1201: What the Latest Data Reveal About Healthy Aging in America

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, September 9, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

 

America's aging population is creating new priorities for public health, and the latest data show both progress and persistent challenges for older adults. The 14th edition of the America's Health Rankings Senior Report finds encouraging gains in the workforce caring for older adults, preventive screenings, and premature mortality, while also highlighting troubling increases in drug deaths, excessive drinking, and suicide among seniors. Today, Rhonda Randall, executive vice president and chief medical officer for United Healthcare employer and individual, and a United Health Foundation board member, discusses what the findings mean for state and territorial health officials and why national averages don't tell the whole story.

 

RHONDA RANDALL: 

America's Health Rankings, which is published by the United Health Foundation, is our nation's longest-running population health report of its kind. It's been published now for more than 35 years, and this platform draws from more than 50 different publicly available data sources. It includes over 250 different measures of our health, and we can slice these at a state level and a subpopulation level, and that really helps users of the report explore trends at a local level, at a state level, at and at a national level by population. So, I always like to start when somebody asks me about the report with grounding of what it is and what it isn't. So, this is America's health rankings. So, the “what”, it is really in the title. This is America's data. It comes from public sources of information, so it's not United Healthcare's data. It's public information across our nation, and it's meant to give public policy leaders, health leaders, physicians, and communities and individuals a set of facts to understand where we're making progress about our health and where challenges are emerging or are remaining.

 

That data also gives us a really broad understanding. We use the World Health Organization's definition of health, which is more than just the absence of disease. We take into account for this report a couple subsets of data: the clinical care that we receive when you go to the doctor or the hospital. I think that's probably the most obvious one, but also our behaviors around health, our individual choices, the micro and macro social and economic considerations, and environmental factors, and most importantly, the thing that's weighted the most here is our outcomes related to health. So today we're talking specifically about the senior report. This focuses on adults generally age 65 and older. This is a 14th edition of the senior report. More than 14 years ago, we asked ourselves the question, and I'm a geriatrician. We asked ourselves the question: As America's health rankings and the United Health Foundation, can a community be healthy if it's seniors or not? And we needed to look at the data and track that over time. And now we have 14 years of longitudinal data to compare how our states are doing across different populations and communities. And that focus is really important because of the aging demographic. 15 years ago, when we thought about this report, and we were looking at the age wave that was just beginning. Now we're getting closer to the point where, at 2030, every baby boomer is going to be 65 years or older. One in five U.S. residents is going to be of retirement age by 2030. So, for state health officials, for people who work in public health, for primary care physicians, this really means something significant for our healthcare priorities in our communities and what we're thinking about how we plan for that.

 

SHEEHAN: 

And so, Rhonda, what are the big takeaways for state and territorial health officials?

 

RANDALL: 

You know, each year when we look at this report, not only do we look at changes from year to year, but I think more importantly, we look at those longitudinal changes over time, and each year we find bright spots and encouraging news in the report, and some things that concern us. So, among the encouraging findings in this year's report, we see the workforce caring for older adults continue to grow. There's a couple in particular that we monitor: the number of home healthcare workers. That's an important measure, and the second is the number of geriatric clinicians, which includes both geriatricians and geriatric nurse practitioners. We also saw improvements in the choices people are making around their preventative care, so more rates of breast and colorectal cancer screenings, for an for example, and then the strongest weight in this report is the premature death rate or the mortality rate. So, years lost before the age of 75, the early death rate among adults between ages 65 and 74 decreased slightly. So, we're seeing it start to return closer to what it was before the pandemic. So. Those are encouraging things. At the same time, the report is identifying a couple concerning trends, particularly in behaviors where it relates to drug use and drug deaths. In this most recent data period, we saw an increase in drug deaths amongst seniors, and excessive drinking and suicide also increased. So, some of those things really give us concern around behavioral health and substance use disorders and alcohol use disorders, for example, among the senior population. We also saw a mixed message around food access and food insecurity. While more adults got registered for the Supplemental Nutritional Assistance program. We also had in a survey more adults tell us that they're concerned about access to nutritious foods. So that grew. At the same time, the number of people who have access to healthy food and those supplemental programs grew. So just as important, that data is showing us that not every measure is reaching its goal equally. So, when we look at these things and break them down by income, gender, race, ethnicity, geography, metropolitan areas versus non-metropolitan areas, for example, we see differences in measures like physical inactivity. There's a significant difference there related to income, and the same is true with drug deaths, excessive drinking, and suicide. Those are all higher among men than they are among women. So, when you take this together, all these findings show we're making progress in some areas, but it's not reaching everyone in every community equally. That's why it's really important to have this data at a subpopulation level and not solely look at the national trend because that doesn't tell the full story.

