The Healthiest County in Each State

May 5, 2015 by Thomas C. Frohlich

ThinkstockPhotos-158403411With the ongoing U.S. economic recovery and implementation of the Affordable Care Act, health insurance coverage rates among Americans have increased significantly. Americans may expect health outcomes to improve as well. Despite the general positive trend in health care, there is still great variation in the health of residents among states and even within states.

24/7 Wall St. reviewed county-level health rankings from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. Rankings are based on overall health outcomes, a weighted composite of length of life, quality of life, and overall health factors. The health factors component is itself a weighted composite of healthy behaviors, clinical care, social and economic factors, and physical environment measures. These are the healthiest counties in each state.

Click here to see the healthiest county in each state.

The years of potential life lost per 100,000 people accounted for the length of life component of the model, while the percent of adults reporting poor or fair health and the numbers of physical and mentally unhealthy days accounted for the quality of life component. Together, the two components made up half the model.

The healthiest county in only three states reported an estimated number of years lost per 100,000 residents due to premature death of more than 6,622 annually — the national estimate. When asked to rate their own health as excellent, very good, good, fair, or poor, 16% of Americans replied fair or poor. The percentage replying fair or poor in the healthiest county in every state was lower than the national percentage.

Health factors made up the other half of the model. Socioeconomic measures were the most important components of the health factors portion of the model. Julie Willems Van Dijk, co-director of the County Health Rankings & Roadmaps program, explained how a good education — as one example — can increase the likelihood of positive health outcomes. Not only can a good education offer the knowledge necessary to lead a healthy lifestyle, but also it can pave the way to higher-paying jobs, which also tend to offer benefits such as health insurance. Residents with higher income also frequently live in safer neighborhoods that offer more expensive and healthier food options.

While income is perhaps the most important factor in the health of a community, it is not merely the size of the residents’ paychecks that matter. According to Willems Van Dijk, income inequality can have a direct impact on health outcomes. “People who are very separate from each other and don’t have the kind of social cohesion and interaction that you have in a community with a more flat income distribution” report higher rates of chronic diseases, higher levels of stress, and on the whole worse health outcomes.

Nationwide, incomes in the 80th percentile were 4.6 times greater than those among the bottom 20th percentile of earners. Incomes in the healthiest counties in all but seven of the 50 states were better distributed than the national inequality ratio. The opposite tended to be true in unhealthy areas.

While strong economic conditions can lead to positive health outcomes, the impacts can also work the other way around. According to another Robert Wood Johnson Foundation study in 2013, annual obesity-related health care costs nationwide have been as high as $210 billion in recent years. That figure excludes productivity losses from poor physical health. The healthiest counties in all but 13 states had an obesity rate lower than the national obesity rate of 27%.

Willems Van Dijk noted that while there is a strong relationship between health and wealth, many other factors play a role. “The county health rankings show you a combination of these factors and how they interact with each other.” In fact, the disparities between areas within a state demonstrate how dependent the health status of an area is on local factors. “What [happens] in the local culture and the environment of local communities will affect all of those other health factors and then subsequently affect how well and how long you live,” said Willems Van Dijk.

To identify the healthiest county in each state, 24/7 Wall St. reviewed health rankings in most counties and county equivalents in each state from County Health Rankings & Roadmaps. The rankings are based on a model developed by the University of Wisconsin and include about 70 different health measures from a range of sources, predominantly U.S. government surveys.

These are the healthiest counties in each state.

The Healthiest Counties

Shelby County, Ala.
> Pct. without health insurance:
11.3%
> Pct. food insecure: 10.5%
> Obesity rate: 31.5%
> 2013 unemployment rate: 4.4%

Shelby is the healthiest county in Alabama. Unintended pregnancies, which can be the result of risky sexual activity, can have long-term social and economic consequences. There were nearly 47 births per 1,000 15-19 year old female Alabama residents, the 10th highest state figure nationwide. Compared to the state’s rate, Shelby’s teen birth rate of 23.2 births per 1,000 female teens was roughly half. And while more than 27% of children lived in poverty in Alabama — the fifth highest rate of all states — about 11% of children in Shelby lived below the poverty level.

