% of adults ages 65+

in the past five years from 24.4% to 25.8% of Medicare enrollees ages 65+

SMOKING ABLE-BODIED SENIORS

HIGH HEALTH STATUS

MULTIPLE CHRONIC CONDITIONS

HOME HEALTH CARE WORKERS

FLU VACCINATION

Page 52: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.231 34+++++ 23.2 8+++ -0.175 30++++ 18.2 20++++ 26.0 11+ 29.3 41+ 10.3 42+ -0.920 47+ 9.5 45++ 10.0 37

++++ 0.495 17+++ 0.306 23+++++ 9.6 6++ 9.4 34++ 53.3 40+++++ 0.844 8++++ $81 11+ 14.8 44++++ 26 14++++ 35.1 13+++++ 77.1 4+++ 374 27

+++++ 0.826 8+++++ 0.810 8++++ 6.6 11+++++ 100.0 1++++ 0.6 20++++ 14.8 20

+++ -0.020 30++ -0.344 36+++++ 3.5 8+ 87.9 48+ 7.0 43++ 107 36++ -0.344 37+ 68.8 42+++ 0.260 22++++ 57.4 19+++ 73.3 28+++ 45.9 24++++ 0.628 13+ 43.4 42+++++ 14.0 1++ 47.4 32+++++ 1,654 10

++++ 0.208 20

+++ 0.294 22++++ 0.650 13++++ 68.1 14+++ 7.2 23++++ 16.7 19+++++ 47.5 9+++ 0.232 21+ 32.5 47+++++ 25.8 3+++++ 24.1 3+++ 14.2 28++ -0.296 31++++ 1,631 17+ 25.4 44

++++ 0.230 —

Montana

Page 53: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Nebraska

Neb

rask

a

Strengths:• Low prevalence of insufficient sleep• Low prevalence of frequent mental distress• Low prevalence of frequent physical distress

Challenges: • High prevalence of obesity• Low number of geriatricians per capita• Low prevalence of cancer screenings

34.136.711.611.24.37.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dhhs.ne.gov

48% 14%

9%

24%

16%

8%

since 2013 from 7.7% to 11.4% of adults ages 60+

in the past two years from 14.5% to 12.2% of residents

in the past two years from 62.7% to 57.9% of adults ages 65+

since 2013 from 40.2% to 45.7% of adults ages 65+

in the past five years from 30.6% to 33.4% of Medicare enrollees ages 65+

in the past three years from 10.7 to 13.3 deaths per 100,000 adults ages 65+

FOOD INSECURITY HIGH HEALTH STATUS

MULTIPLE CHRONIC CONDITIONS

SUICIDE

LOW-CARE NURSING HOME RESIDENTS

FLU VACCINATION

Page 54: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.389 13+++++ 21.5 2+++ 0.093 21+++ 17.5 25+++ 29.7 28++++ 37.2 16+++ 13.8 22+++++ 0.254 10+++ 7.5 24+++++ 7.8 8

++++ 0.490 18++++ 0.500 18++++ 11.4 16++++ 7.6 11++ 54.3 38++++ 0.447 16++++ $72 12++ 12.2 35++++ 22 12++++ 35.5 11+++ 66.0 24++++ 285 18

+++++ 0.842 7++++ 0.687 13++++ 7.1 19+++++ 100.0 1+++ 0.7 25+++++ 12.8 6

++++ 0.359 16+++ 0.060 23++++ 3.7 13+++ 93.6 27++ 8.9 38++ 108 35++++ 0.230 16++ 70.2 38+++++ 0.997 4++++ 57.9 17+++++ 76.6 8+++++ 53.3 8+++++ 0.788 10++++ 50.8 17+++++ 15.0 7++++ 54.9 16++++ 1,876 13

++++ 0.475 11

++++ 0.454 14+++++ 0.968 7+++ 66.3 27+++++ 5.5 4+++++ 14.1 3++++ 45.7 12+++ 0.028 29+++ 27.4 28++++ 33.4 14+ 32.4 41++++ 12.3 16++++ 0.280 16+++ 1,776 30++++ 13.3 11

++++ 0.470 —

Nebraska

Page 55: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Nevada

Nev

ada

Strengths:• Low prevalence of falls• High flu vaccination coverage• Low percentage of serious drinking water violations

Challenges: • High prevalence of insufficient sleep• Low prevalence of cancer screenings• High suicide rate

34.841.112.89.95.28.8

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dhhs.nv.gov

32% 19%

14%

23%

21%

16%

in the past three years from 13.3% to 17.5% of adults ages 60+

since 2013 from 8.1% to 9.8% of adults ages 65+

in the past year from 10.0 to 11.6 per 100,000 adults ages 65+

since 2014 from 50.0% to 59.5% of adults ages 65+

in the past five years from 31.6% to 35.9% of Medicare enrollees ages 65+

in the past three years from 15.4 to 18.9 deaths per 100,000 adults ages 65-74

FOOD INSECURITY FLU VACCINATION

MULTIPLE CHRONIC CONDITIONS

DRUG DEATHS

POVERTY

GERIATRICIANS

Page 56: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.907 47+ 31.4 46++ -0.732 39+++ 17.4 26++ 30.5 32+ 28.7 42+ 7.6 50+ -1.037 48+ 8.8 42+ 11.0 42

+ -0.476 43+ -0.642 43+ 17.5 44++ 9.8 36++++ 77.9 19++ -0.135 32+ $21 47+++ 9.1 24+++ 48 25+ 24.1 41++++ 67.4 19+ 541 46

+ -0.460 49+ -0.453 47+ 9.0 46+ 0.0 42+++++ 0.0 1+ 19.6 44

+ -0.702 48++ -0.710 40++ 5.5 37+ 90.0 46+++ 11.6 26+ 92 41+ -0.990 44+ 66.0 49++ -0.377 37+++++ 59.5 9+ 68.5 45+ 39.9 41+ -0.405 43++ 47.1 32+ 17.0 45++ 41.9 39+++ 2,316 21

+ -0.649 47

++ -0.287 37++ -0.548 39+++ 66.4 24+++ 7.9 30+ 21.1 45+ 36.2 41++++ 0.356 15++++ 26.0 17+++ 35.9 21+++ 28.0 21+++ 13.8 27+ -1.052 43++ 1,907 36+ 33.5 50

+ -0.559 —

Nevada

Page 57: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

New Hampshire

New

Ham

pshi

re

Strengths:• Low percentage of seniors living in poverty• High prevalence of high health status• Low prevalence of frequent physical distress

Challenges: • Low coverage of smokefree laws• Low flu vaccination coverage• High suicide rate

31.936.610.610.74.45.4

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dhhs.nh.gov

15% 15%

11%

23%

21%

18%

in the past four years from 7.1% to 8.2% of adults ages 65+

in the past year from 13.6% to 10.7% of adults ages 60+

in the past year from 61.9% to 50.7% of adults ages 65+

in the past five years from 64.0% to 54.2% of certified nursing home beds rated 4- or 5-stars

since 2013 from 1,729 to 1,533 deaths per 100,000 adults ages 65-74

since 2013 from 8.1% to 6.2% of adults ages 65+

EXCESSIVE DRINKING NURSING HOME QUALITY

EARLY DEATH

COGNITIVE DIFFICULTY

FOOD INSECURITY

FLU VACCINATION

Page 58: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.640 7+++ 26.1 27+++++ 1.061 7+++++ 20.6 7+++++ 25.8 10+++++ 40.7 5+++++ 17.8 5++++ 0.162 16++ 8.2 35+++++ 7.5 6

+++++ 0.850 4+++++ 0.956 5++++ 10.7 14+++++ 5.5 1+ 52.5 42++++ 0.601 12+++++ $91 8++ 11.5 33+++++ 2 2+++ 32.3 22++++ 68.0 17+++++ 173 3

+++ 0.272 25+++ 0.140 25+++++ 4.4 1+ 0.0 42++ 2.4 40+++ 15.1 25

+++++ 0.556 9+++++ 0.750 4+++++ 3.2 3+++++ 95.6 7+++++ 17.9 10+++ 127 26+++++ 0.614 7++++ 76.2 14++++ 0.690 11++ 50.7 39+++++ 78.6 1++++ 52.5 11+++ 0.305 22+++ 47.5 30+++ 16.0 23++++ 54.2 19++++ 2,071 16