 

SHEEHAN: 

Yep, let's take one of those one of those data sets: the growth of the workforce for caring for older adults. Why is that workforce so important?

 

RANDALL: 

Yeah, this is an area where we have not had, and we still don't have enough geriatric healthcare providers, but people who are specially trained to deal with an aging population and the complexity. You know, as we, I'm a geriatrician. As we become older, we become more different, right? So, I think you know when you think about young people, if you have children, grandchildren who are in still in school, like they really like to feel like they're unique and different from their peers. But from a physiologic standpoint, we become more different as we have more birthdays. So having somebody who is specially trained in that unique complexity, right where you have to sometimes make shared decision-making conversations about you have multiple chronic conditions, and if I treat one of them, it could make the other one worse. So, we need to really have a thoughtful conversation about all of your medications and all of your specialty referrals, and make some priorities around which fits with your goals of care, because some of those priorities or even treatments might be competing with one another, and really have those goal-focused conversations. So, having somebody who is trained in that, and then from a hands-on caregiving perspective, right? As we age, we're more likely to have need for assistance with our activities of daily living and our instrumental activities of daily living, and those are people like nurses' aides, home health aides, med techs, etc. that are the workforce that do a lot of this. And then we shouldn't forget about unpaid caregivers. That's an important part of this conversation. Our report found that greater than 14% of individuals age 15 and older are providing some type of unpaid support or assistance to a loved one who is older than 65 years old. So that figure has remained essentially unchanged in recent years, and it's probably underreported. And we know that family members and friends provide a substantial amount of support, and that is often underrecognized and it's not paid. So, we think about the future healthcare workforce. This is an area where we, as the United Health Foundation, have really been paying attention to the trends that are in America's Health Rankings report, not only for seniors but for adults and children, women and children as well. And we've funded a significant amount of scholarships since 2007. We've funded over 10,000 current and future healthcare professionals by the year 2033 to improve the access that we need and support, whether they're studying nursing, pharmacy, mental health, and other healthcare-related fields.

 

SHEEHAN: 

When you talk about healthy aging, what does that mean, and what else can we think about in in terms of support?

 

RANDALL: 

As we age, one of the single most important things is being able to maintain. Your independence, both physically and mentally, right? So that is so important to support muscle mass, bone density, cardiovascular health, balance, and mobility. So those supports that you can get from your primary care physician, and if you're noticing that you're starting to need some assistance with those activities of daily living, I think that's a really good time to talk to your primary care physician about maybe getting a referral for a comprehensive geriatric assessment from somebody who is specialty trained in that area. You don't necessarily even need to change physicians for that. You can go get a really thorough one-time assessment, and they'll give great feedback to your primary care physician. But that independence and quality of life as we age is as important, and something that this report also looks at is our social connectedness. So that social isolation, which is a measure that is put together by an index of the likelihood that people have meaningful relationships. We know has really strong ties to longevity, to morbidity and mortality. People who have less social isolation and more social connectedness have a tendency to not only live longer but live with less disease burden. So, for state health officials, that means looking across sectors and using this data, where older adults might need those additional supports, bringing together and marrying public health with primary care.

 

SHEEHAN: 

And so, with some of that in mind, along with improvements around cancer screenings and physical activity, what can states do to help build in prevention to their aging strategies?