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Juneau Borough, Alaska
> Pct. without health insurance:
18.8%
> Pct. food insecure: 11.4%
> Obesity rate: 26.9%
> 2013 unemployment rate: 4.6%

Alaskans living in Juneau Borough were the healthiest of all the state’s counties. More than 20% of state residents reported physical inactivity. While this was one of the lower proportions in the country, Juneau residents were even less physically inactive, with less than 16% reporting physical inactivity. As in the healthiest counties in many other states, Juneau residents were also relatively wealthy, even compared to Alaskans overall, who had among the nation’s highest incomes.

Maricopa County, Ariz.
> Pct. without health insurance:
20.0%
> Pct. food insecure: 15.7%
> Obesity rate: 22.6%
> 2013 unemployment rate: 6.7%

Maricopa is the healthiest county in Arizona. Less than 20% of area adults reported being physically inactive compared with 23% nationally. Physical activity may also have helped keep the area’s obesity rate down. Just 22.6% of Maricopa adults were obese, while 27% of adults nationwide reported being obese.

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Benton County, Ark.
> Pct. without health insurance:
18.9%
> Pct. food insecure: 14.0%
> Obesity rate: 27.2%
> 2013 unemployment rate: 5.7%

Staying healthy in Benton County is far easier than it is in the rest of Arkansas. Nearly one in five state residents were food insecure, the second highest food insecurity rate. In Benton County, however, just 14% of residents reported such food deprivation. County children were also better off than children across the state. Just over 17% of Benton County children lived in poverty in 2013, not an especially low rate compared to the national rate, but far lower than the 28.3% child poverty rate across Arkansas — the fourth highest of all states.

Marin County, Calif.
> Pct. without health insurance:
12.3%
> Pct. food insecure: 11.5%
> Obesity rate: 15.8%
> 2013 unemployment rate: 5.0%

Less than 16% of Marin County residents were considered obese, one of the lowest rates in the country. It was far lower than the state’s obesity rate of 22.9%, which itself was nearly the lowest compared to other states. Strong health insurance coverage and a strong job market also contributed to better health among area residents. About 12.3% of Marin County residents did not have health insurance in 2013, lower than the national rate and far lower than the state’s rate of 20%, which was the 10th highest compared to other states. Marin County’s unemployment rate of just 5.0% was also lower than the state’s 8.9% unemployment rate.

Douglas County, Colo.
> Pct. without health insurance:
7.5%
> Pct. food insecure: 9.9%
> Obesity rate: 16.3%
> 2013 unemployment rate: 5.4%

Strong socioeconomic factors helped make Douglas County residents the healthiest in Colorado. Area households with incomes in the bottom 20th percentile earned $51,149 annually, twice what their statewide counterparts earned. With county residents in the 80th percentile earning only about 3.3 times that number, income in Douglas was also fairly well distributed. Douglas residents also had healthy habits. Just 8.3% of Douglas residents were smokers, about half the state’s rate of 16.9%, which was still relatively low compared to the rest of the nation.

Tolland County, Conn.
> Pct. without health insurance:
7.0%
> Pct. food insecure: 10.7%
> Obesity rate: 24.0%
> 2013 unemployment rate: 6.7%

Only 7% of children in Tolland County lived in poverty, a factor that contributed to its top ranking. By contrast, more than 14.5% of children lived in poverty statewide. A low smoking rate among area adults may also have contributed to the county’s first-place health ranking, and helped prolong Tolland residents’ lives. Only 13.8% of area adults in the area smoked, well below the 17.8% of adults who smoked nationally. An estimated 4,371 years of potential life were lost annually per 100,000 people in Tolland due to premature death, lower than the state estimate which itself was the fourth lowest figure compared to all states.

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New Castle County, Del.
> Pct. without health insurance:
9.8%
> Pct. food insecure: 12.0%
> Obesity rate: 25.9%
> 2013 unemployment rate: 6.7%

Access to exercise opportunities contributed to New Castle’s standing as Delaware’s healthiest county. Nearly 98% of county residents had access to places to exercise, much higher than the 88% of state residents who did. However, more than 22% of the area’s population was potentially exposed to poor water systems, well higher than the 13.6% of people who found themselves in similar situations statewide.

