The Most (and Least) Healthy States: A Survey of All 50

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Waikiki Beach, Hawaii

1. Hawaii
> Pct. obese: 22.7% (2nd lowest)
> Cardiovascular deaths per 100,000 people: 206.6 (4th lowest)
> Primary care physicians per 100,000 people: 172.6 (10th highest)
> Uninsured rate: 4.7% (3rd lowest)

Residents of Hawaii are the healthiest of any state residents for the fifth year in a row. Hawaii excels in a number of health measures. Of particular note is the state’s health insurance system. The state enacted in 1974 the Hawaii Prepaid Health Care Act which required employers to provide health insurance to employees who work at least 20 hours per week. With the legislation, Hawaii became the nation’s first state to boast near-universal health care system. Currently fewer than 5% of residents do not have health insurance, nearly the best health insurance coverage of any state. Further, the rate of preventable hospitalizations per year in Hawaii, at 23.5 per 1,000 people, is the lowest of all states and less than half the national rate of 50 per 1,000 Americans.

Hawaiians are also more likely than residents in other states to report healthy behaviors. Just 14.1% of adults report a smoking habit, for example, the eighth lowest share of all states.

Cape Cod, Massachusetts (runner)

2. Massachusetts
> Pct. obese: 24.3% (5th lowest)
> Cardiovascular deaths per 100,000 people: 205.6 (3rd lowest)
> Primary care physicians per 100,000 people: 227.5 (2nd highest)
> Uninsured rate: 3.1% (the lowest)

While healthy habits are not necessarily learned in college, people who have attained higher education tend to earn higher incomes and make healthier choices. College-educated Americans also tend to live in higher socioeconomic environments, where greater resources are often available to support healthier behaviors. With the nation’s most educated population, these factors are likely at play in Massachusetts, the second healthiest state. Over 40% of adults have at least a bachelor’s degree in the state, considerably higher than the national rate of a little over 30%.

Those with a college degree report considerably lower smoking and obesity rates compared with adults who have less education. Like several of the nation’s healthiest states, Massachusetts’ smoking rate of 14.0% and obesity rate of 24.3% are among the lowest of all states.

Hartford, Connecticut dusk

3. Connecticut
> Pct. obese: 25.3% (9th lowest)
> Cardiovascular deaths per 100,000 people: 217.2 (10th lowest)
> Primary care physicians per 100,000 people: 197.8 (4th highest)
> Uninsured rate: 6.5% (7th lowest)

A high income makes a world of difference in the health of American families. A variety of complex factors explain the link between income and health. For example, higher income Americans tend to make healthier choices, and tend to live in wealthy communities with greater resources available to support healthier lifestyles. Connecticut’s median household income of $71,346 a year is among the highest of all states. Unlike most other top 10 states, however, this income is not especially well distributed in Connecticut. Based on the Gini coefficient, income is more poorly distributed in the state than in every other state except for New York. Connecticut residents also report relatively health behaviors. For example, the state’s smoking rate of 13.5% is fourth lowest of all states and well below the national smoking rate of 17.5%.

Canoe on rocky shore of calm lake with pine trees Minnesota

4. Minnesota
> Pct. obese: 26.1% (12th lowest)
> Cardiovascular deaths per 100,000 people: 188.2 (the lowest)
> Primary care physicians per 100,000 people: 159.3 (14th highest)
> Uninsured rate: 5.2% (4th lowest)

Minnesota’s poverty rate of just 10.2% is tied for fourth lowest in the country. Nearly 35% of the population has a bachelor’s degree, among the higher shares of U.S. states. The typical Minnesota household earns $63,488 a year, far more than the national median income of $55,775. Relative affluence, a lack of poverty, and higher educational attainment together have far-reaching consequences on the state’s health outcomes. Educated residents with a steady income are more likely to have the resources needed to afford healthy lifestyle choices and are more likely to make decisions in the interest of long-term health. Minnesota has among the lowest rates of adults reporting poor mental or physical distress. The state also has below average incidence of several negative health outcomes, including the lowest rate of premature death in the country. An estimated 5,369 years are lost to residents dying of preventable causes per 100,000 residents, the lowest of all states and much lower than the national rate of 7,054 lost years per 100,000 residents.

Vermont (snowboarder)

5. Vermont
> Pct. obese: 25.1% (8th lowest)
> Cardiovascular deaths per 100,000 people: 226.9 (15th lowest)
> Primary care physicians per 100,000 people: 173.0 (9th highest)
> Uninsured rate: 4.4% (2nd lowest)

Vermont has always been a leader in health insurance coverage and at one point was set to implement a universal payer system. The plan was abandoned in 2014, but the state still manages a health insurance exchange and expanded Medicaid under the ACA. Just 4.4% of state residents lack health insurance, second lowest share in the country after Massachusetts. An insured population is more likely to receive treatment when needed, is more likely to engage in preventative medicine, and also will not suffer from the stress of being at risk of financial catastrophe in case of an unexpected medical emergency. Vermont has one of the highest rates of immunization in a number of categories. The state also has one of the lowest rates of premature death of any state.