The American Dream Prosperity Index


US Mental Health Weakened; Physical Health & Healthcare Access Strengthened


Milken Center for Advancing the American Dream & the Legatum Institute


Mental health levels have weakened in all states but there are some improvements in other areas of health.

People who enjoy good physical and mental health report high levels of wellbeing, while poor health provides a major obstacle to people fulfilling their potential. Stronger mental health among Americans therefore contributes to greater U.S. prosperity. Within the American Dream Prosperity Index (ADPI), the Mental Health element captures the level and burden of mental illness on Americans, using self-reported and objective measures, including drug overdose deaths, suicides, serious mental illness and self-reported mental health to assess this.

The 2022 Index reveals that, over the past six years, all U.S. states and the District of Columbia have weakened in the Mental Health element. Has this general demise been experienced equally across America and what has led to the deterioration? Since 2016, the largest state deteriorations occurred in Kansas, Nevada and Colorado. At the county level, all but 13 of the 1,481 counties in the Index have seen a deterioration in mental health in the past six years, with Colorado’s Denver County and New Mexico’s San Juan County seeing the biggest decline. Of the ten counties that have seen the biggest decline in mental health, seven are in Colorado.

Prior to the COVID-19 pandemic, 70,000 Americans were already dying each year because of a drug overdose, and this has been further exacerbated by the pandemic. In 2021, for example, deaths from drug overdose increased by nearly 50% to 107,000, although there is significant geographic variation in the prevalence of drug overdose deaths across the United States. For instance, in West Virginia, the drug overdose death rate is 81 per 100,000 population, which is eight times higher than in South Dakota, where the rate is 10 overdose deaths per 100,000 people. At the county level, disparities are even more pronounced. Kentucky’s Harrison County has a drug overdose rate of 135 deaths per 100,000 people, which is nearly 20 times the drug overdose rate of Texas’ Cameron County.

An additional 46,000 Americans died of suicide in 2021. As with drug overdose deaths, suicide rates vary across the US. In Oklahoma’s Kay County, for example, there are 50 deaths per 100,000 people, which is ten times greater than that in New York’s Kings County, where it is five suicides per 100,000 people.

When we examine the Mental Health element in Kansas, which has seen the greatest deterioration of all states since 2012, its suicide rate has increased by nearly a third, and the percentage of residents living with a serious mental health issue increased from 4.1% to 6.7%, which implies that an additional 80,000 Kansans are struggling with mental illness than a decade previously. As a result of these changes, Kansas has fallen from 16th in 2012 to 33rd in 2022 in the state rankings for Mental Health.

Although mental health has weakened across the country, improvements in certain aspects of physical health and healthcare coverage provide some hopeful encouragement. National rates of smoking have fallen by nearly a third, excessive alcohol use has decreased 17% and pain reliever misuse has decreased 21% since 2012. Furthermore, in the past decade, the percentage of Americans who regularly visited the doctor has increased from just over two-thirds to nearly three-fourths; immunizations for HPV and other illnesses have also increased. Nationally, 13% of adults in 2022 report that they do not have healthcare coverage, down from 19% in 2012. The percentage of adults that reported not having medical treatment due to cost has fallen from 16% in 2012 to 11% in 2022. As illustrated by the chart, these improvements have led to the other Health elements strengthening in recent years.

However, while these improvements are notable, it is worth mentioning that there are considerable differences in these rates across the United States. For example, in Florida, 16% of residents avoided medical care due to cost, whereas in Hawaii it was only 6%, representing a significant disparity in healthcare accessibility.

With 33 indicators overall, the American Dream Prosperity Index provides a comprehensive overall Health assessment across all states and counties and how this contributes to the prosperity of each place. It is a helpful tool to understand the performance of each place and the variation between these different places. We hope that you will find it useful in your research. 

The Legatum Institute Foundation logo

Search powered by Algolia. Website by Tuple.
Note: All content is available under The Creative Commons Attribution-NoDerivatives 4.0 International.

Privacy Policy

Stay Informed

© 2022 Copyright Legatum Institute Foundation and the Milken Center for Advancing the American Dream. All rights reserved.
The Legatum Institute Foundation is a registered charity No. 1140719. Company limited by guarantee and incorporated in England and Wales No. 7430903.