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Jeffrey D. Allred, Deseret News
An inversion covers Salt Lake County on Wednesday, Dec. 28, 2016.

SALT LAKE CITY — Despite the current, asthma-inducing inversion invading its most populous county, Utah is the fourth healthiest state in the nation, according to a new report that cited improved air quality as one reason the state climbed four places to make the top five in 2017.

According to the United Health Foundation, only Massachusetts, Hawaii and Vermont fare better than Utah in an array of health markers that include rates of smoking, obesity, children in poverty, cancer deaths, preventable hospitalizations and diabetes.

Aaron Thorup, America's Health Rankings 2017, United Health Foundation
America's Health Rankings 2017, United Health Foundation

The 10 states with the worst outcomes were all in the South.

The report released Tuesday lauds Utah, along with Florida, for making the largest gains since 2016. Both states moved up four spots: Florida for declining percentages in children in poverty and “frequent mental distress,” Utah for improving in air quality and immunizations.

Utah also got points for a decline in smoking. Fewer than 9 percent of Utahns smoke, a 25 percent decline from 11.8 percent five years ago.

And the number of preventable hospitalizations declined 25 percent in the same period, from 37.2 to 27.9 discharges per 1,000 Medicare enrollees, the report said

The news was not all good, even in the healthiest states. Massachusetts, which knocked Hawaii out of the top slot, was among three Northeastern states with significantly higher drug deaths. Massachusetts’ rate increased 69 percent, which amounts to an additional 8.1 deaths per 100,000 people.

Aaron Thorup, America's Health Rankings 2017, United Health Foundation
America's Health Rankings 2017, United Health Foundation

In Utah, drug deaths increased 24 percent in the past five years, from 18.4 to 22.9 deaths for every 100,000 people.

Challenges ahead

Utah’s other “challenges,” the report said, are an inadequate number of primary care doctors and high rates of pertussis, the clinical name for whooping cough.

Utah, as well as Idaho, has fewer than 100 primary care physicians for every 100,000 people. Massachusetts, Connecticut and Rhode Island have more than 200 primary care doctors to serve every 100,000 people.

And Utah has seen a 10 percent increase in its cardiovascular death rate since 2012, the report said, while the rate in Louisiana, which ranked 49th on the list, declined.

Marc Watterson, government relations director for the Utah chapter of the American Heart Association, said there is no one factor responsible for the rise in cardiovascular deaths in Utah, but he noted a possible connection to the need for more primary care doctors in the state.

“I bring that up because, at the American Heart Association, we encourage people to know their numbers — the risk factors for developing cardiovascular disease. What are your cholesterol levels, your blood pressure, your blood sugar, your BMI, are you overweight or obese?

"Those all contribute to your cardiovascular disease risk. Having a low number of primary care physicians in the state means people are less likely to know what their numbers are, and they're less likely to receive the necessary interventions," Watterson said.

Another possible reason is that Utah has a rapidly growing population of seniors, Watterson said, a factor that was also noted by Dr. Jeffrey Anderson, a Salt Lake City cardiologist and distinguished research physician at Intermountain Medical Center Heart Institute.

Scott G Winterton, Deseret News
A bicyclist rides along North Temple in the fog and inversion on Monday, Dec. 11, 2017.

“We’re an aging population and you know, you’ve got to die of something. If it's not heart disease, it's cancer," Anderson said. “We have the lowest smoking rate in the country, which is wonderful and helps us a lot with cancer and heart disease. But we struggle with blood pressure, and not enough exercise, and gaining weight — all of those things are going up in Utah. I think we can do better."

According to the report, obesity increased 3.3 percent in Utah between 2016 and 2017, from a rate of 24.5 per 100,000 people to 25.3. The incidence of cardiovascular disease also increased about 3 percent, from a rate of 225 per 100,000 people to 231.8.

Anderson said that Massachusetts obtained the top rating in part because it has the lowest number of uninsured people, 2.7 percent.

“In Massachusetts, almost everyone has health insurance, and we've struggled with covering our population here,” Anderson said. “I suspect that’s one of the issues, as well, there’s not uniform access to health care.”

In 2016, 9.7 percent of Utahns did not have health insurance, compared to 11.5 percent in 2017, the report said.

Air apparent

The news that Utah fared so well in the rankings in part because of its improving air quality arrived on a day in which Salt Lake City was in the throes of an inversion expected to linger until the new year. The poor air quality prompted state officials to ask residents to curtail travel and to refrain from using wood-burning fireplaces or stoves.

Scott G Winterton, Deseret News
Inversion fills the Wasatch Front on Friday, Dec. 8, 2017.

In its ratings, the United Health Foundation considers the average annual mean concentration of PM2.5, the small particulates that emit from exhaust pipes and smoke stacks. The U.S. Environmental Protection Agency's 24-hour standard is 35 micrograms per cubic meter.

The average concentration of PM2.5 in Salt Lake County between 10 a.m. Tuesday and 10 a.m. Wednesday was 47.5, according to the Utah Department of Environmental Quality.

“When you use the average annual data, in a state like Utah, the bad winter air days get diluted out by the good air days,” said Dr. Scott Williams, a physician, former state health official and the new executive director of HEAL Utah. Williams said the foundation should be using a different metric — the number of days each year that the Environmental Protection Agency defines Utah's air as unhealthy.

"That's what measures what we're experiencing right now and what results in serious respiratory and cardiac problems that send people to emergency rooms," Williams said.

Jeffrey D. Allred, Deseret News
The downtown skyline is covered by an inversion in Salt Lake City on Wednesday, Dec. 28, 2016.

Nonetheless, Williams said the state probably deserves its overall health ranking because of Utah's many other positive health markers.

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“We have lower cancer and heart disease rates than most other states because of our healthy lifestyles, so generally, we’re going to do well in these health rankings year after year," he said. "Tobacco and diet are lifestyle choices about what we put into our bodies, air quality is a choice about what we put out of our cars and homes."

Anderson noted that rankings in national surveys like this are constantly in flux, but he's happy that Utah has improved from last year’s No. 8 spot.

“It goes up and down, but I like to see us in top 5 or 6. Whatever the problem was last time, I’m glad we’re back where we need to be,” he said.