+++++ 0.639 5

+++++ 0.870 5+++++ 1.543 1+++++ 69.5 3+++++ 5.7 5+++++ 13.2 1+++++ 51.7 2++++ 0.515 11+++ 26.2 21++++ 32.1 12+++ 28.3 22++++ 12.4 17++++ 0.234 18+++++ 1,533 9++ 20.8 36

+++++ 0.696 —

New Hampshire

Page 59: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

New Jersey

New

Jers

ey

Strengths:• Low prevalence of falls• High prevalence of food insecurity• High prevalence of cancer screenings

Challenges: • High prevalence of avoided care due to cost• High prevalence of frequent mental distress• High prevalence of physical inactivity

31.639.014.311.17.28.3

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: state.nj.us/health

34% 71%

44%

84%

11%

30%

in the past four years from 28.0% to 37.4% of adults ages 65+ in fair or better health

in the past five years from 57.2% to 63.7% of adults ages 65+

in the past two years from 14.0% to 9.8% of adults ages 60+

in the past four years from 6.8% to 11.6% of adults ages 65+

since 2014 from 13.9% to 7.8% of adults ages 65+

in the past three years from 4.3 to 7.9 deaths per 100,000 adults ages 65-74

PHYSICAL INACTIVITY FREQUENT MENTAL DISTRESS

TEETH EXTRACTIONS

DRUG DEATHS

FLU VACCINATION

FOOD INSECURITY

Page 60: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.412 39+ 32.5 47++ -0.514 36+++ 17.6 24+ 37.4 48+++ 35.7 25+++ 13.0 27++++ 0.205 12+++ 7.8 30+++++ 7.7 7

+++ 0.375 22+++++ 0.956 5+++++ 9.8 8++++ 8.0 17++++ 99.2 12+ -0.531 45++++ $44 20++ 10.6 31+++ 51 27+ 21.9 45+ 60.3 46+++++ 208 6

+ -0.432 48+ -0.267 43++ 8.1 36+++++ 100.0 1+ 8.8 48+ 21.7 47

++ -0.088 33+ -0.748 43+ 8.2 50+++ 94.0 21+++++ 18.0 9+++ 132 25++++ 0.238 15+++++ 79.2 3++ -0.403 38+++++ 63.7 3+ 68.1 46+ 35.2 49+++ 0.245 24++ 44.7 39+++ 16.0 23+++++ 59.6 9+++ 2,381 26

++ -0.066 31

+++++ 0.647 8+++ 0.228 26+++++ 70.0 2+ 11.6 50+++++ 14.7 7++++ 43.8 20+++++ 0.916 3+++++ 21.2 2+ 44.2 45+++++ 25.8 7+++++ 7.8 3+++++ 0.948 4++++ 1,590 12+++++ 9.4 1

+++ 0.112 —

New Jersey

Page 61: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

New Mexico

New

Mex

ico

Strengths:• High coverage of smokefree laws• High home health care worker rate• Low prevalence of multiple chronic conditions

Challenges: • High prevalence of food insecurity• High prevalence of avoided care due to cost• High suicide rate

39.940.116.212.16.212.2

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: nmhealth.org

20% 10%

25%

11%

13%

12%

in the past three years from 11.1% to 13.3% of adults ages 65+

in the past year from 14.9% to 13.0% of residents

in the past two years from 60.6% to 68.1% of seniors receiving recommended screenings

since 2013 from 58.8% to 53.2% of adults ages 65+

since 2013 from 19.9% to 24.9% of adults ages 65+

in the past two years from 33.1% to 29.4% of adults ages 65+

POVERTY FLU VACCINATION

OBESITY

FALLS

LOW-CARE NURSING HOME RESIDENTS

CANCER SCREENINGS

Page 62: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.219 17+++ 25.8 25++++ 0.323 18++++ 19.3 17++++ 26.3 12++++ 36.9 19++ 11.9 36+++ -0.023 25++++ 6.7 17+++ 9.4 28

+ -0.989 49+ -1.384 48+ 17.7 45+ 13.3 50+++ 76.1 21++ -0.243 35++++ $65 14++ 13.0 40+ 95 49+++ 30.5 28+++ 66.5 21+ 857 49

+++ 0.312 22++++ 0.383 20+++++ 6.0 8+++++ 100.0 1+ 7.0 47++ 17.8 39

++ -0.404 38+ -0.956 48+ 7.7 49+ 89.1 47++++ 14.5 15+++++ 227 6++ -0.590 39+ 68.1 44+++ -0.037 29+++ 53.2 29++ 71.3 36++++ 48.8 17++++ 0.335 20+++ 49.5 25+++++ 15.0 7+ 36.1 45+++++ 1,634 9

++ -0.337 40

++ -0.468 40+ -1.088 42+ 60.0 47+ 9.3 43+ 21.1 45++ 40.0 32++++ 0.288 18++ 29.4 37++++ 32.3 13+++++ 24.9 5++ 15.1 31+ -0.740 41+++ 1,755 28+ 28.8 48

++ -0.370 —

New Mexico

Page 63: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

New York

New

Yor

k

Strengths:• High home health care worker rate• Low suicide rate• High coverage of smokefree laws

Challenges: • High prevalence of insufficient sleep• High percentage of seniors living in poverty• Low percentage of hospice care use

33.039.915.411.99.211.5

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.ny.gov

11% 16%

23%

8%

17%

37%

since 2013 from 31.3% to 28.0% of adults ages 65+ in fair or better health

in the past four years from 6.9% to 8.1% of adults ages 65+

in the past two years from 19.3% to 12.1% of adults ages 60+

in the past two years from 342 to 398 aides per 1,000 adults ages 65+ with a disability

in the past year from 58.0% to 44.8% of adults ages 65+

since 2013 from 1,668 to 1,535 deaths per 100,000 adults ages 65-74

PHYSICAL INACTIVITY HOME HEALTH CARE WORKERS

FLU VACCINATION

EARLY DEATH

EXCESSIVE DRINKING

FOOD INSECURITY

Page 64: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.075 27+ 34.1 49++++ 0.396 16+++ 17.4 26++++ 28.0 18+++++ 40.9 4++++ 14.6 14++++ 0.068 19++ 8.1 33++++ 7.9 11

++ -0.296 38++ -0.230 36+++ 12.1 21+ 11.8 47+++++ 100.0 1+ -0.499 44+++++ $112 5++++ 6.8 13+ 85 44+ 22.2 43+ 60.6 45+++ 351 26

+++ 0.304 23+++++ 0.810 8++++ 6.6 11+++++ 100.0 1++++ 0.6 20+ 23.9 48

+ -0.523 42+++ 0.116 21+ 6.9 44++ 93.1 35+++++ 21.3 6+++++ 398 1+ -1.072 46+++ 72.6 28+ -1.553 50+ 44.8 50+ 64.0 50+ 38.8 45+ -0.613 46+ 30.6 48+ 17.0 45+++ 51.8 25+++ 2,330 23

++ -0.218 38

++++ 0.454 14++++ 0.398 20++++ 68.5 12+++ 7.3 26++++ 16.5 18+++ 41.0 30+++ 0.208 22++++ 25.7 13+ 42.3 42++++ 27.0 14+++ 13.6 25+++++ 1.056 2+++++ 1,535 10+++++ 9.4 1

++ -0.050 —

New York

Page 65: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

North Carolina

Nor

th C

arol

ina

Strengths:• High flu vaccination coverage• Low prevalence of falls• Low percentage of hospital readmissions

Challenges: • High prevalence of food insecurity• High prevalence of avoided care due to cost• Low percentage of 4- or 5-star nursing home beds

35.839.514.510.64.49.2

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: ncdhhs.gov

47% 7%

12%

13%

33%

10%

in the past four years from 4.9% to 7.2% of adults ages 65+

in the past two years from 8.8% to 11.7% of adults ages 65+

in the past five years from 35.7% to 39.2% of Medicare enrollees ages 65+

since 2013 from 61.5% to 65.7% of adults ages 65+

in the past two years from 28.1% to 24.8% of adults ages 65+

in the past five years from 10.0% to 8.7% of adults ages 65+

EXCESSIVE DRINKING ABLE-BODIED SENIORS

FALLS

COGNITIVE DIFFICULTY

SMOKING

MULTIPLE CHRONIC CONDITIONS

Page 66: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.577 42+++ 25.6 23++ -0.715 38++ 14.4 39+++ 29.3 27+ 27.1 45++ 11.7 37+ -0.836 44+++ 7.2 22+ 11.7 44