St. Johns County, Fla.
> Pct. without health insurance:
14.6%
> Pct. food insecure: 12.7%
> Obesity rate: 23.0%
> 2013 unemployment rate: 5.6%

Unintended pregnancies, which can be the result of risky sexual activity, can have long-term social and economic consequences. There were 36.1 births per 1,000 female 15-19 year old Florida residents, roughly inline with the nation. In St. Johns County, the teen birth rate was less than 20 per 1,000 female teens, reflecting the strong socioeconomic status of the area’s population. Less than 12% of children in St. Johns lived in poverty, far lower than the state’s 24.8% child poverty rate. About 22% of children live in poverty nationwide.

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Forsyth County, Ga.
> Pct. without health insurance:
14.4%
> Pct. food insecure: 8.4%
> Obesity rate: 24.9%
> 2013 unemployment rate: 6.0%

Just as poor socioeconomic conditions across Georgia contributed to poor health outcomes compared to other states, strong socioeconomic conditions in Forsyth County helped make the county the healthiest in the state. While 70% of Georgian ninth graders graduated high school, nearly the lowest percentage in the nation, Forsyth had a high school graduation rate of 88%, far higher than both the state and national figures. An educated populace often has greater financial security. Just 8.4% of people in Forsyth were food insecure, less than half the nearly 19% of people statewide reporting limited access to adequate food. The 15.7% of children in the county eligible for free lunch was also a fraction of the 51.2% of children who qualified across the state.

Honolulu County, Hawaii
> Pct. without health insurance:
7.0%
> Pct. food insecure: 12.9%
> Obesity rate: 22.1%
> 2013 unemployment rate: 4.3%

As Hawaii reports some of the best health measures compared to other states, Honolulu County may be both the healthiest county in the state and one of the healthiest in the country. Even accounting for the exceptionally high cost of living, state residents have high incomes and low poverty rates. And Honolulu residents are even better off financially. Just 12.2% of children lived below the poverty line, for example, less than the state’s rate and roughly half the national child poverty rate. The county’s smoking rate of 14.6% was also lower than the state rate, which itself was nearly the lowest state figure nationwide.

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Madison County, Idaho
> Pct. without health insurance:
14.1%
> Pct. food insecure: 20.9%
> Obesity rate: 25.9%
> 2013 unemployment rate: 4.6%

Madison County residents have some of the healthiest behaviors in the state and in the country. Just 3.1% of area adults reportedly smoked, far lower than the 16.5% of adults who smoked across the state. Additionally, only 3.2% of residents 18 and over reported drinking excessively compared to 14.5% across the nation. At 50.7 incidents per 100,000 people, reports of chlamydia were more than nine times less frequent in Madison County than across the country. The low incidence of sexually-transmitted diseases in the Madison area suggests relatively healthy lifestyles among the area’s population.

Woodford County, Ill.
> Pct. without health insurance:
8.5%
> Pct. food insecure: 8.8%
> Obesity rate: 30.0%
> 2013 unemployment rate: 7.6%

Likely due to the area’s relative affluence, only 8.8% of Woodford County residents did not have reliable access to nutritious and affordable foods compared with nearly 15% of Americans. Also, just 9.3% of children in the area lived in poverty, well below the 20.6% and 22% of children living in poverty in Illinois and across the nation, respectively. Strong socioeconomic factors such as these are frequently associated with a lower incidence of unintended pregnancies. The county’s rate of 18.1 births per 1,000 female teens was roughly half the comparable state rate.

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Hamilton County, Ind.
> Pct. without health insurance:
9.5%
> Pct. food insecure: 9.8%
> Obesity rate: 22.9%
> 2013 unemployment rate: 5.3%

While Indiana’s obesity rate of 31.3% was higher than the national obesity rate, less than 23% of Hamilton residents were obese. Nearly 27% of Indiana adults said they were not physically active in the past month, while in Hamilton only 18% reported physical inactivity, also lower than the national rate. Access to healthy food also helped promote good health in the area. While nearly 16% of households across the state were identified as food insecure, less than 10% of Hamilton County residents were.

Winneshiek County, Iowa
> Pct. without health insurance:
9.7%
> Pct. food insecure: 10.9%
> Obesity rate: 25.2%
> 2013 unemployment rate: 4.5%

Social inclusion can often help people feel less depressed and handle stress more effectively. Such was likely the case in Winneshiek County, where there were more than twice as many membership associations per 100,000 residents as across the country. Additionally, just 9.7% of residents did not have health insurance, in line with the state’s rate of 9.9% but lower than the national rate of 17%.

