“Your zip code is a bigger determinant of how you do in health than many other things,” says Manisha Juthani, MD, Connecticut Department of Public Health commissioner. 

New England states consistently rank among the healthiest in the United States. In the most recent U.S. News & World Report ranking, Massachusetts held the #1 spot, Connecticut #6, Rhode Island #7, and Vermont #10. Maine and New Hampshire have ranked high for health care among other lists as well over the years. The ranking factors in rates of mortality, infant mortality, obesity, smoking, suicide, and poor mental health in adults.  

New England’s strong outcomes reflect decades of effective policy decisions and investments in public health. By examining New England’s approach, health care leaders can identify key factors contributing to better health and explore how other states might replicate the region’s success. 

Investment in preventive and public health

“Making public health investments, which often are cheaper and more upstream, can help prevent so much of the very expensive health care later on,” Dr. Juthani says. This includes providing education about and access to screenings and innovative health care interventions that reach families across the state. 

CradleME is a free service that helps connect home-based or virtual resources for expecting families or those with newborns in Maine. The organization partners with many programs across the state to offer services like visits from registered nurses, education on health-related topics, and more programs to help support parents and their babies.

“[Rhode Island has] safety net clinics that are extraordinary. Our network of community health centers makes a big difference in the lives of vulnerable people,” says Amy Nunn, CEO of the Rhode Island Public Health Institute and professor of public health and medicine at Brown University. “I’ve lived in other places that don’t have that, and I think that really matters.” These centers offer wraparound services, including help getting patients to get insurance, primary care, and mental health services. 

Massachusetts provides crisis care services across the state through its community behavioral health centers. The offering aims to provide quicker assistance for those experiencing mental health challenges and are open 24/7 for walk-ins.

New England also boasts some of the highest vaccination rates in the country, which insulates the population from diseases ranging from polio to HPV-related cancers. All six New England states make the top 10 most vaccinated list, and Rhode Island, Massachusetts, and Maine occupy the top three spots.

Health insurance coverage across New England

New England leads the nation in health insurance coverage statistics. Massachusetts, in particular, has an uninsured rate of less than three percent compared to the national average of eight percent. Experts agree these high coverage rates are the result of all New England states opting to expand Medicaid coverage under the Affordable Care Act. Massachusetts’ lead, even among New England states, can be attributed to the state’s early adoption of RomneyCare, which aimed to provide affordable, quality care for all Commonwealth residents and was used as a model for the Affordable Care Act. 

“What is most closely associated with long life expectancy? It’s three things,” says John McDonough, professor of the practice of public health at Harvard T.H. Chan School of Public Health and former Massachusetts state representative. “Number one: household income. Number two: education. And number three: it’s the percent of people who are covered under health insurance.” 

For those with insurance, many health plans have additional offerings members can access to stay on track with their health and well-being. Some plans have personalized support options that help to manage your health needs and improve your overall health and well-being. For instance, Harvard Pilgrim Health Care has a care team of registered nurses, licensed behavioral health specialists, peer support specialists, and community health workers that are available to support members with anything from the day-to-day of managing a chronic condition to finding an in-network therapist. 

And no matter your zip code, one of the best ways to stay on top of health is to prioritize preventive health care. Through annual check-ups and routine screenings, chronic conditions or diseases can be prevented or caught earlier when they are typically easier and less expensive to treat.

Policies that support healthy choices

If you want to improve health, make healthy choices easier and unhealthy choices harder. 

For example, smoking is still the leading cause of preventable death in the United States, but New England states like Massachusetts have some of the lowest rates of smoking thanks to aggressive anti-tobacco policies.  

“It’s good to educate people about how unhealthy it is to smoke and it has an impact,” McDonough says. “But if you want to do something that’s going to have a rapid and dramatic impact, there’s nothing better you can do than tax [tobacco products]. Nothing close.”

In the 1980s, McDonough helped Massachusetts ban smoking in public areas and implement a tax on cigarettes. “We used the money to greatly expand health insurance for younger, poorer, or uninsured kids and to help senior citizens buy prescription drugs,” McDonough says. “We saw the smoking rate drop a lot, and we still made about 100 million bucks a year that we used for those two purposes. …There’s got to be a sense among the public that these kinds of interventions just make sense.” 

Rewarding people for healthy behaviors can also make an impact. Since 2022, Rhode Islanders with EBT cards who shop at Stop and Shops and Walmart Super Centers get 50 cents back on the dollar for fresh produce they buy. “We’ve seen an uptick in the nutrition security data,” Nunn says. Preliminary findings show the program has been impactful, with nearly 90 percent of eligible Rhode Islanders having used it. 

“A lot of this comes down to leadership,” McDonough says. “Political leaders, but other leaders — clergy, business leaders, university leaders — who are willing to stand up and speak the truth, even when it will make some people mad.” While there is no one thing that makes New England states healthy, as he explains, “Leadership is an indispensable ingredient.”

Harvard Pilgrim Health Care, a Point32Health company, provides health plans, programs, and services to nearly 1 million members in Massachusetts, New Hampshire, Maine, and Rhode Island. A leading not-for-profit health services company, Harvard Pilgrim Health Care guides members — and the communities it serves — to better health. Founded by doctors more than 50 years ago, it builds on that legacy and partnerships with an expansive network of doctors and hospitals to improve health outcomes and lower costs through clinical quality and innovative care management.