++ -0.171 34++ -0.532 40+ 17.8 47+++ 8.7 25+++ 63.2 30+++ 0.232 22++ $30 32+++++ 4.7 4+++ 57 30++++ 32.7 20+++ 66.1 23+++ 378 28

++ 0.108 33++ -0.030 31+++ 7.2 22+ 0.3 41+++++ 0.0 1+++ 15.6 28

+++ 0.086 25++ -0.476 38+ 7.0 46+++++ 96.3 3++++ 14.3 17++ 106 37+++++ 0.838 2+++++ 77.1 8+++++ 0.923 5+++++ 65.6 1+++++ 76.7 7++ 43.8 32++ -0.105 34+++ 49.6 24+++++ 15.0 7+ 34.9 48++ 2,851 37

++ -0.174 37

+++ 0.032 30++ -0.065 35++ 65.7 34++++ 6.8 14++ 18.2 33++ 37.6 39++++ 0.269 19+++++ 24.8 8+++ 39.2 29++++ 27.6 17++ 17.4 39+++ -0.248 29++ 1,902 35+++ 17.1 23

++ -0.122 —

North Carolina

Page 67: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

North Dakota

Nor

th D

akot

a

Strengths:• Low prevalence of avoided care due to cost• Low prevalence of frequent mental distress• Low prevalence of food insecurity

Challenges: • High prevalence of obesity• Low percentage of hospice care use• Low number of geriatricians per capita

33.436.110.510.64.79.1

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: ndhealth.gov

16% 7%

41%

24%

65%

9%

since 2013 from 34.6% to 29.1% of adults ages 65+ in fair or better health

in the past year from 2.6 to 4.3 per 100,000 adults ages 65+

since 2014 from 68.8% to 75.2% of adults ages 65+

in the past five years from 31.9% to 34.2% of Medicare enrollees ages 65+

since 2013 from 24.4% to 34.3% of adults ages 65+

since 2014 from 17.1% to 13.0% of adults ages 65+

PHYSICAL INACTIVITY MULTIPLE CHRONIC CONDITIONS

OBESITY

TEETH EXTRACTIONS

GERIATRICIANS

PNEUMONIA VACCINATION

Page 68: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.060 20+++++ 23.1 7++ -0.238 32+ 13.7 42+++ 29.1 23++++ 38.4 11+++ 12.9 30+++ -0.012 24++++ 6.9 18+++ 9.2 26

++++ 0.535 14+++ 0.098 29+++++ 8.4 3+ 10.3 41+ 33.5 49+++++ 1.058 3+++++ $83 10+ 13.1 41+++++ 16 9+++++ 38.7 3+++++ 76.4 6++++ 281 17

+++++ 1.272 1+++++ 1.110 1+++++ 4.6 2+++++ 100.0 1+++++ 0.0 1+++++ 11.2 1

++++ 0.184 20+++ 0.090 22+++++ 2.8 1+ 90.5 45+ 4.3 49++++ 180 14++++ 0.218 18+++ 71.3 30+++++ 0.803 7++++ 57.5 18++++ 75.2 14+++++ 52.6 10+++ 0.245 24+ 29.7 49+++++ 15.0 7+++++ 63.0 3+++ 2,371 25

++++ 0.413 15

++++ 0.351 19++++ 0.610 15+++ 66.6 22+++++ 5.1 2+++++ 15.5 10++ 39.0 36++ -0.026 32+++ 26.2 21++++ 34.2 18+ 34.3 49+++ 13.0 21+++++ 0.586 10+++ 1,691 22+++++ 11.5 5

++++ 0.398 —

North Dakota

Page 69: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Ohio

Ohi

o

Strengths:• High percentage of hospice care use• Low prevalence of falls• Low prevalence of severe housing problems

Challenges: • High prevalence of obesity• High early death rate• High prevalence of smoking

34.640.214.011.75.38.1

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: odh.ohio.gov

12% 15%

8%

49%

13%

11%

in the past four years from 5.7% to 6.4% of adults ages 65+

in the past year from 5.3% to 4.6% of adults ages 65+

in the past year from 63.0% to 55.8% of adults ages 65+

in the past four years from 30.1% to 25.6% of adults ages 65+

since 2013 from 8.6% to 7.9% of adults ages 65+

in the past three years from 6.8 to 10.1 deaths per 100,000 adults ages 65-74

EXCESSIVE DRINKING FALLS

COGNITIVE DIFFICULTY

DRUG DEATHS

AVOIDED CARE DUE TO COST

FLU VACCINATION

Page 70: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.632 43+ 29.2 43++ -0.868 40++ 15.1 37++ 33.0 38++ 30.8 38+ 10.1 43++ -0.331 37++++ 6.4 14+ 10.7 41

+++ 0.215 25+++ 0.222 26+++ 12.9 28+++ 8.6 22+++ 75.0 22+++ 0.101 28++ $30 32++++ 7.3 16++ 63 33+++ 30.3 30++++ 67.1 20++++ 280 16

++++ 0.512 17+++ 0.367 21+ 8.5 45+++++ 100.0 1++++ 0.6 20++++ 14.1 12

+++ -0.004 29+++ 0.060 23+++ 4.6 25+++ 93.7 25+++ 12.9 23++++ 149 19++ -0.138 32+++ 71.3 30+++ 0.210 23+++ 55.8 23+++ 74.3 21+++ 45.1 26+++ 0.065 30+++++ 56.4 6+++ 16.0 23++ 45.6 33++ 2,989 39

+++ -0.030 29

++ -0.211 34++ -0.003 32++ 65.9 32+++ 7.8 29+++ 17.3 26++ 40.1 31++ -0.266 37++++ 25.6 12++ 41.3 37+ 32.7 45++ 17.0 37++ -0.518 35+ 2,069 41++++ 16.1 17

++ -0.075 —

Ohio

Page 71: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Oklahoma

Okl

ahom

a

Strengths:• High flu vaccination coverage• Low prevalence of excessive drinking• Low prevalence of avoided care due to cost

Challenges: • High early death rate• Low percentage of able-bodied seniors• High prevalence of falls

41.940.615.310.93.08.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: ok.gov/health

13% 6%

13%

5%

23%

10%

in the past three years from 38.8% to 33.6% of adults ages 65+ in fair or better health

in the past year from 5.2% to 4.0% of adults ages 65+

in the past year from 22.9% to 20.7% of residents

in the past year from 80.3% to 75.1% of adults ages 65+

in the past five years from 37.8% to 42.8% of Medicare enrollees ages 65+

in the past five years from 2,274 to 2,398 deaths per 100,000 adults ages 65-74

PHYSICAL INACTIVITY PNEUMONIA VACCINATION

MULTIPLE CHRONIC CONDITIONS

EARLY DEATH

AVOIDED CARE DUE TO COST

LOW-CARE NURSING HOME RESIDENTS

Page 72: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.778 46++ 27.3 31+ -1.526 47+ 12.2 45++ 33.6 39+ 22.4 49+ 8.5 49+++ -0.044 26+++++ 4.1 4+ 11.7 44

++ -0.254 36++ -0.204 35++ 15.7 39+++ 8.7 25+++ 70.5 25++ -0.244 36++ $25 39+ 20.7 48+ 79 41++++ 33.0 18++ 64.7 31++ 466 39

+ -0.236 44+ -0.560 49++ 8.2 39+ 0.0 42+ 3.3 42++++ 14.2 13

++ -0.192 35+++ -0.126 29++++ 4.0 18++++ 94.1 19+ 6.9 44+ 81 45+++ 0.038 27+ 69.6 41+++++ 0.770 8+++++ 64.5 2++++ 75.1 15+++ 43.9 30+ -0.488 45+++ 49.1 26+++ 16.0 23+ 35.1 47+ 3,096 43

