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CASPER — The suicide rate among older teenagers in Wyoming has increased by 40 percent over the past three years, according to a sweeping health report released last month that placed the Equality State in the lower half of states for women and children’s health.

Among adolescents between the ages of 15 and 19, the suicide rate jumped from 22.2 deaths per 100,000 residents in 2016 to 31.1 this year. It’s the second-worst rate in America, behind Alaska. While teen suicide has been on the rise nationally, Wyoming’s rate is triple the national average.

“It’s horrifying anywhere you see it,” said Dr. Janice Huckaby, “and certainly a 40 percent jump is significant.”

Huckaby is the chief medical officer for maternal and child health strategy for Optum, which is under the umbrella of UnitedHealth. The UnitedHealth Foundation released the report — “America’s Health Rankings” — that placed Wyoming as the 33rd best state in the nation for women and children’s health. The report has a wealth of data that has some positives but overall shows that the Equality State is lagging behind in key areas.

The teen suicide rate is the most alarming, and the report did not examine causes. The national rate has indeed ticked upward — a separate national study found that suicide was the second-leading cause of death in 2017 for those between the ages of 15 and 24. According to data from the state Department of Health, the suicide rate in Wyoming is highest among those between the ages of 35 and 44, with nearly 38 deaths per 100,000 people.

The report also found that maternal mortality in Wyoming — 34.8 deaths per 100,000 residents — is the 10th highest in the nation. Only 63 percent of women here have a dedicated health provider, and only 76 percent of women received a cervical cancer screening. Both percentages were among the lowest four in America.

Only 30 percent of women received a flu vaccine, one of the lowest rates in the nation. Fewer than 34 percent received an HPV vaccine, the worst rate of the 50 states. Men here fared little better, with a 28.4 percent rate coming in at third-worst.

Tobacco use among youth dropped to 6.6 percent of children between 12 and 17. Meanwhile, 5.4 percent of Wyoming’s adolescent residents have substance use issues.

Too few people have health insurance — just 68.7 percent have “adequate” insurance, one of the lowest rates in America. One in four Wyoming children had an adverse childhood experience, a spectrum of traumatic events that includes death of a parent, abuse or divorce of parents. The more of these experiences a child has, the more likely it is that there will be negative outcomes in that child’s future, including drug abuse, poor mental health, obesity and cancer.

Huckaby said many of Wyoming’s weaknesses revealed in the report go hand in hand. For instance, poor access to care can lead to struggles with mental health, which can lead to an increase in suicides. It can also lead to higher rates of smoking and lower rates of immunizations.

There are fixes to the ills outlined in the report, Huckaby said. The suicide rate, for instance, has a spectrum of solutions that ranges from interpersonal interactions — adults watching for warning signs from teenagers — to policy fixes, like health clinics with a mental health focus in schools. Huckaby said policymakers in Tennessee were discussing a program to offer tele-mental health services in schools, beyond the nurse available in most buildings.

“I really think if there were a way that it was in a place the adolescents are — usually that’s schools, or in a community center or something like that — they can access that” and it would improve mental health outcomes, she said.

Better access to care for women could help lower the maternal mortality rate, along with other negatives — like the high rate of women who smoke while pregnant.

“If you don’t have a doctor, you don’t have anybody saying to you, ‘Hey you’re 25, you just had a baby two years ago, let’s address your smoking now, so when you get pregnant it’s not an issue,’” Huckaby said.

The poor access to a health care provider was a common thread among the sharp issues raised by the report. That lack of access certainly isn’t new to Wyoming policymakers. Indeed, a hospital feasibility study released to lawmakers earlier this month showed that, in several Wyoming counties, there is fewer than one medical doctor for every 1,000 residents.

Those counties include Weston, Washakie, Uinta, Sweetwater, Sublette, Niobrara, Lincoln, Hot Springs, Crook, Converse, Carbon and Big Horn. Several counties have few or no specialists, like anesthesiologists, emergency physicians, OB-GYNs and surgical specialists.

What’s more, those numbers are getting worse in many parts of the state. In Weston, Lincoln, Big Horn and Hot Springs counties, for instance, the number of medical doctors per 1,000 people has declined in recent years. That rate has improved elsewhere — Teton County has 4.1 doctors per 1,000, nearly double the national average — but most counties continue to languish.

Huckaby said telemedicine may be a solution to the problem. It’s certainly one being explored across the state. Wyoming Medical Center, for instance, has launched a telestroke program recently to offer stroke care to more rural parts of the state.

There were positives in the report. Wyoming was in the top 10 for lowest rates of infant and neonatal mortality. There were low levels of physical inactivity, chlamydia and intimate partner violence in women. Wyoming cracked the top 10 rate of supportive neighborhoods and neighborhoods with amenities.

Still, even those positives seemed isolated. While infant and neonatal mortality were low, Wyoming’s child mortality rate was the 12th highest in the nation. The number of teen births has dropped — from a rate of 30.1 births per 1,000 teenage girls in 2016 to 24.6 this year — but Wyoming still has one of the highest rates in the nation. Progress in curbing tobacco use doesn’t include vaping and is thus hard to celebrate.

“When I was looking at the rankings for Wyoming, one thing that did concern me was the slide downward,” Huckaby said. “The ranking for women in 2016 was 30th. In 2019, it’s 32. The ranking for infants is down from 16th to 31st. I think there were some good things ... but there are some challenges.”