Johnson County, Kan.
> Pct. without health insurance:
9.6%
> Pct. food insecure: 11.7%
> Obesity rate: 23.0%
> 2013 unemployment rate: 4.7%

Strong life evaluations helped Johnson County rank as the healthiest county in Kansas. Only 8.2% of county residents said their quality of life was poor or fair, compared to 16% of Americans nationwide. Additionally, at 17.5 births per 1,000 teenage girls, the county’s teen birth rate was less than half both the national and state rates.

Boone County, Ky.
> Pct. without health insurance:
11.0%
> Pct. food insecure: 11.4%
> Obesity rate: 30.2%
> 2013 unemployment rate: 6.8%

A good education can lead to a healthier life in any number of ways: better employment, higher income, and better health literacy. Ninth graders in Boone County were far more likely to graduate than ninth graders across Kentucky. Also, nearly 71% of 24-44 year old county residents had completed at least some college versus about 58% of state residents in the age group. Healthy habits also likely contributed to healthier area residents. While nearly 26% of Kentucky residents smoked — higher than the national rate — less than 18% of Boone County adults reported a smoking habit.

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St. Tammany Parish, La.
> Pct. without health insurance:
17.1%
> Pct. food insecure: 9.7%
> Obesity rate: 28.8%
> 2013 unemployment rate: 5.1%

Louisiana scored very poorly in many health measures. St. Tammany Parish, while the healthiest in the state, still performed poorly when compared to national averages. Premature death, as measured by years lost annually, was much lower in St. Tammany Parish than in the state but higher than across the nation. Similarly, St. Tammany’s obesity rate of 28.8% was lower than the state’s obesity rate of 34.1%, which was second highest of all states. However, it was still higher than the national obesity rate of 27%. Also, compared to the 75.8% of Louisiana residents who lived close to locations for physical activity, as many as 83.8% of St. Tammany residents did. Still, this was lower than the 85% of Americans who had access to exercise opportunities.

Cumberland County, Maine
> Pct. without health insurance:
11.1%
> Pct. food insecure: 14.1%
> Obesity rate: 21.5%
> 2013 unemployment rate: 5.3%

Access to primary care physicians helped Cumberland earn the title of Maine’s healthiest county. While there was one physician per 935 residents across the state, in Cumberland County there was one physician per every 641 residents. Additionally, a strong economy likely also contributed to the health of working people. Just 5.3% of the county’s labor force was unemployed compared to 7% across the nation.

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Howard County, Md.
> Pct. without health insurance:
7.1%
> Pct. food insecure: 7.9%
> Obesity rate: 23.3%
> 2013 unemployment rate: 4.9%

Nearly all of Howard County residents had access to exercise opportunities compared with 85% of residents nationwide. Additionally, the concentration of primary care physicians per 100,000 residents was twice as high in Howard County than in the state as a whole. Higher incomes can also contribute to better health outcomes. Only 6.7% of children lived in poverty in Howard County, lower than the state’s child poverty rate of 13.9% and significantly lower than the national rate of 22%.

Middlesex County, Mass.
> Pct. without health insurance:
4.0%
> Pct. food insecure: 9.0%
> Obesity rate: 23.1%
> 2013 unemployment rate: 5.6%

Healthy habits in Middlesex County contributed to its rank as the healthiest county in Massachusetts. Just 11.4% of county residents reported a smoking habit, significantly lower than the state rate of 15.2%, which itself was nearly the lowest compared to other states. Food environments, as measured by access to healthy food and the level of food insecurity among residents, were also exceptionally strong in the county. Less than 12% of Massachusetts residents were food insecure, the fourth lowest rate of all states. Even fewer Middlesex residents were food insecure at 9.0%.

Ottawa County, Mich.
> Pct. without health insurance:
10.8%
> Pct. food insecure: 10.6%
> Obesity rate: 24.6%
> 2013 unemployment rate: 6.7%

While an estimated 7,218 years were lost per 100,000 people due to premature death annually in Michigan — higher than the national estimate — about 4,637 years were lost in Ottawa County. A longer life is among the possible benefits of a healthy lifestyle. While Ottawa residents were not especially wealthy, income was relatively well distributed in the county — much like in the healthiest counties in most states. Incomes in the 80th percentile were 3.7 times greater than incomes in the 20th percentile, versus the state and national income ratios of 4.7 and 4.6.