+ -0.375 41

+ -1.081 46+ -1.143 44+ 57.4 50++ 8.8 40+ 19.9 41+ 34.9 43+ -0.847 46+ 31.2 45+ 42.8 44+++ 29.4 28+ 20.2 45+ -1.424 48+ 2,398 48++ 20.1 33

+ -0.551 —

Oklahoma

Page 73: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Oregon

Ore

gon

Strengths:• High prevalence of exercise• Low prevalence of multiple chronic conditions • Low percentage of seniors living in poverty

Challenges: • High prevalence of excessive drinking• High prevalence of falls• High suicide rate

36.238.813.611.54.28.0

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: oregon.gov/oha/ph

29% 72%

9%

21%

61%

14%

in the past three years from 15.7% to 11.1% of adults ages 60+

in the past two years from 99 to 159 aides per 1,000 adults ages 65+ with a disability

in the past three years from 56.9% to 49.2% of adults ages 65+

since 2014 from 18.4% to 31.6% of adults ages 65+

in the past five years from 26.4% to 28.7% of Medicare enrollees ages 65+

in the past two years from 10.3% to 8.1% of adults ages 65+

FOOD INSECURITY FALLS

MULTIPLE CHRONIC CONDITIONS

COGNITIVE DIFFICULTY

HOME HEALTH CARE WORKERS

FLU VACCINATION

Page 74: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.502 8++++ 24.1 12+++++ 1.348 3+++++ 21.7 4+++++ 23.7 7+++++ 41.2 2+++++ 18.2 3+ -0.891 45+ 10.1 48+++ 9.4 28

+++++ 0.711 8++++ 0.818 11++++ 11.1 15++++ 7.9 13+++++ 100.0 1++++ 0.604 11+++ $33 30+++++ 5.5 9+++ 50 26+++++ 36.5 9++++ 70.6 13++++ 286 19

+++ 0.324 21++++ 0.513 16++ 7.8 32+++++ 100.0 1+++ 0.8 26+ 19.4 43

+++++ 0.619 7++++ 0.130 20++++ 4.0 18+ 91.6 42++++ 14.1 18++++ 159 16+++++ 0.488 10++++ 75.5 17++++ 0.593 12+ 49.2 41+++++ 77.3 4+++++ 54.8 5+++++ 1.238 4+++++ 53.9 9+++++ 14.0 1++++ 55.5 15+++++ 1,529 6

+++++ 0.579 8

++ -0.026 31+++ 0.093 29+++ 66.4 24++ 8.7 38+++ 17.7 29++++ 45.5 13+++ 0.019 30+ 31.6 46+++++ 28.7 6++++ 27.9 19+++ 13.5 24++ -0.352 33++++ 1,618 14+ 26.5 46

++++ 0.428 —

Oregon

Page 75: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Pennsylvania

Penn

sylv

ania

Strengths:• High flu vaccination coverage• Low prevalence of falls• High community support expenditure

Challenges: • High level of air pollution• Low prevalence of high health status• High prevalence of food insecurity

34.138.914.212.66.68.1

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.pa.gov

24% 41%

9%

45%

9%

16%

in the past four years from 80.4 to 100.0 participants per 100 adults ages 60+ in poverty

in the past two years from 65.5% to 59.7% of adults ages 65+

in the past two years from 182 to 212 aides per 1,000 adults ages 65+ with a disability

in the past two years from 5.9% to 8.3% of adults ages 65+

since 2014 from 18.2% to 16.5% of adults ages 65+

in the past three years from 6.6 to 9.6 deaths per 100,000 adults ages 65-74

SNAP REACH FREQUENT MENTAL DISTRESS

TEETH EXTRACTIONS

DRUG DEATHS

FLU VACCINATION

HOME HEALTH CARE WORKERS

Page 76: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.176 31+ 28.3 41+++ 0.007 24+++ 18.0 23+++ 30.0 30+++ 35.9 24+++ 13.0 27++ -0.389 39++ 7.9 32++ 9.6 31

+++ 0.257 24+++ 0.250 25++ 14.7 35++++ 8.3 20+++++ 100.0 1+++ 0.213 24+++++ $96 7++++ 5.9 11++ 71 37++++ 32.8 19++ 63.9 36+++ 306 22

+ -0.306 46+ -0.597 50+ 9.2 47+ 0.0 42+++ 1.1 28+++ 14.9 22

++++ 0.320 19+++++ 0.692 6+++ 4.2 22+++++ 95.3 10+++++ 18.7 8+++++ 212 8++++ 0.352 13+++ 74.4 21++++ 0.540 13+++++ 59.7 7++++ 75.3 13+++ 44.9 27++ -0.085 33+++ 48.4 29+++ 16.0 23++ 44.8 35+++ 2,587 30

+++ 0.083 28

+++ 0.062 29++ -0.048 34+++ 66.8 21++ 8.3 36+++ 16.9 22++ 38.4 38++++ 0.239 20+++++ 24.2 6++ 41.1 35+++ 28.3 22++ 16.5 35+++ -0.074 24++ 1,826 32+++ 16.8 21

+++ 0.078 —

Pennsylvania

Page 77: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Rhode Island

Rho

de Is

land

Strengths:• High prevalence of cancer screenings• Low prevalence of falls• High number of geriatricians per capita

Challenges: • High percentage of seniors living in poverty• High risk of social isolation• High percentage of hospital readmissions

33.440.714.312.78.09.9

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.ri.gov

42% 47%

26%

20%

21%

24%

since 2013 from 18.0% to 10.5% of residents

in the past year from 64.3% to 51.1% of adults ages 65+

in the past year from 9.0% to 11.2% of adults ages 65+

in the past four years from 44.8% to 65.8% of certified nursing home beds rated 4- or 5-stars

since 2013 from 36.9% to 46.4% of adults ages 65+

since 2013 from 22.2% to 26.6% of adults ages 65+

LOW-CARE NURSING HOME RESIDENTS NURSING HOME QUALITY

HIGH HEALTH STATUS

OBESITY

FLU VACCINATION

POVERTY

Page 78: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.203 32+ 30.4 45+++ -0.104 27++ 16.3 31++ 32.7 37++++ 38.4 11++++ 14.6 14+++ -0.047 27++ 8.3 37++++ 8.1 13

++ -0.240 35++ -0.326 37++ 13.9 33+ 11.2 46+++++ 100.0 1+ -0.449 41+ $22 45+++ 10.5 30+ 81 42++ 28.4 33+ 61.6 43+++++ 219 9

++++ 0.532 15++++ 0.700 12+++ 7.3 24+++++ 100.0 1+++++ 0.0 1+ 18.4 41

+++++ 0.638 5+++++ 0.608 7+++ 4.7 26+++++ 96.1 4+++++ 26.9 1+++ 123 27+++++ 0.828 3+++++ 81.1 1+++ 0.280 21++ 51.1 37++++ 75.5 12++++ 49.9 15++++ 0.478 15+++++ 55.0 7+ 17.0 45+++++ 65.8 2+++ 2,334 24

+++ 0.107 25

++++ 0.428 16+++ 0.365 21++++ 67.6 17++ 8.0 32+++ 17.4 27++++ 46.4 11++++ 0.411 13+++++ 25.2 9++ 39.6 31++++ 26.6 12+++ 13.4 23+++++ 0.588 9+++ 1,717 25+++++ 10.7 4

+++ 0.187 —

Rhode Island

Page 79: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

South Carolina

Sout

h C

arol

ina

Strengths:• Low percentage of hospital readmissions• Low percentage of low-care nursing home residents• Low prevalence of excessive drinking

Challenges: • High prevalence of food insecurity• Low prevalence of exercise• Low home health care worker rate

35.938.514.811.04.29.2

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: scdhec.gov

16% 11%

18%

25%

19%

11%

in the past four years from 26.8% to 31.2% of adults ages 65+ in fair or better health

in the past year from 6.4% to 5.2% of residents

in the past two years from 82 to 91 aides per 1,000 adults ages 65+ with a disability

in the past five years from 65.3% to 58.4% of adults ages 65+

since 2013 from 10.8% to 8.9% of adults ages 65+

since 2013 from 25.2% to 31.5% of adults ages 65+

PHYSICAL INACTIVITY FLU VACCINATION

COGNITIVE DIFFICULTY

OBESITY

LOW-CARE NURSING HOME RESIDENTS

HOME HEALTH CARE WORKERS

Page 80: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++ -0.403 38+++ 26.0 26+ -0.915 42++ 14.1 40++ 31.2 34++ 29.7 40+ 9.7 45+++ -0.007 23++++ 6.4 14++ 9.6 31