 

RANDALL: 

Yeah, the subpopulation data can be incredibly helpful for a state health official, and they can find that easily on the America's Help ranking website, and that can really shine a light on where those gains are not being experienced equally, and where health disparities are persistent. So, a couple things that we look at there are the depth of those disparities, how significant a gap there is, the persistence of the healthcare disparities. Are they staying the same, getting better, or getting worse? And then the breadth of those healthcare disparities. Is it focused in a metropolitan area, a rural community, or is it a broader problem throughout the state or the nation as a whole? So that really that data can really support state health agencies when they're working with their aging network as well as primary care to connect older adults with those recommended screenings and preventative care. I think that this idea of primary care and public health thinking about each other and partnering more deliberately together is a terrific area that's probably fairly underutilized. I'm a primary care physician and I also work in a role that is very public health focused and I can see where the two groups of folks who have the same common goals often aren't aware that there are things that where each other exist, and there's opportunities for alignment and partnership, and working together towards those common goals. So, I think that broader lesson is important. That the most successful interventions that we see in this report have happened because of multi-sector influence. My single best example of that is if we look at not in a senior report, but in our overall America's Health Rankings for 35 years, the cigarette smoking rate in our nation is the single best improvement over that 35-year period of time, and some states really outpaced others in that. And if you look at what did those states do, it was always a combination of individuals made the choices that they didn't want to smoke anymore. Public health officials did something with policy that influenced that. The primary care community had conversations or offered treatments and supports related to that, so you can see in the states that made the greatest movement there that that was a multi factor thing happening simultaneously to get the good results that we can observe in the America's health ranking trends.

 

SHEEHAN: 

And speaking specifically of the experience of rural older adults, how should states tailor their strategies to face their challenges?

 

RANDALL: 

Yeah, I think if this report tells you a couple things, it's number one, where you live matters, and number two, your behaviors matter, and it's often influenced by. The people that you spend your time with, right? So, health officials can think about those statewide findings, but then very importantly, drill down to understand what's happening based on income, race, ethnicity, geography, gender, and rural communities are an excellent example of why a deeper look matters. And you know, some rural areas certainly have some challenges related to senior health, and we can talk about those. But the opposite is also true. There are areas where the rural areas are doing significantly better. Social isolation is a great example of that. There has a tendency to be lower social isolation in rural areas, because of the strong social ties that people have in that index or in that measure, but when we look nationally, the rural areas have a tendency to have higher rates of physical inactivity, higher rates of cigarette smoking, lower cancer screening rates than their counterparts who live in metropolitan areas, but at the same time, you see that positivity that we talk about with greater social connection, lower levels of depression, lower levels of excessive drinking, and there are also concerns around avoided care due to cost compared to their Metropolitan counterparts, so that county level map data can show really different levels of risk in communities that zip codes are contiguous, right, in next to each other, even when your state picture might look positive or negative, and that level of detail really helps you identify where to put precious limited resources that can make the most meaningful impact. So when you're thinking about doing interventions, this data can really help you do it in a targeted fashion that can have the greatest amount of impact for the investment. So that takeaway is every rural community is different. State averages are just the starting point, and dig deeper into that data, and partner with the local health departments, the local aging organizations, and geriatricians and primary care leaders as well.

 

SHEEHAN: 

And so, for state officials who are looking to act on these findings, to dig into them, how can they find the data, and where should they start?

 

RANDALL: 

I'd really encourage them to look at those measures that underpin their state's rankings and not just the ranking number. So, every measure in this report has its own rank, and then it has its own subpopulation data. And the website is interactive and can really help you in pointing a spotlight on where the data show meaningful improvement. It also can show you, you know, with other states that are similar to you, your neighboring state, or a state that might have a natural comparison where they have made significant gains and use this as a learning platform for communities and understand where those gaps remain. So, I think this data is a terrific way to understand that healthy aging requires multi-sector caregivers, older adults, and others to work together. And those most effective strategies combine using the data and the trends with that local knowledge that you can only get at a local level and the lived experience of the adults and the caregivers, so I'll close by saying I'm really grateful to be with you today, and I hope that this is a continued resource for state health officials, and that they come away from reading this report both encouraged and also motivated to act, and motivated to act in a targeted, collaborative way.

 

SHEEHAN: 

Rhonda Randall is executive vice president and chief medical officer for United Healthcare Employer and Individual and a United Health Foundation board member.

 

UHF is a founding member of ASTHO's Innovation Advisory Council, a multi-sector forum that brings state and territorial health leaders together with leaders across industries to advance public health innovation.

 

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.