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Carver County, Minn.
> Pct. without health insurance:
5.8%
> Pct. food insecure: 7.1%
> Obesity rate: 26.2%
> 2013 unemployment rate: 4.7%

Socioeconomic factors in Carver County were some of the strongest of all counties in Minnesota. Nearly 82% of 25-44 year olds in Carver had completed at least some college versus the comparable state attainment rate of 73.3%, which was the second highest of all states. County residents also tended to earn more than their already relatively wealthy state peers, and income was better distributed than it was across both the state and the nation. Economic stability likely helped support healthier lifestyles and lengthen the lives of area residents. Minnesota residents lost an estimated 5,038 years per 100,000 state residents annually due to premature death, the lowest figure compared to all states. In Carver, fewer than 3,500 years were lost per 100,000 area residents annually on average.

DeSoto County, Miss.
> Pct. without health insurance:
16.1%
> Pct. food insecure: 14.3%
> Obesity rate: 35.2%
> 2013 unemployment rate: 6.3%

Mississippi residents routinely fare poorly on health assessments, so while DeSoto County is the healthiest in the state, it is not especially healthy compared to the nation. When asked to rate their own health as excellent, very good, good, fair, or poor, 21.5% of Mississippi residents responded fair or poor, the worst share compared to all states. In DeSoto County, 15.4% of residents rated their health as such, only slightly lower than the national share of 16.0%. DeSoto’s obesity rate of 35.2% was roughly in line with Mississippi’s nation-leading rate of 35.3%. A low child poverty rate helped improve the county’s ranking. While 34% of children across the state lived in poverty — the highest rate of all states — just 16.4% of DeSoto children lived below the poverty line, also lower than the national child poverty rate of 22%.

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Platte County, Mo.
> Pct. without health insurance:
10.7%
> Pct. food insecure: 13.0%
> Obesity rate: 30.0%
> 2013 unemployment rate: 5.9%

While Missouri and other states in the region suffer from poor socioeconomic conditions and a range of poor health outcomes, Platte County residents benefit from relatively strong economic factors and are relatively healthy. More than 77% of 25-44 year old county residents had completed at least some college versus less than 64% of state residents in that age cohort. Strong educational attainment helped raise incomes and health outcomes. For example, while more than 17% of Missouri households were food insecure, one of the higher rates, 13% of Platte households had limited access to food.

Gallatin County, Mont.
> Pct. without health insurance:
18.2%
> Pct. food insecure: 13.7%
> Obesity rate: 16.9%
> 2013 unemployment rate: 4.4%

Gallatin County residents, like Montana residents as a whole, reported unhealthy drinking habits. Nearly 45% of driving deaths in the county were alcohol-related versus nearly 47% for Montana — the highest rate of all states. However, Gallatin reported other relatively healthy habits. Less than 17% of area adults were obese and 13.4% were smokers, each far lower than both the state and national rates.

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Boone County, Neb.
> Pct. without health insurance:
12.2%
> Pct. food insecure: 10.2%
> Obesity rate: 28.4%
> 2013 unemployment rate: 2.8%

Boone County, the healthiest in Nebraska, boasted strong socioeconomic factors. Only 2.8% of the area’s workforce was unemployed compared to 7% nationally. Additionally, less than 16% of households in Boone County were single-parent households, far less than the 33% of households nationwide.

Douglas County, Nev.
> Pct. without health insurance:
20.2%
> Pct. food insecure: 13.6%
> Obesity rate: 21.9%
> 2013 unemployment rate: 10.5%

Douglas County’s unemployment rate of 10.5% actually exceeded the already quite high state jobless rate of 9.8%, which was the highest of all states in 2013. Still, other socioeconomic measures were strong in the county, and its residents’ health was rated better than in any other Nevada county. While 64% of ninth graders across Nevada graduated high school in four years, for example, 80% of Douglas ninth graders graduated, in line with the national graduation rate. Health evaluations were also better. More than 17% of Nevada residents rated their own health as fair or poor — one of the higher shares — while less than 15% of Douglas residents did so, also lower than the comparable national proportion.

