As a state, Montana is in better physical shape than a year ago, but residents are not nearly as healthy as they were in 1990, according to America's Health Rankings, an annual report that measures the overall healthiness of Americans.
Montana is ranked 25th this year; it was 26th in 2009 and in 2008. Montana was at its healthiest in 1990, when it was ranked 12th in the nation.
Wyoming is ranked 19th this year, unchanged from 2009. Wyoming's strengths include a low incidence of infectious disease, low levels of air pollution and a low percentage of children in poverty. The state continues to be challenged with a limited availability of primary care physicians, high occupational fatalities and a high premature death rate.
For the second consecutive year, Vermont is the healthiest state.
State rankings are determined by evaluating four factors: behaviors; the environment and the community in which people live; public policy and health policy decisions; and practices of the government and clinical care received.
The purpose of America's Health Rankings is to stimulate action by individuals, communities, health care professionals, elected officials and employers to improve the health of Americans.
The annual ranking took into account several changes in Montana, including:
--In the past year, public health funding has increased from $76 to $94 per person.
--In the past five years, smoking has decreased from 20.4 percent to 16.8 percent of the population.
--Since 1990, the infant mortality rate has decreased from 9.8 to 6.1 deaths per 1,000 live births.
--In the last 10 years, the violent crime rate increased from 139 to 254 offenses per 100,000 people.
Montana's strengths include a lower prevalence of obesity than most other states at 23.7 percent of the population, a low incidence of infectious disease, low levels of air pollution and a low rate of deaths from cardiovascular disease.
Challenges include low immunization coverage, with just 85.4 percent of children ages 19 to 35 months receiving immunizations, a high occupational fatalities rate at 8.9 deaths per 100,000 workers and the low density of the state's population.
The report accurately describes the state's strengths and weaknesses, said Anna Whiting Sorrell, director of the state Department of Health and Human Services.
"For example, I believe we're doing life-saving work in cardiovascular health and diabetes prevention," Whiting Sorrell said. "We're making a difference in the lives of Montanans every day. On the other hand, we know we have work to do on immunization coverage and addressing health disparities among American Indians. We continue to look at innovative ideas that might help us improve in these areas."
Dr. Christopher Stanley, senior medical director for United Healthcare's Rocky Mountain region, said he is impressed and encouraged by Montana's significant decrease in the number of people who smoke and the increase in public health funding.
"The smoking improvement is huge," said Stanley, who oversees Montana, Colorado, Wyoming and New Mexico.
And, he added, increased public funding for health care is a "great signal" that the state will see long-term improvement in health care in the next three to five years.
But, before anyone cracks open a bottle of champagne to celebrate, Stanley cautions against losing sight of the "opportunities for improvement."
"The biggest single opportunity is obesity, from a public health emergency," Stanley said. "The second-biggest issue, or opportunity, is that not every person across the state has the same access to high quality and high value health care."
Montana must continue to leverage new technology and innovative solutions such as telemedicine so that patients across the state will have access to health care no matter where they live, Stanley said.
Dr. Manuel A. Selva Jr., who has worked as a medical consultant for the United Health Foundation since 2002, acknowledges the strides Montana has made in its smoking rates and increased public health funding, but said the state might look at improving its immunization for children.
"Early-childhood immunization has been shown to be a safe and cost-effective manner of controlling diseases within the population," Selva said. "So, with only 85.4 percent covered, which is below the national average of 89.8 percent, that leaves a significant number of children at possible risk."
America's Health Rankings is the result of a partnership between United Health Foundation, the American Public Health Association and Partnership for Prevention.