++ -0.259 37++ -0.458 38+ 15.8 41++ 9.5 35+++ 63.3 29+++ 0.095 29+ $24 41+++++ 5.2 7+++ 55 29+++ 31.9 24++ 64.2 34+ 488 42

+++ 0.194 30+++ 0.013 29+++ 7.4 25++ 32.0 32++ 1.7 35++++ 14.7 18

+++ 0.121 24++ -0.254 34++ 5.0 32++++ 94.5 13++ 9.8 34+ 91 42+++ 0.178 21++++ 75.7 16+++ 0.043 26++++ 58.4 13+++ 73.6 26++ 40.2 40++++ 0.438 17++++ 51.0 16+++++ 15.0 7+++ 48.9 30+++ 2,473 28

++ -0.136 36

++ -0.259 36++ -0.240 38++ 65.7 34++ 8.2 34++ 18.6 38++ 39.5 33++ -0.196 33+++ 26.8 24+++ 38.3 27++ 31.5 36++ 17.0 37++ -0.422 34++ 1,981 38+++ 17.3 24

++ -0.166 —

South Carolina

Page 81: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

South Dakota

Sout

h D

akot

a

Strengths:• High shingles vaccination coverage• Low prevalence of frequent mental distress• Low prevalence of insufficient sleep

Challenges: • Low percentage of hospice care use• High prevalence of excessive drinking• Low home health care worker rate

32.736.110.611.55.09.2

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: doh.sd.gov

93% 34%

34%

33%

5%

21%

in the past three years from 4.5% to 8.7% of adults ages 65+

in the past year from 17.0% to 16.2% of residents

in the past year from 65.0% to 51.1% of adults ages 65+

since 2013 from 23.8% to 31.8% of adults ages 65+

since 2014 from 19.4% to 12.8% of adults ages 65+

in the past five years from 7.8% to 5.2% of adults ages 65+

EXCESSIVE DRINKING OBESITY

TEETH EXTRACTIONS

COGNITIVE DIFFICULTY

LOW-CARE NURSING HOME RESIDENTS

FLU VACCINATION

Page 82: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.020 22+++++ 22.7 6+++ -0.173 29++ 15.9 33++ 30.3 31+++ 36.5 21+++ 13.1 26++ -0.383 38++ 8.7 40+++ 8.9 24

+++ 0.053 30++ -0.196 34++ 13.6 31+++ 9.0 28+ 44.3 45++++ 0.415 17++++ $72 12+ 16.2 46++++ 24 13+++++ 36.8 7+++ 66.4 22++ 405 33

+++++ 1.090 2+++++ 0.933 4+++++ 5.1 4+++++ 100.0 1++ 2.0 37+++++ 11.9 4

+++ 0.073 26+++ -0.102 28++++ 3.7 13++ 91.9 40++ 10.2 32+ 84 44+++ 0.176 22++ 71.2 33+++++ 0.747 9++ 51.1 37+++++ 77.0 6+++++ 55.9 1+++ 0.145 27+ 39.2 46+++++ 15.0 7+++ 51.0 27+++ 2,327 22

+++ 0.177 22

++++ 0.462 13+++++ 0.853 8+++++ 68.8 10+++++ 5.7 5+++++ 15.5 10+++ 42.8 24+++ 0.172 24+++ 27.3 27+++++ 30.8 10++ 31.8 37++++ 12.8 19++++ 0.258 17++++ 1,656 18+++ 17.0 22

++++ 0.248 —

South Dakota

Page 83: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Tennessee

Tenn

esse

e

Strengths:• Low percentage of low-care nursing home residents• Low prevalence of excessive drinking• High prevalence of seniors with a dedicated health care provider

Challenges: • High early death rate• High prevalence of avoided care due to cost• High prevalence of physical inactivity

38.739.916.310.64.19.4

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: tn.gov/health

21% 7%

28%

37%

56%

34%

in the past four years from 31.1% to 37.5% of adults ages 65+ in fair or better health

since 2013 from 10.6% to 4.7% of residents

in the past five years from 73.4% to 48.1% of adults ages 65+

since 2013 from 58.6% to 62.6% of adults ages 65+

in the past four years from 23.9% to 30.7% of adults ages 65+

in the past three years from 7.8 to 10.7 deaths per 100,000 adults ages 65-74

PHYSICAL INACTIVITY ABLE-BODIED SENIORS

OBESITY

DRUG DEATHS

LOW-CARE NURSING HOME RESIDENTS

FLU VACCINATION

Page 84: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -0.568 41++ 27.3 31+ -0.920 43+ 13.8 41+ 37.5 49++ 31.7 37++++ 14.4 16++ -0.308 36+++++ 4.1 4+ 13.0 48

++ -0.389 39++ -0.172 33++ 14.6 34++ 9.2 32+++ 70.3 26++ -0.373 39+ $22 45+++++ 4.7 4++ 77 40++ 27.6 35+ 59.5 47+ 624 48

++ 0.042 35++ -0.177 38+++ 7.4 25+ 0.0 42+++ 1.1 28++++ 14.7 18

+ -0.602 45+ -1.124 50+ 7.4 48++++ 94.8 12+ 6.2 47+ 64 48++ -0.256 36++++ 75.3 19+ -0.613 42+ 48.1 44++++ 74.5 19+ 38.5 46+ -0.425 44+ 43.7 41+++ 16.0 23++ 43.5 36+ 3,020 41

+ -0.436 44

+ -1.052 44+ -1.250 45+ 62.6 41+ 10.3 47+ 20.6 42+ 34.2 45+ -0.802 44++ 30.0 39++ 41.3 37++ 30.7 32+ 22.0 47+ -1.158 44+ 2,251 43++ 19.8 32

+ -0.590 —

Tennessee

Page 85: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Texas

Texa

s

Strengths:• High home health care worker rate• Low prevalence of insufficient sleep• High percentage of hospice care use

Challenges: • High prevalence of falls• High prevalence of food insecurity• Low percentage of 4- or 5-star nursing home beds

38.039.915.98.24.210.7

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dshs.state.tx.us

42% 7%

34%

14%

10%

21%

since 2013 from 14.3% to 8.3% of residents

since 2014 from 73.6% to 66.2% of seniors receiving recommended screenings

in the past two years from 57.3% to 45.2% of adults ages 65+

since 2013 from 59.3% to 63.6% of adults ages 65+

since 2013 from 26.3% to 35.3% of adults ages 65+

since 2013 from 11.1% to 9.6% of adults ages 65+

LOW-CARE NURSING HOME RESIDENTS ABLE-BODIED SENIORS

OBESITY

COGNITIVE DIFFICULTY

CANCER SCREENINGS

FLU VACCINATION

Page 86: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.162 30+++++ 24.0 10++ -0.471 35++ 15.6 34++ 33.6 39++ 31.8 36++++ 14.8 11++ -0.202 32++ 8.1 33+++ 8.8 21

+ -0.591 45+ -1.048 47+ 17.9 49+ 11.1 45+++ 71.6 23++ -0.120 31+ $21 47++++ 8.3 20++ 61 32++ 27.5 36+++ 65.5 28++ 411 34

+ -0.114 41++ -0.157 37++ 8.3 40+++ 44.5 30++ 2.3 39++ 17.7 37

+ -0.544 44+++ 0.044 25+++ 4.8 29+ 91.6 42++++ 13.9 20+++++ 216 7+ -1.294 50+ 66.2 47+ -0.917 47+ 45.2 49++ 71.3 36++ 41.8 36+ -0.383 42++++ 52.1 13+++ 16.0 23+ 30.1 50++ 2,686 31

+ -0.400 43

+ -0.810 42+ -0.678 41++ 63.6 38++ 8.7 38++ 19.6 39++ 37.4 40+ -1.271 50+ 33.6 50++ 41.9 39+ 35.3 50+++ 13.6 25+++ -0.154 27++ 1,881 33++++ 16.4 18