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Rockingham County, N.H.
> Pct. without health insurance:
10.3%
> Pct. food insecure: 8.8%
> Obesity rate: 25.7%
> 2013 unemployment rate: 5.7%

Rockingham County had the highest health ranking in New Hampshire largely on strong socioeconomic factors. Just over 11% of Rockingham children were eligible for free lunch, far lower than the 21.3% of children across the state who qualified, which itself was nearly the lowest percentage of all states. Rockingham’s child mortality rate was also lower than the New Hampshire rate, which was the lowest state figure nationwide. The county had one of the best high school graduation rates with 90% of ninth graders graduating in four years, higher than the state rate, and 10 percentage points higher than the national rate.

Hunterdon County, N.J.
> Pct. without health insurance:
7.5%
> Pct. food insecure: 7.1%
> Obesity rate: 20.6%
> 2013 unemployment rate: 5.9%

When asked to rate their own health as excellent, very good, good, fair, or poor, less than 8% of Hunterdon County residents rated their health as fair or poor, far less than the state share of people rating their health as such and roughly half the national figure. Healthy habits and outcomes among area residents also helped make the county the healthiest in the state. Less than 13% of area adults were smokers, and less than 21% were obese, each far less than the respective state and national rates. Financial well-being largely explains the strong health ranking. Just 4.2% of area children lived in poverty, for example, a fraction of the 16.5% and 22% state and national rates.

Los Alamos County, N.M.
> Pct. without health insurance:
4.8%
> Pct. food insecure: 11.8%
> Obesity rate: 20.0%
> 2013 unemployment rate: 4.0%

Although New Mexico tends to report relatively poor health measures, Los Alamos County reports much better measures. The county is home to some of the state’s wealthiest residents, which contributed substantially to the health ranking. More than 21.5% of New Mexico residents did not have health insurance, the sixth highest rate of all states. In Los Alamos County, on the other hand, less than 5% did not have health insurance. Also, while nearly 62% of children across the state qualified for free lunch — the second highest state figure — no children were considered poor enough to qualify in Los Alamos.

Putnam County, N.Y.
> Pct. without health insurance:
9.4%
> Pct. food insecure: 6.1%
> Obesity rate: 29.4%
> 2013 unemployment rate: 5.8%

While Putnam County ranked first for health in New York, its obesity rate of 29.4% was higher than both the state and national rates. However, residents fared much better in other measures. Less than 10% smoked, for example, half the national rate and far less than the 16.6% of New Yorkers who smoked. Also, not only were Putnam County residents better off financially than most New Yorkers, but income was better distributed. Putnam County household incomes in the 80th percentile were 4.2 times greater than those in the bottom 20th percentile, versus the 5.5 income ratio across New York — the worst level of income inequality compared to all states.

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Orange County, N.C.
> Pct. without health insurance:
14.7%
> Pct. food insecure: 15.6%
> Obesity rate: 21.3%
> 2013 unemployment rate: 5.3%

The connection between health measures and income distribution is well acknowledged among researchers today, as an even distribution promotes social cohesion. Indeed, income in most of the healthiest counties was relatively well distributed. In Orange County, however, household incomes in the 80th percentile were 6.4 times greater than those in the bottom 20th percentile — one of the widest income gaps nationwide. Area residents on the whole were still very healthy, however, with a low smoking rate and a low percentage of people reporting physical inactivity.

Traill County, N.D.
> Pct. without health insurance:
11.1%
> Pct. food insecure: 6.8%
> Obesity rate: 35.8%
> 2013 unemployment rate: 3.1%

Nearly 36% of Traill County residents were obese, significantly higher than both the state and national rates. Still, the county had the highest health ranking of any other county in the state, largely due to strong socioeconomic factors. Like North Dakota, Traill had an especially low unemployment rate at just 3.1%. Also, more than 76% of residents 25-44 had completed at least some college, versus the state rate of 74.4%, which was itself the highest rate of all states. Financial security helped improve housing situations for many residents — 11% of North Dakotan households had at least one severe housing problem, the lowest state share. In Traill, just 6.5% of households reported such concerns. In addition, the vast majority of residents had access to health insurance and healthy food.

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Delaware County, Ohio
> Pct. without health insurance:
6.9%
> Pct. food insecure: 9.4%
> Obesity rate: 26.5%
> 2013 unemployment rate: 5.2%

Just 7% of Delaware County residents rated their own health as poor or fair, less than half the 15.3% figure for Ohio. Relatively even income distribution and a high rate of health insurance coverage contributed to the high quality of life among area residents. And these factors helped lower the incidence of disease in the area. For example, less than 9% of the Delaware County population was diabetic, less than the 11.2% of state residents that were, which was itself one of the lowest shares.

