The Health Policy Institute of Ohio’s new Health Value Dashboard shows that Ohio ranks 46th on a measure of health spending and outcomes — that we spend more for worse health than nearly every other state in the union. And one major factor is smoking.

States with high smoking rates tend to do poorly in HPI’s “health value” ranking, the organization said, and more than one in five adult Ohioans smokes. That puts our state 43rd for adult smoking. On children’s exposure to secondhand smoke, we scrape the bottom of the barrel at 49th.

Unfortunately, smoking isn’t just a cause of the bad outcomes, it is one of the bad outcomes HPI calculates into its “health value” score for each state and the District of Columbia. So even if smoking had zero impact on health, states with less smoking would get better “health value” scores. However, when asked to take adult smoking and youth tobacco use out and rerun the numbers, HPI took out adult smoking (but not youth tobacco) and said the correlation between a state’s smoking rate and its health-value rank was still strong.

So the study does provide more reason to think Ohio should lower its smoking rate. Adult smoking is associated with at least some other undesirable outcomes, even if one of them, youth tobacco use, is also in part a measure of smoking. And there are 16 metrics that weigh equally in HPI’s measurement of population health, only two of which directly include smoking. Others include infant mortality and deaths from cardiovascular disease; smoking may contribute to both of them.

One way to help reduce Ohio’s smoking problem would be raising the cigarette tax. The price of a pack gives smokers an immediate incentive to quit, and according to HPI, other Midwestern states that raised their cigarette taxes from 2012 to 2015 saw reductions in smoking.

The state should also create incentives to get Medicaid recipients to quit cigarettes. As of 2015, 42 percent of the state’s working-age Medicaid beneficiaries were smoking.

Ohio should be ashamed of this. Climbing out of the bottom of the tobacco barrel should be a public-health priority.

First Published May 6, 2017, 4:00 a.m.