+ -0.503 —

Texas

Page 87: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Utah

Uta

h

Strengths:• Low prevalence of smoking• Low risk of social isolation• Low percentage of seniors living in poverty

Challenges: • High prevalence of falls• Low prevalence of seniors with a dedicated health care provider• High suicide rate

34.032.412.77.22.76.4

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.utah.gov

27% 7%

12%

66%

47%

12%

since 2013 from 14.2% to 10.4% of adults ages 60+

in the past year from 5.5% to 2.9% of residents

in the past three years from 59.0% to 52.0% of adults ages 65+

since 2014 from 30.9% to 28.7% of adults ages 65+

in the past five years from 26.9% to 30.0% of Medicare enrollees ages 65+

in the past three years from 8.9 to 14.8 deaths per 100,000 adults ages 65-74

FOOD INSECURITY FALLS

MULTIPLE CHRONIC CONDITIONS

DRUG DEATHS

LOW-CARE NURSING HOME RESIDENTS

FLU VACCINATION

Page 88: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 1.050 1++++ 24.9 17++++ 0.552 13+++++ 20.2 9+++++ 23.6 6++++ 37.0 17++ 11.5 38+++++ 1.912 1+++++ 3.6 1+++++ 5.5 1

+++++ 1.110 1+++++ 0.892 7++++ 10.4 11+++++ 6.1 2+ 42.8 46+++++ 1.425 1++++ $49 17+++++ 2.9 2+++++ 1 1+++++ 44.6 1+++++ 73.5 10++++ 233 12

++++ 0.562 13++++ 0.437 19+ 8.4 43+++++ 100.0 1+++++ 0.1 8++++ 14.2 13

++++ 0.456 13+++ -0.088 27++++ 4.1 20++ 92.5 38++ 9.7 35+++ 119 29+++ -0.008 29+++ 73.0 26+++ 0.160 24++ 52.0 35+++ 73.7 25++++ 49.7 16+++++ 1.465 1+++++ 59.4 1+++++ 14.0 1+++ 53.2 21+++++ 1,228 2

+++++ 0.847 1

++++ 0.342 20++++ 0.425 19++++ 67.1 19++++ 7.0 19+++ 17.2 25++++ 44.6 17++++ 0.312 16++ 28.7 35+++++ 30.0 9+++ 29.2 26+++++ 10.4 8++++ 0.234 18+++++ 1,516 7++ 21.3 38

+++++ 0.720 —

Utah

Page 89: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Vermont

Verm

ont

Strengths:• Low prevalence of multiple chronic conditions • High prevalence of high health status• Low prevalence of food insecurity

Challenges: • High prevalence of falls• Low percentage of hospice care use• Low prevalence of cancer screenings

32.637.911.812.95.57.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: healthvermont.gov

33% 15%

16%

13%

26%

9%

in the past three years from 15.4% to 10.3% of adults ages 60+

since 2013 from 6.5% to 8.2% of residents

in the past two years from 209 to 190 aides per 1,000 adults ages 65+ with a disability

since 2014 from 82.8% to 70.6% of seniors receiving recommended screenings

in the past five years from 65.0% to 54.4% of adults ages 65+

in the past five years from 1,708 to 1,486 deaths per 100,000 adults ages 65-74

FOOD INSECURITY CANCER SCREENINGS

FLU VACCINATION

EARLY DEATH

LOW-CARE NURSING HOME RESIDENTS

HOME HEALTH CARE WORKERS

Page 90: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.772 5++++ 24.2 14+++++ 1.150 6+++++ 20.1 10+++++ 25.3 9+++++ 42.2 1+++++ 18.4 2++++ 0.177 14+++ 7.8 30+++++ 7.8 8

+++++ 0.634 10++++ 0.584 15+++++ 10.3 10++ 9.3 33++++ 98.6 13++++ 0.525 14+++++ $105 6++++ 8.2 19++++ 38 20++++ 33.6 16++++ 68.2 16+++++ 172 2

+++++ 0.906 5+++++ 1.067 3+++++ 5.1 4+++++ 100.0 1++++ 0.5 15++ 17.0 34

++++ 0.349 18+++++ 0.534 8+++++ 3.4 6++++ 94.4 16+++ 11.6 26++++ 190 12+++ 0.106 26++ 70.6 36+++++ 0.730 10+++ 54.4 28++++ 74.8 18+++++ 55.5 2++++ 0.408 18+ 42.9 43+++++ 15.0 7+++ 50.2 29++++ 1,856 12

+++++ 0.631 6

++++ 0.520 11+++++ 1.000 6++++ 68.1 14++++ 6.6 12++++ 16.3 16+++++ 52.6 1+++ 0.051 27+ 32.9 48+++++ 26.2 4+++++ 25.4 6++ 15.4 32++++ 0.498 11+++++ 1,486 5+++ 18.5 29

+++++ 0.603 —

Vermont

Page 91: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Virginia

Vir

gini

a

Strengths:• Low prevalence of food insecurity• Low prevalence of falls• Low violent crime rate

Challenges: • Low coverage of smokefree laws• High prevalence of smoking• Low percentage of 4- or 5-star nursing home beds

32.938.413.810.15.07.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: www.vdh.virginia.gov

30% 27%

12%

76%

8%

6%

in the past four years from 13.9% to 9.7% of adults ages 60+

in the past year from 63.8% to 58.9% of adults ages 65+

in the past five years from 35.2% to 37.3% of Medicare enrollees ages 65+

since 2014 from 16.1% to 11.8% of adults ages 65+

since 2013 from 9.4% to 8.3% of adults ages 65+

in the past three years from 3.8 to 6.7 deaths per 100,000 adults ages 65-74

FOOD INSECURITY TEETH EXTRACTIONS

COGNITIVE DIFFICULTY

DRUG DEATHS

FLU VACCINATION

MULTIPLE CHRONIC CONDITIONS

Page 92: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.030 24++ 27.7 34+++ 0.046 23+++ 18.1 21++++ 27.7 17++ 33.2 31++ 12.8 31+++ -0.101 28++++ 6.2 13++ 10.1 38

++++ 0.611 11++++ 0.592 14+++++ 9.7 7+++ 8.4 21++ 62.0 32++++ 0.501 15++ $26 37++++ 7.6 17++++ 28 15++++ 33.5 17++++ 70.1 15+++++ 200 4

++ 0.124 32++ -0.060 33++++ 6.9 17+ 0.0 42+++ 1.1 28+++ 14.9 22

++ -0.041 31++ -0.246 33++ 5.2 34+++ 93.6 27+++ 12.0 25++ 114 33++++ 0.360 12++++ 74.9 20++++ 0.473 17++++ 58.9 12+++ 73.9 24+++ 47.1 21++ -0.238 35++ 45.3 37+++ 16.0 23++ 40.3 40+++ 2,381 26

+++ 0.201 21

+++ 0.268 24+++ 0.285 23++++ 66.9 20+++ 7.2 23+++ 17.1 23+++ 42.3 27++++ 0.362 14+++++ 25.3 10+++ 37.3 24+++ 29.2 26++++ 11.8 13+++ 0.046 23+++ 1,751 27+++ 17.3 24

+++ 0.218 —

Virginia

Page 93: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Washington

Was

hing

ton

Strengths:• Low prevalence of physical inactivity• High voter turnout• Low percentage of seniors living in poverty

Challenges: • Low community support expenditure• High suicide rate• Low percentage of hospice care use

35.538.013.610.04.37.7

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: doh.wa.gov

26% 9%

16%

16%

9%

30%

since 2013 from 14.3% to 10.6% of adults ages 60+

in the past year from 63.9% to 58.4% of adults ages 65+

in the past year from 8.8% to 6.2% of residents

in the past two years from 44.1% to 47.9% of adults ages 65+

since 2014 from 32.7% to 27.6% of adults ages 65+

in the past three years from 8.6 to 10.0 deaths per 100,000 adults ages 65-74

FOOD INSECURITY HIGH HEALTH STATUS

FALLS

DRUG DEATHS

FLU VACCINATION

LOW-CARE NURSING HOME RESIDENTS

Page 94: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++++ 0.995 3+++++ 24.0 10+++++ 1.393 1+++++ 21.2 5+++++ 20.4 2+++++ 41.2 2+++++ 16.6 6+++++ 0.441 7+++ 7.7 28+++++ 7.0 5

