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Runners race last year in Valparaiso. The state of Indiana moved up two spots in America's Health Rankings in 2016 from 2015, in part due to a decrease in obesity.

Jonathan Miano, Times file photo

Indiana moved up two spots in an annual ranking of the healthiest states, though still came in 39th out of 50.

The Hoosier state had been ranked 41st overall for four consecutive years.

Indiana scored high marks in percentage of high school graduates, low incidence of salmonella, and disparity in health status by educational attainment. But the state did poorly in air pollution, number of dentists and infant mortality, according to the United Health Foundation's America's Health Rankings.

Overall, the nation made improvements in smoking, the number of uninsured residents and preventable hospitalizations, but fell backward in drug deaths, obesity and cardiovascular disease.

"The health of our country is at a crossroads," said Dr. Rhonda Randall, chief medical officer for UnitedHealthcare Medicare & Retirement. "Since 1990, smoking has decreased 41 percent, 17 of that in the last four years. In the most recent report we've seen the lowest point in American history for the uninsured rate, down 35 percent from last year."

But the uptick in obesity and drug deaths are countering those improvements in smoking rates and health coverage, she said. And, for the first time in many years, cardiovascular disease is on the rise. Due to factors like those, U.S. life expectancy dropped last year for the first time since 1993.

Success, challenges in Indiana

Indiana mirrored some of those national trends, seeing a rise in both drug and cardiovascular deaths over last year (the state's obesity rate did decline slightly). The Hoosier state ranked 38th in cardiovascular deaths, 36th in obesity and 35th in drug deaths, with rates for each category above the national average.

In Indiana, many of the drug deaths have been due to the opioid epidemic that has been taking lives around the nation. It's a scourge Northwest Indiana has not been spared from. Drug deaths in Indiana as a whole have increased by 27 percent over the past five years.

While immunization of females aged 13 to 17 for HPV, a sexually transmitted disease that can cause cervical cancer, declined by nearly a third in the past year, more male adolescents have been getting the vaccine in Indiana, with an increase of 115 percent from 2015 to 2016.

Also in Indiana, preventable hospitalizations among Medicare enrollees decreased 25 percent over the past three years.

In addition, the state saw its smoking rate decrease from 22.9 percent last year to 20.6 percent in 2016, improving the state's ranking from 44th to 39th.

Work underway in the Region

In the Region and Indiana as a whole, groups have been sprouting up to tackle the state's health problems. The Alliance for a Healthier Indiana — which is made up of the state hospital and medical associations, chamber of commerce and Anthem Blue Cross Blue Shield — formed last month to try to improve the state's health status, first by reducing tobacco use. In Northwest Indiana, the Porter County Wellness Coalition and wellness coordinators with Purdue Extension Lake County have been aiming to address local health priorities.

"One of the challenges is just making people aware of just how large the problem is and how this kind of issue affects every aspect of the community," said Terri Saltzman, wellness coordinator for Purdue Extension Lake County. "It's not just the health of the citizens it affects. It's an economic issue. If you're not a healthy community, you're not going to attract new citizens, you're not going to attract new businesses, you're going to have a hard time retaining the talent you do have."

Wellness initiatives in Lake County include enhancing work-site wellness, increasing access to healthy food and creating indoor walking paths.

Annetta Jones, chairwoman for the Porter County Wellness Coalition, said projects are underway in that county to improve nutrition, curb smoking and decrease drug use. But she believes it will require a concerted, centralized effort to really make a difference.

"Communitywide I don't think we're quite all on board with giving the same messages," Jones said. "People are focused on specific mandates or specific programming. I think we're still trying to develop that message to really get it out in the community and make it a total, community awareness campaign."

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Giles is the health reporter for The Times, covering the business of health care as well as consumer and public health. He previously wrote about health for the Lawrence (Kansas) Journal-World. He is a graduate of Northern Illinois University.