Health report card gives states varied marks Arkansas is flunked, though progress is noted

The American Public Health Association has issued a public health "report card" that documents enormous variations among U.S. states, flunking President-elect Bill Clinton's home state of Arkansas.

Arkansas was the only state that ranked in the bottom 25 percent on all five categories rated by the Public Health Association -- medical care access, environmental quality, overall community health, social behaviors and community health services.


However, reflecting the Clinton administration's emphasis on education, Arkansas actually ranked 15th -- well ahead of most other states -- in the rate of adolescents graduating from high school. Arkansas also did well in the incidence of work-related injuries.

"Arkansas is one of the poorest states in the country, and we know it has been making progress," said Dr. Joyce Lashof, president of the association, which ranked states for the first time on 25 public health yardsticks.


Dr. Lashof said the "report card," released yesterday at the opening of the association's annual convention in Washington, was not deliberately timed to avoid embarrassing Mr. Clinton during the election campaign. She acknowledged that if the report had been released before Nov. 3, Republicans would have called attention to Arkansas' rock-bottom rating. "But I think Clinton would have had a good solid response," Dr. Lashof said.

The public health organization issued the report, officials said, to emphasize that the public's health is determined by many factors in addition to people's access to medical care.

"There have been many reports on infant mortality and longevity," Dr. Lashof said in a telephone interview. "What we need to do in this country is look behind those measures at the factors that determine why we are 19th in infant mortality and ninth in life expectancy. Health-care reform that focuses only on health insurance and cost containment will not be sufficient to change those overall health statistics."

The "report card" relies largely on measures of effort rather than outcome, such as infant mortality rates, in probing how well states are doing in protecting public health.

For instance, it looks at the proportion of people without health insurance, the percentage of pregnant women who get adequate prenatal care, the fraction of communities with unsafe drinking water and the amount of tax placed on a pack of cigarettes.

On these and other indices, states displayed dramatic inequities. For example:

* Rhode Island has the lowest proportion of uninsured (8 percent in 1988) and New Mexico the highest (26 percent).

* States had a tenfold range of per-capita spending on Medicaid, the state-federal program to pay for medical and nursing home care for the poor, from $48.55 in Delaware to $483.68 in the District of Columbia.


* The proportion of state populations with unsafe drinking water ranged from 1 percent in Colorado to 53 percent in New Jersey.

* Only 15 percent of the population smokes in Utah, no doubt because of the influence of the Mormon Church. Smoking rates in Washington, D.C., were more than twice as high.

* Spending on education was only $708 per capita in Tennessee, but it was $2,320 in Alaska.

* North Carolina spends only $35 per capita on sanitation and sewage treatment, compared with $224 in Alaska.

* Ninety-five out of 100 Hawaiians wear auto seat belts regularly, compared with only 40 percent of North Dakotans.