Eighth, and then not
In 1991 Kansas ranked eighth in America's Health Rankings. By 2022 the state had fallen to a low of 31st, and as of 2024 it sat at 28th. Those three figures are the Kansas Health Institute's, taken from the ranking series in its September 2025 report on the decline[1]. The publisher's own 2025 Annual Report puts Kansas 27th overall[2].
KHI also records that in 2019 America's Health Rankings reported Kansas as having experienced the steepest decline in rankings of any state since the rankings began[1]. That is a statement about position relative to other states over three decades, and it is the sentence that made the question worth a study rather than a headline.
What the ranking is made of, and what it cannot tell you
The Kansas state summary in the 2025 Annual Report lists three strengths and three challenges. The strengths are a low prevalence of non-medical drug use, low income inequality, and a measure of unpaid community work given as a share of the population aged 16 and over. The challenges are a high prevalence of obesity, a high prevalence of cigarette smoking, and a low number of mental health providers per 100,000 population[2].
The same page carries movements rather than levels. Cancer screening among adults aged 40 to 75 rose from 54.8 percent to 63.6 percent between 2022 and 2024, a rise of 16 percent. The share of adults reporting high health status fell from 53.4 percent to 47.2 percent between 2014 and 2024, a fall of 12 percent. Arthritis rose from 24.5 percent of adults to 27.1 percent between 2020 and 2024[2].
The report's rural spotlight puts the Kansas rural population at 28.2 percent in 2023, from the American Community Survey, and sets chronic conditions side by side by metropolitan status from the 2024 Behavioral Risk Factor Surveillance System[2]. Four of the differences below are marked in the report as significant at 95 percent confidence: three or more conditions, cardiovascular disease, diabetes and arthritis. The rest are not, and depression runs the other way.
A ranking cannot separate any of this from what other states did. KHI says so directly: changes in these rankings are difficult to interpret because a shift may come from a change within Kansas or from a change in another state on any of the indicators[1].
| Condition | Metropolitan | Rural |
|---|---|---|
| Three or more chronic conditions | 10.5% | 13.4% |
| Arthritis | 26.1% | 29.5% |
| Depression | 21.6% | 20.8% |
| Diabetes | 11.6% | 14.6% |
| Asthma | 11.3% | 11.6% |
| Cardiovascular diseases | 8.7% | 10.7% |
| Cancer | 8.4% | 8.6% |
| Chronic obstructive pulmonary disease | 6.3% | 8.0% |
| Chronic kidney disease | 3.4% | 4.1% |
The figure that does not depend on anybody else
KHI puts a second series beside the rank, and this one is a Kansas rate measured against a national rate rather than a place in a queue. In 1999 the age-adjusted all-cause mortality rate in Kansas was 27.5 deaths per 100,000 lower than the national rate. By 2023 it exceeded the national rate by 63.0 deaths per 100,000, which the report describes as a relative increase of approximately 90 deaths per 100,000[1].
The report calls the widening almost linear, at an average of 3.5 deaths per 100,000 a year, and reads that steadiness as evidence of a sustained and systemic decline rather than short-term fluctuation[1]. That inference is KHI's. The arithmetic underneath it is the part that does not move if another state has a good decade.
What 100 Kansas health leaders were asked, and how
The study behind the report is a three-round Delphi exercise, a structured method for building consensus on a problem where the drivers are disputed. A total of 100 people took part: 50 completed the first round, 67 the second and 60 the third, an average of 1.8 rounds each. They came from academia and research, advocacy, public health, health care, community organizations, foundations and government[1].
Round one asked open questions. Round two rated importance. Round three gave each participant 100 points to distribute across the issues, a constant-sum method chosen to force the tradeoffs a budget forces. From 52 distinct issues, four met every criterion for the top tier: the closure of rural hospitals and health care services, which drew a mean investment score of 11.1; the lack of Medicaid expansion, at 11.0; limited availability of mental health services, at 7.8; and low public health funding, at 5.9. Only those four drew points from more than half the participants[1].
Seven more were classed as high priorities: chronic disease, overweight and obesity, income and wealth inequality, rural health care workforce shortages, the lack of a culture that prioritizes health, limited access to affordable and safe housing, and fragmentation across health care and public programs[1]. KHI notes that the participants prioritized structural and system-level drivers over individual behaviors, and that all four of the highest priorities sit upstream or downstream of the health system rather than in the middle of it.
Those are the priorities of the people KHI surveyed, reported by KHI, and the recommendations the report closes with are KHI's own. This publication takes no position on any of them. The second item on that list is a policy question rather than a measurement, and this publication reports it as one, in the account of who currently falls between KanCare and the federal Marketplace.
What the study says about itself
The report sets out its own limits, and they matter for how far the finding can be carried. Participation from elected officials, business leaders and some community groups was limited. The panel lacked full racial, ethnic and geographic diversity: 76 percent identified as White and 92 percent as non-Hispanic, and 59 percent came from the northeast region of the state against 17 percent from south central[1].
KHI states plainly that the exercise reflects informed opinion rather than the representative views of the broader Kansas population, and that issues scoring lower may still matter greatly to groups not well represented among the participants[1]. A reader who wants the underlying rank rather than the analysis of it should go to the annual report itself, which publishes the measure list, the source of each measure and the methodology behind them[2]. Where the other three measurements in this section sit, and what else gets read here, is set out on this publication's front page.