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Kansas has fallen from being ranked as one of the healthiest states in the nation 30 years ago, to one of the least, according to data included in a report from the Kansas Health Institute.

TOPEKA — Kansas’ health ranking had one of the steepest declines in the nation in the past 30 years, according to a study that sought to identify potential reasons and fixes for the state’s downward slide.

One hundred experts determined that Kansas’ lack of a coherent policy agenda, income disparities and fragile, underfunded health care systems have contributed to the state dropping from eighth in the country in 1991 to 28th in 2024.

“Kansas’ health ranking decline reflects deeply rooted structural and cultural dynamics, not simply individual behaviors or programmatic gaps. Turning the tide will require a fundamental shift in how health is prioritized and pursued,” said four authors who recently published reports through the Kansas Health Institute under the title, “What Happened to Health in Kansas?”

The institute surveyed health professionals, academics, advocates, community organizations and public health, state and local government officials and analyzed their responses after three rounds of questionnaires to identify a collective consensus.

That consensus contained insight into the reasons for Kansas’ ill health and why leadership is the most direct way to fix it.

“Kansas is one of only 10 states that have not expanded Medicaid, and not surprisingly, nine of those 10 states fall in the bottom half of the rankings,” one participant said in the report.

The report cited rural hospital closures, the lack of Medicaid expansion, limited mental health services and low public health funding as the highest priorities to resolve. Next, participants said chronic disease, obesity, wealth inequality, workforce shortages, housing access, absence of a culture of health, and piecemeal systems were also identified as key priorities to address the state’s health dip.

The decline also can be attributed, in part, to lower than average levels of physical activity, higher than average smoking and a higher than average teen birth rate, according to America’s Health Rankings, a platform under the United Health Foundation.

“While downstream conditions such as chronic disease, obesity and related risk factors were rated as important, participants placed greater emphasis on the upstream and midstream policy and infrastructure conditions that influence these outcomes,” the report said. “This suggests that stakeholders perceive many of Kansas’ downstream health challenges as symptoms of broader systemic issues, particularly insufficient access to care, underinvestment in public health capacity and fragmentation across sectors.”

Another survey participant characterized the cultural norms surrounding health care in Kansas: “There’s a whole ideology built around the idea that people’s circumstances are the direct result of their behavior, their choices and their fundamental goodness or badness.”

In the report, the authors — who are Kevin Kovach, Emma Uridge, Viktoria Sterkhova and Wen-Chieh Lin — acknowledge that Kansas’ health ranking was declining before Medicaid expansion was an option. They concluded that Kansas’ health systems need strong leadership.

“But this is not leadership as authority or position,” they wrote. “It is leadership as practice focused on engaging others to co-create change through action, learning and shared meaning making.”

The Kansas Health Foundation is positioning itself to embody that kind of leadership.

Despite the state’s declining well-being, the health rankings platform featured the Kansas Health Foundation as a prime example for approaching health holistically while using data to focus on the root causes of health problems, such as social and economic factors.

“Data holds you accountable. The point of measuring something is to create pressure to do something,” said Ed O’Malley, president and CEO of the foundation, in a Sep. 29 news release.

The foundation is a Wichita-based nonprofit that funds the Topeka-based Kansas Health Institute, along with other health-focused organizations.