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What ails Minnesota?

The Aug. 13, 1973, issue of Time magazine highlighted "The Good Life in Minnesota." The front cover featured a man with a big smile on his face catching a fish out on the lake.

And, minus the man in the background of the picture who is smoking a pipe, Minnesota Department of Health Commissioner Ed Ehlinger said Minnesota needs to get back to the healthy way of life rather than slipping in national ratings as it has the last several years.

Healthy living, healthy communities and healthcare that includes prevention and treatment are the three main avenues back to being the healthiest state, he said.

Minnesota is still healthy, he said, but there are numerous warning signs it is starting to slide as well. For years, Minnesota was ranked the first or second healthiest state in the nation. It's now ranked No. 6.

What's the cause?

There are four main factors: infectious disease (Minnesota is ranked No. 49 in the country; No. 1 being good), state public health expenditures (No. 46), binge drinking (No. 44) and disparities (No. 24).

Tobacco, poor diet-little physical activity and alcohol account for 60 to 70 percent of the decline in healthy living.

He said that binge drinking isn't just for college students and teenagers either. Fifteen percent of binge drinking comes from people over the age of 65. Adult smokers in Minnesota have gone from No. 8 in having the least smokers to No. 10. Obesity and no physical activity have also increased.

"We're actually seeing our health ranking going in the wrong direction," Ehlinger said.

Child welfare is getting worse as well.

"This one bothers me the most."

Minnesota has drastically slipped from No. 1 to No. 20 in the nation in infant mortality, he said. More and more children are dying and others are less and less healthy.

Ehlinger said there are several factors as to why the state is failing and what needs to be done to turn it around.

The state has increased in diversity and there are more disparities because of that. He said Minnesota needs to embrace an influx in diversity and address differences and inequalities.

Budget deficits also come into play, as does decreases in government investment in education and public health. Minnesota has slipped to the 46th state in the nation for funding public health, he said.

In 2006, the government spent $249 per person on public health. By 2011, that number has dropped to $49 per person.

Funding for the SHIP (Statewide Health Improvement Program) program has also dropped from $47 million to $15 million, a decrease of about 70 percent.

The SHIP program, he said, has had quite a bit of success since it was implemented several years ago. Many cities have taken advantage of the Safe Routes to School grant (including Detroit Lakes). There have been changes to school lunch programs because of the emphasis put on agriculture in schools. Many buildings have gone smoke-free, and there has been an increase in farmers markets throughout the state.

But beyond funding, it's a matter of public- and private decision-making.

Ehlinger said some people ask why doesn't everyone just make the changes for a healthier lifestyle, but in all fairness, sometimes they don't have those options.

For example, some people may not live where fresh produce is available. Or maybe some live in a dangerous neighborhood and can't get out for a bike ride. Or it's hard when their demographic is targeted in a multi-million dollar ad campaign to get them to smoke.

Ehlinger said he feels there should be a price increase on tobacco, alcohol and sugar beverages, like soda, to deter usage. Some beer is cheaper than bottled of water, he said, which is a problem and clearly sends a negative message.

There also needs to be access to primary care in the health field. Many times, he said, the expense of co-payments and deductibles are "roadblocks" that deter people from going to the doctor for preventative care.

Primary care, he said, is public health because everyone needs it. It is a social responsibility, he added, to make sure everyone gets his or her needs met and that no one is benefiting at someone else's expense.

Communities also need to work together -- with each other, individuals and the government -- to encourage healthy living, and to make it accessible to everyone.

Engaging citizens in improving health in their own communities, he said, both encourages the community as a whole, and encourages legislators because it shows the community is dedicated to healthier living.

Regardless of the fix, he said, it needs to be a collaborative effort.

Follow Pippi Mayfield on Twitter at @PippiMayfield.