Isles No 4. in ranking of healthiest states

A yearly report notes a significant decrease in smoking in Hawaii

Hawaii edged up a notch -- to fourth place from fifth -- in the United Health Foundation's annual examination of the nation's health.

Minnesota held onto the "healthiest state" title for the fourth year, followed by Vermont, New Hampshire, Hawaii and Connecticut. The least healthy states are Louisiana, Mississippi, South Carolina, Tennessee and Arkansas.

One of the significant changes noted for Hawaii in "America's Health Rankings: A Call to Action for People & Their Communities" was a 38 percent decrease in smoking since 1990, when the rankings began.

Dr. Chiyome Fukino, Hawaii's health director, believes the state's new smoke-free law banning smoking in workplaces and most public places will help improve Hawaii's ranking next year.

Other state changes were:

Fukino said, however, that the question posed for the survey did not address serious and persistent mental illness. "It applied to a broad range of more minor reasons for not going to work related to behavioral health issues," she said, such as stress or depression over a situation.

Hawaii's strengths, the report says, are: high per capita public health spending at $499 per person, a low obesity rate at 19.7 percent of the population, and a low 10 percent of children under age 18 living in poverty.

HEALTH FACTORS Here are some of the factors leading to Hawaii's ranking as a healthy state: STRENGTHS » High per capita public health spending » Relatively low prevalence of obesity » Low rate of uninsured population » Low rate of cancer deaths CHANGES » Incidence of infectious disease decreased by 9 percent in the past year. » Percentage of children in poverty declined by 52 percent since 1990. » Smoking decreased by 38 percent since 1990. Source: United Health Foundation

The drop in children living in poverty is significant, Fukino said, attributing it to an improved economy.

Many homeless people are working but can't afford high rents or prices of homes being sold to capitalize on a booming market, she said.

"That's going to be a challenge for us going forward. I don't know what the answer will be. I know we need to do something. We can't keep up with spiraling valuations on homes."

With Hawaii's aging population and growing number of residents living on fixed incomes, she said, "If the acceleration doesn't slow down or stop, we will have very severe problems, not just for older folks, but for young folks."

Other Hawaii strengths, according to the national report, are a low death rate from cardiovascular disease at 230.9 deaths per 100,000 population and a low cancer death rate at 159.8 deaths per 100,000 population.

Limited access to adequate prenatal care and a low high school graduation rate are among "challenges" cited.

The report says only 66.1 percent of pregnant women receive adequate prenatal care and 71.3 percent of ninth-graders graduate from high school in four years.

Fukino said access to health care is a major concern for the state Health Department, particularly with doctors, nurses and other health care workers leaving their profession or the state because of malpractice, reimbursement and housing issues.

Access to adequate prenatal care may be hampered by high malpractice premiums driving doctors from obstetrics work, she said.