+++++ 0.944 3+++++ 1.046 4++++ 10.6 12+++++ 7.2 7+++++ 100.0 1+++++ 0.943 5+ $19 50++++ 6.2 12++++ 30 16+++++ 36.8 7+++++ 77.0 5+++ 312 23

++++ 0.386 20++++ 0.440 18++ 8.0 34+++++ 100.0 1+++ 1.1 28++ 17.3 35

+++++ 0.635 6++++ 0.324 14+++++ 3.6 10++ 93.4 34+++ 13.1 21+++ 145 22+++++ 0.760 5+++ 74.4 21+++++ 1.220 1++++ 58.4 13+++++ 78.0 2+++++ 54.4 7+++++ 0.820 8++ 45.6 36+++++ 15.0 7++++ 58.1 11+++++ 1,514 5

+++++ 0.801 3

+++++ 0.580 9++++ 0.758 11+++ 66.0 30+++++ 6.2 8++++ 15.8 12+++++ 47.9 7+++++ 0.656 7+++ 27.6 29+++++ 29.7 8++++ 26.9 13+++++ 9.3 4+++ 0.070 21++++ 1,591 13++ 21.4 39

+++++ 0.745 —

Washington

Page 95: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

West Virginia

Wes

t Vir

gini

a

Strengths:• Low prevalence of excessive drinking• High flu vaccination coverage• Low prevalence of severe housing problems

Challenges: • High prevalence of food insecurity• High prevalence of smoking• High early death rate

43.139.517.412.94.59.4

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dhhr.wv.gov

16% 9%

23%

22%

7%

14%

since 2013 from 41.2% to 34.7% of adults ages 65+ in fair or better health

in the past year from 11.1 to 10.3 per 100,000 adults ages 65+

in the past five years from 73.9% to 63.5% of adults ages 65+

in the past year from 3,806 to 4,143 discharges per 100,000 Medicare enrollees ages 65-74

since 2013 from 27.7% to 34.0% of adults ages 65+

since 2014 from 33.7% to 26.3% of adults ages 65+

PHYSICAL INACTIVITY PREVENTABLE HOSPITALIZATIONS

OBESITY

TEETH EXTRACTIONS

GERIATRICIANS

FLU VACCINATION

Page 96: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+ -1.101 49+ 32.8 48+ -1.582 49+ 11.8 46+ 34.7 44+ 21.6 50+ 9.2 48++ -0.200 31+++++ 3.6 1+ 13.8 50

+ -0.427 42+ -0.674 44+ 17.8 47++ 10.0 37++++ 84.2 16++ -0.369 38+++ $39 23+++ 9.3 26+ 91 47+++ 31.0 26+ 62.1 41++++ 290 20

++ 0.014 36+ -0.450 46+++ 7.6 29+++ 65.1 28+ 14.4 49+++++ 11.4 2

+ -0.643 46+ -0.802 45+ 6.9 44+++ 94.0 21++ 10.3 31++ 100 39++ -0.134 31++ 69.8 39++++ 0.450 19+++++ 63.5 4+++ 73.0 29++ 42.8 34+ -0.993 50+ 42.9 43+++ 16.0 23+ 35.2 46+ 4,143 50

+ -0.606 46

+ -1.452 50+ -1.860 50+ 58.8 48+ 11.3 48+ 23.6 50+ 33.0 47+ -1.041 48++ 28.4 33+ 45.6 48+ 34.0 47+ 26.3 50+ -1.460 50+ 2,353 46++ 21.1 37

+ -0.817 —

West Virginia

Page 97: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Wisconsin

Wis

cons

in

Strengths:• High percentage of able-bodied seniors• High percentage of volunteerism• High prevalence of exercise

Challenges: • High prevalence of excessive drinking• Low flu vaccination coverage• High percentage of serious drinking water violations

31.235.911.911.45.87.6

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: dhs.wisconsin.gov

11% 77%

18%

8%

14%

39%

in the past three years from 7.1% to 7.9% of adults ages 65+

in the past year from 52.7% to 45.4% of adults ages 65+

since 2014 from 13.6% to 8.3% of residents

since 2014 from 14.5% to 25.7% of adults ages 65+

in the past two years from 34.6% to 28.4% of adults ages 65+

since 2013 from 1,801 to 1,660 deaths per 100,000 adults ages 65-74

POVERTY FALLS

OBESITY

EARLY DEATH

FLU VACCINATION

LOW-CARE NURSING HOME RESIDENTS

Page 98: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

+++ -0.021 23+++ 25.3 22++++ 0.427 14+++++ 20.6 7+++ 29.2 26+++++ 38.9 10+++ 13.2 25+ -0.919 46+ 10.1 48+++ 9.5 30

+++++ 0.837 5++++ 0.782 12+++++ 10.2 9++++ 7.9 13++++ 80.2 18+++++ 0.979 4+++ $39 23++++ 8.3 20++++ 20 11+++++ 37.1 5+++++ 76.0 7+++ 295 21

+++ 0.200 28+++ 0.000 30++++ 6.8 15+++++ 100.0 1+ 20.1 50++++ 14.4 17

++++ 0.484 11+++++ 0.508 10++++ 3.9 16++++ 94.5 13+++ 11.4 28+++++ 234 5+++ 0.136 25+++++ 76.9 10++ -0.213 34+ 45.4 48++++ 74.9 17++++ 48.4 18+++++ 0.808 9+++++ 54.2 8+++++ 15.0 7++++ 53.9 20++++ 2,084 17

++++ 0.429 14

+++++ 0.558 10++++ 0.610 15+++++ 69.4 4++++ 6.5 11+++ 17.7 29++++ 44.2 19+++++ 0.566 9++++ 25.7 13++++ 33.6 15+++ 28.4 24+++++ 10.5 9++++ 0.440 12++++ 1,660 19++++ 14.4 13

++++ 0.461 —

Wisconsin

Page 99: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

State Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

State Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

Wyoming

Wyo

min

g

Strengths:• Low prevalence of multiple chronic conditions • Low percentage of seniors living in poverty• Low prevalence of frequent mental distress

Challenges: • Low prevalence of cancer screenings• Low prevalence of seniors with a dedicated health care provider• High suicide rate

36.337.510.510.52.77.9

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

State Health Department Website: health.wyo.gov

20% 26%

19%

29%

33%

12%

in the past year from 33.8% to 27.2% of adults ages 65+ in fair or better health

since 2013 from 19.2% to 12.8% of residents

in the past two years from 86 to 96 aides per 1,000 adults ages 65+ with a disability

in the past two years from 9.1% of adults to 11.5% of adults ages 60+

in the past two years from 32.1% to 26.0% of adults ages 65+

since 2013 from 20.4% to 26.4% of adults ages 65+

PHYSICAL INACTIVITY FOOD INSECURITY

FALLS

OBESITY

LOW-CARE NURSING HOME RESIDENTS

HOME HEALTH CARE WORKERS

Page 100: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

++++ 0.110 19++++ 25.0 18++++ 0.227 19++++ 19.9 12++++ 27.2 16+++ 33.6 29++ 12.4 35++ -0.297 35+++ 7.3 23++ 9.8 34

++++ 0.581 12+++ 0.358 22++++ 11.5 18+++++ 7.3 8+ 28.4 50+++++ 0.738 9+++++ $137 4++ 12.8 38+++++ 14 8+++ 32.6 21++++ 71.8 12+++++ 212 7

++++ 0.592 12+++ 0.303 23+++++ 5.0 3+ 0.3 41++++ 0.6 20+++++ 11.8 3

+ -0.538 43+ -0.726 42+++ 4.9 30+ 87.1 49++ 8.4 40++ 96 40+ -1.090 47+ 62.8 50++ -0.483 40++ 52.9 31++ 70.1 40++ 42.9 33+++ 0.203 26+ 31.7 47+++++ 15.0 7+++ 52.5 23++++ 1,682 11

+++ 0.158 23

++++ 0.394 17++++ 0.573 17+++ 66.1 29+++++ 6.1 7++++ 16.0 15+++ 43.7 22+++++ 0.753 6++++ 26.0 17+++++ 23.6 1++++ 26.4 11++ 16.1 34++ -0.680 39+++ 1,723 26+ 30.4 49

