endowment, 2010 Health care For overall health care, South Carolina is ranked 33rd out of the 50 states, according to the Commonwealth Fund, a private health foundation working to improve the health care system. The state's teen birth rate was 53 births per 1,000 teens, compared to the national average of 41.9 births, according to the Kaiser Family Foundation. The state's infant mortality rate was 9.4 deaths per 1,000 births compared to the national average of 6.9 deaths. There were 2.6 physicians per 1,000 people compared to the national average of 3.2 physicians. There was $5,114 spent on health expenses per capita in the state, compared to the national average of $5,283. There were 26 percent of children and 13 percent of elderly living in poverty in the state, compared to 23 percent and 13 percent, respectively, doing so in the U.S. And, 34 percent of children were overweight or obese, compared to the national average of 32 percent. Government and politics South Carolina's state government consists of the Executive, Legislative, and Judicial branches. Also relevant are the state constitution, law enforcement agencies, federal representation, state finances, and state taxes. South Carolina has historically had a weak executive branch and a strong legislature. Before 1865, governors in South Carolina were appointed by the General Assembly, and held the title "President of State". The 1865 Constitution changed this process, requiring a popular election. Local governments were also weak. But, the 1867 Constitution, passed during the Reconstruction era, extended democratization by establishing home rule for counties, which were established from the formerly designated districts of the state. The 1895 state constitution overturned this, reducing the role of counties and strengthening the relative role of the state legislature; essentially the counties were agents of the state and ruled by the General Assembly through the legislative delegation for each county. They are geographically comprehensive; all areas of the state are included in counties. As each county had one state senator, that position was particularly powerful. This status continued until 1973, when the state constitution was amended to provide for home rule for the counties. During this time the state had changed, with increasing urbanization, but rural counties retained proportionally more power as the legislature was based in representatives elected from counties rather than population districts. The federal court case, Reynolds v. Sims (1964), "established the one-man, one-vote concept for electoral representation at the state