An analysis that looks at more than 100 statistics related to health outcomes and health-care spending ranks Ohio 46th among the states, the same ranking the state held in 2017.

The 2019 Heath Value Dashboard from the Health Policy Institute of Ohio compared Ohio to the 49 other states and the District of Columbia, and it fell in the bottom one-fourth on 30 percent of the ranked metrics and in the top quarter on 5 percent of the metrics, said Amy Rohling McGee, president of the institute.

Along with Ohio’s high rates of smoking and drug-overdose deaths, she said, disparities and misdirected resources are to blame for the low rankings.

“Too many Ohioans are left behind. We see very large disparities and inequities across a variety of measures,” Rohling McGee said. “Resources are out of balance. We’re spending a lot on costly downstream care to treat health-care problems; this is because of the fact that we missed many opportunities to invest upstream to prevent injury and illness an disability for thousands of Ohioans.”

The report, which follows similar dashboards released in 2014 and 2017, looks at statistics in seven areas: population health, which includes health behaviors; medical conditions and overall well-being; health-care spending; access to care; the health-care system; public health and prevention; social and economic issues; and the physical environment, which includes issues such as air quality, housing and access to physical activity.

Ohio ranked best, 18th among states, in the access-to-care category and in the bottom half in all other areas.

Rohling McGee said that shows that access to high quality health care is necessary, but not sufficient, to achieve overall improved population health and sustainable health-care spending The analysis cites a report from the University of Wisconsin Public Health Institute that showed only 20 percent of modifiable factors that influence health are related to clinical care, while 50 percent are related to the social, economic and physical environment and 30 percent to health behaviors.

The report highlights tobacco use, where Ohio’s 21.1 percent of adult smokers falls in the bottom fourth of states, and researchers say there is a significant correlation between health value and adult smoking rate. Further, 23 percent of children live in households where someone smokes, ranking Ohio 48th.

Amy Bush Stevens, vice president of prevention and public health policy at the institute, said some of Ohio’s greatest challenges — cardiovascular disease, cancer and asthma, are related to smoking.

The report also takes a look at e-cigarettes, noting that use among high school-aged Ohioans rose from 11.7 percent to 20.8 percent from 2017 to 2018. Researchers recommend restricting access to adult-only stores, banning flavors, applying the tobacco tax to the products and increasing enforcement of Tobacco 21 laws.

Disparities remain a strong concern, and the report reviewed 19 metrics, where data was available, as they relate to race, ethnicity, income, education level and disabilities, said Reem Aly, vice president of healthcare system and innovation policy at the institute. Factors such as high-school graduation, poverty, housing quality, exposure to violence and food access come into play, she said..

“We found overwhelmingly that those groups of Ohioans have experienced poor health outcomes as it relates to socioeconomic factors ... and physical environment,” she said. “Those will be the drivers of the outcomes that we see.”

For example, Aly said, black babies are three times more likely than white babies to die before their first birthdays. And Ohioans with less than a high school education are six times more likely to be unemployed than Ohioans with a high-school education and 6.6 times more likely to be uninsured than those with a college degree.

The report estimates that 320,000 Ohioans would report better overall health if the gap was closed between people without a high school education and people with a college degree.

Among metrics where the state saw the biggest gains were breastfeeding support in hospitals; Medicare patients discharged with primary diagnoses of diabetes with long-term complications; comprehensiveness of the public-health system; and, security and safety of water and food supplies and protection of workers and emergency responders from health hazards.

Drops were most significant in seven areas, including adult obesity; drug overdose deaths; the unmet need for primary care physicians and psychiatrists in underserved areas; average cost per Medicare beneficiary without chronic conditions; heart failure re-admissions for Medicare patients; and surveillance of health threats and hazards.