Minnesota, which used to rank No. 1 or 2 on almost any social indicator you could name, has suffered a modest fall from grace in recent years.
The latest reminder comes in an annual health ranking of the states by the UnitedHealth Foundation. For the third consecutive year, Minnesota finished No. 6.
Not bad, but that's a demotion from the early 2000s, when Minnesota finished first four years in a row.
The foundation, endowed by the Minnesota-based health insurance giant, compiles a broad set of indicators, from obesity to prenatal care to cancer deaths. The top spots this year went to a cluster of New England states -- Vermont, New Hampshire, Connecticut and Massachusetts -- plus Hawaii.
Minnesota did well on some familiar and worthy measures: third-best for the number of uninsured, ninth for the supply of primary care physicians. The disappointments were startling: binge drinking (44th) and infectious disease rates (49th).
There were also hints that political gridlock is taking a toll on the state. Minnesota registered 24th in child immunization rates, for example, and 46th in public health spending. (The top state spent five times more, per capita, on public health infrastructure.) Those are troubling signs at a time of tremendous health policy ferment at the state level. (Massachusetts is closing in on universal coverage; Mississippi has ambitious plans for online health insurance shopping tools.)
"Many of the factors in this ranking relate to public health infrastructure,'' said Dr. Ed Ehlinger, Minnesota's health commissioner. "And given the budget pressures at the local, state and federal levels, I'm looking at a perfect storm.''
Of course, some of the indicators also reflect a good measure of personal choice. The report notes a breathtaking drop in U.S. smoking rates, from 30 percent of adults in 1990 to 17 percent last year.
Next up: Diet and exercise. More than 1 in 4 Americans is obese.
The full report can be found at: www.americashealthrankings.org.