+++ 0.217 —

Wyoming

Page 101: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

D.C. Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Summary

Trends Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Highlights:

Risk of Social Isolation by County

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

D.C. Value (%)

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

District of Columbia

Dis

tric

t of C

olum

bia

Strengths:• High home health care worker rate• Low prevalence of obesity• High flu vaccination coverage

Challenges: • High prevalence of excessive drinking• High prevalence of food insecurity• High prevalence of falls

35.845.417.611.119.614.5

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

14% 16%

18%

209%

51%

25%

in the past year from 17.7% to 20.1% of adults ages 60+

in the past year from 6.3% to 3.1% of adults ages 65+

in the past year from 100.0 to 74.8 participants per 100 adults ages 60+ in poverty

in the past two years from 51.7% to 59.8% of adults ages 65+

since 2013 from 39.3% to 46.4% of adults ages 65+

in the past three years from 20.4 to 63.0 deaths per 100,000 adults ages 65-74

FOOD INSECURITY FLU VACCINATION

HIGH HEALTH STATUS

DRUG DEATHS

AVOIDED CARE DUE TO COST

SNAP REACH

Health Department Website: dchealth.dc.gov

Page 102: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

—Indicates data suppressed.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

27.0‡

19.026.443.529.0

‡10.211.8

‡20.116.774.8

‡$250

‡99

30.466.7996

‡9.8‡‡

21.5

‡3.1

92.044.5371

‡74.5

‡59.871.043.6

‡32.017.061.6

3,559

‡64.07.813.646.4

‡31.735.725.210.9

‡1,9578.6

District of Columbia

2020 Value

‡ Scores not calculated for D.C.

Page 103: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

Nation

For source details and methodology visit www.AmericasHealthRankings.org.

FLU VACCINATION

PERC

ENTA

GE

OF

AD

ULT

S AG

ES 6

5+PE

RCEN

TAG

E O

F A

DU

LTS

AGES

60

+

100

80

60

40

20

0

30

25

20

15

10

5

0

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

2013 2014 2015 2016 2017 2018 2019 2020EDITION YEAR

FOOD INSECURITY

Trends

Highlights:

U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R DATA 2 0 2 0 U P DAT E

United StatesU

nite

d St

ates

Risk of Social IsolationSocial isolation, defined as an absence of meaningful social relationships, can negatively impact physical health and mental well-being of seniors. The risk of social isolation measure can be used by states to identify counties in greater need of inter-ventions that alleviate isolation and loneliness in older adults.

Source: U.S. Census Bureau, American Community Survey, 2014-2018

Risk Factors Among Adults Ages 65+ Disability Divorced, Separated or Widowed Independent Living Difficulty Live Alone Never Married Poverty

U.S. Value (%)35.338.713.910.95.48.8

State Nation

Flu Vaccination - Ages 65+

State Nation

Food Insecurity - Ages 60+

18% in the past year from 11.9% to 9.8% of residents

LOW-CARE NURSING HOME RESIDENTS

5% since 2013 from 63.2% to 66.1% of adults ages 65+

ABLE-BODIED SENIORS

7% in the past two years from 29.5% to 27.4% of adults ages 65+

FALLS

7% in the past two years from 14.5% to 13.5% of adults ages 65+

TEETH EXTRACTIONS

27% in the past two years from 137 to 174 aides per 1,000 adults ages 65+ with a disability

HOME HEALTH CARE WORKERS

5% in the past five years from 37.6% to 39.3% of Medicare enrollees ages 65+

MULTIPLE CHRONIC CONDITIONS

3% in the past three years from 16.5 to 17.0 deaths per 100,000 adults ages 65+

SUICIDE

35% in the past three years from 6.8 to 9.2 deaths per 100,000 adults ages 65–74

DRUG DEATHS

4% in the past three years from 9.0% to 9.4% of adults ages 65+

POVERTY

10% in the past year from 60.4% to 54.1% of adults ages 65+

FLU VACCINATION

Health Department Website: hhs.gov

<= 18th 19th to 38th 39th to 57th 58th to 77th >= 78th

Percentile of the mean z-scores for six risk factors in adults ages 65 and older, relative to all U.S. counties

Page 104: Alabama - America's Health Rankings

AMERICA’S HEALTH RANKINGS® SENIOR DATA 2020 UPDATE www.AmericasHealthRankings.org

* Value indicates z-score. Negative scores are below U.S. value; positive scores are above U.S. value. Years reflect edition year, not data source year. For measure definitions, including data sources and years, visit www.AmericasHealthRankings.org.

� Not calculated.

Rating 2020 Value 2020 Rank No. 1 State

1.05020.91.39324.520.342.219.61.9123.65.5

1.1101.3986.65.5

100.01.425$265

2.11

44.678.9112

1.2721.1104.4

100.00.011.2

0.7951.5242.8

96.626.9398

0.85081.1

1.22065.678.655.91.46559.414.067.91,128

0.847

1.1831.54370.64.613.252.6

1.66020.023.617.46.2

1.0981,4199.4

0.868

B E H AV I O RS*

S O C I A L & EC O N O M I C FACTO RS*

P H YS I CA L E N V I RO N M E N T*

C L I N I CA L CA R E*

H E A LT H O U TC O M E S*

MeasuresRating Rank

+++++++++

+++++

+

1–1011–2021–3031–4041–50

Insufficient Sleep (% of adults ages 65+)Physical Activity and Nutrition* Exercise (% of adults ages 65+) Physical Inactivity (% of adults ages 65+ in fair or better health) Fruit Consumption (% of adults ages 65+) Vegetable Consumption (% of adults ages 65+)Substance Use* Excessive Drinking (% of adults ages 65+) Smoking (% of adults ages 65+)

Household Economics* Food Insecurity (% of adults ages 60+) Poverty (% of adults ages 65+) SNAP Reach (participants per 100 adults ages 60+ living in poverty)Social Support and Engagement* Community Support Expenditure (dollars per adult ages 60+) Low-care Nursing Home Residents (% of residents) Risk of Social Isolation (percentile of mean z-scores for risk factors in adults 65+) Volunteerism (% of adults ages 65+) Voter Turnout (% of citizens ages 65+)Violent Crime (offenses per 100,000 population)

Air and Water Quality* Air Pollution (micrograms of fine particles per cubic meter) Non-smoking Regulation (% of population) Drinking Water Violations (% of community water systems)Severe Housing Problems (% of occupied housing units)

Access to Care* Avoided Care Due to Cost (% of adults ages 65+) Dedicated Health Care Provider (% of adults ages 65+) Geriatricians (number per 100,000 adults ages 65+) Home Health Care Workers (number per 1,000 adults ages 65+ with a disability)Preventive Clinical Services* Cancer Screenings (% of seniors) Immunizations* Flu Vaccination (% of adults ages 65+) Pneumonia Vaccination (% of adults ages 65+) Shingles Vaccination (% of adults ages 65+)Quality of Care* Hospice Care (% of Medicare decedents) Hospital Readmissions (% of hospitalized Medicare enrollees ages 65–74) Nursing Home Quality (% of 4- or 5-star beds) Preventable Hospitalizations (discharges per 100,000 Medicare enrollees ages 65–74) ALL DETERMINANTS*

Health Status* Able-bodied (% of adults ages 65+) Frequent Mental Distress (% of adults ages 65+) Frequent Physical Distress (% of adults ages 65+) High Health Status (% of adults ages 65+)Injury and Illness* Falls (% of adults ages 65+) Multiple Chronic Conditions, 4+ (% Medicare enrollees ages 65+) Obesity (% of adults ages 65+) Teeth Extractions (% of adults ages 65+)Mortality* Early Death (deaths per 100,000 adults ages 65-74) Suicide (deaths per 100,000 adults ages 65+)

OVERALL*

027.3

017.629.434.913.4

07.28.9

00

13.49.4

78.80

$559.8�

28.066.1381

00

8.461.11.7

17.9

00

5.293.714.11740

74.10

54.173.644.4

048.216.047.3

2,504

0

00

66.17.917.741.10

27.439.328.913.5

01,78317.0

0

United States

2020 Value