What Happened to Health in Kansas?

Kansas has experienced one of the steepest long-term declines in health ranking in the nation. In 1991, Kansas was ranked eighth in America’s Health Rankings. By 2024, the state had fallen to 28th. This decline is evident in widening mortality gaps — between 1999 and 2023, Kansas’ age-adjusted all-cause mortality rate rose by 90 deaths per 100,000 compared to the U.S. average.

To understand both the drivers of decline and what could change the trajectory of Kansas’ health ranking, the Kansas Health Institute (KHI) conducted a statewide, three-round survey of more than 100 health leaders and experts from August 2024 to March 2025. The results of this Delphi study are recorded in the following two reports.

What Happened to Health in Kansas?

Priorities for Reversing a Long-Term Decline in Health Ranking

Study participants identified 52 concerns. The top four were:

• Closure of rural hospitals and health care services
• Lack of Medicaid expansion
• Limited availability of mental health services
• Low public health funding

Other high priority issues included chronic disease, obesity, income and wealth inequality, rural workforce shortages, housing access, lack of a culture of health, and system fragmentation.

Participants emphasized structural and system-level drivers of Kansas’ health ranking decline, rather than individual behaviors. The findings underscore that policy decisions, underinvestment and infrastructure gaps are key contributors to the state’s health outcomes.

What Happened to Health in Kansas?

Themes Contextualizing Why Health in Kansas Has Not Kept Pace With the United States

Researchers analyzed the survey results using the Flow of Health framework — which examines upstream, midstream and downstream determinants of health — to identify how structural, cultural and system-level forces shape health outcomes in Kansas. They found:

• Upstream: Participants reported that Kansas lacks a coherent policy agenda to support health.
• Midstream: Economic strain, poverty and income inequality were described as key barriers to health.
• Downstream: Participants described the health care system as fragile, citing rural hospital closures, workforce shortages and mental health service gaps.

The analysis concludes that Kansas’ health ranking decline is the result of a complex adaptive system where policy, cultural values and structural inequities reinforce one another. Technical fixes alone will not suffice. Reversing this trajectory will require bold, collective leadership, focused investment and policy reform.