Cleveland County, Okla.
> Pct. without health insurance:
16.7%
> Pct. food insecure: 14.6%
> Obesity rate: 29.3%
> 2013 unemployment rate: 4.6%

An estimated 9,121 years of life were lost annually per 100,00 people in Oklahoma due to premature death, the fifth highest amount compared to all states. In Cleveland County, the rate of premature death was much lower with only 6,455 years lost per 100,000 people annually due to premature death. This was only slightly lower than the national estimate, however. A low teen birth rate is frequently tied to both strong socioeconomic factors as well as healthy behaviors. There were just 23.4 births per 1,000 15-19-year old female county residents, less than half the state rate of 53.8 births per 1,000 female teens, which was the fifth highest figure of all states.

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Benton County, Ore.
> Pct. without health insurance:
15.9%
> Pct. food insecure: 15.8%
> Obesity rate: 20.8%
> 2013 unemployment rate: 5.8%

Benton County had the highest health ranking in Oregon largely due to the high concentrations of primary care physicians and mental health providers in the area. Residents were also well educated. Higher educational attainment rates tend to improve both health knowledge and the likelihood of financial stability, which in turn leads to better health outcomes. More than 80% of adults 25-44 years old had completed at least some college, far higher than both the state and national rates. The area’s obesity rate of less than 21% was also far lower than both the state and national rates.

Centre County, Pa.
> Pct. without health insurance:
12.0%
> Pct. food insecure: 14.5%
> Obesity rate: 23.9%
> 2013 unemployment rate: 5.6%

Social support networks help foster healthier behaviors and outcomes. The prevalence of single-parent households partly reflects this feature of a community. In Centre County, the healthiest in Pennsylvania, nearly 23% of households were single-parent households, about 10 percentage points lower than both the state and national rates. Area residents also had healthy behaviors. Just 12.2% were smokers, and 18.1% reported physical inactivity in the past month, both some of the lowest rates nationwide.

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Bristol County, R.I.
> Pct. without health insurance:
9.2%
> Pct. food insecure: 11.8%
> Obesity rate: 20.7%
> 2013 unemployment rate: 8.0%

Nearly 15% of Rhode Island’s population drank water from systems that had at least one health violation, more than double the national share. In Bristol, Rhode Island’s healthiest county, no people were exposed to such health concerns. Bristol residents also had excellent health insurance coverage rates. Only 9.2% of county residents did not have health insurance, lower than the 17% of Americans and nearly 13% of state residents. When asked to rate their own health excellent, very good, good, fair or poor, only 8.7% replied fair or poor, far less than both the state and national shares.

Beaufort County, S.C.
> Pct. without health insurance:
21.7%
> Pct. food insecure: 13.0%
> Obesity rate: 22.0%
> 2013 unemployment rate: 6.8%

Like South Carolina as a whole, Beaufort County, the healthiest in the state, had relatively weak socioeconomic factors. Area residents still stayed healthy, however. More than 81% of Beaufort County residents lived near a park or exercise facilities, nearly 10 percentage points higher than the state proportion. Perhaps as a result, only 16.5% of residents reported physical inactivity, far lower than both the state and national rates.

Lincoln County, S.D.
> Pct. without health insurance:
7.3%
> Pct. food insecure: 8.6%
> Obesity rate: 27.6%
> 2013 unemployment rate: 2.9%

When asked to rate their own health as excellent, good, fair, or poor, only 11.1% of South Dakota residents replied fair or poor, nearly the lowest such share of all states. In Lincoln County, the healthiest in the state, even fewer residents — just over 8% — replied fair or poor. County residents were also far less likely than people across the state to die prematurely. An estimated 3,451 years were lost per 100,000 people annually in Lincoln due to premature death, almost half the estimate for South Dakota, which was roughly in line with the national figure.

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Williamson County, Tenn.
> Pct. without health insurance:
8.2%
> Pct. food insecure: 8.9%
> Obesity rate: 27.0%
> 2013 unemployment rate: 5.6%

Similar to other healthiest counties in most states, Williamson County residents were far less likely than Americans at large to rate their own health as fair or poor, with less than 7% of residents doing so. Residents reported an average of just two physically unhealthy days per month, less than half the state figure. Residents also had healthy habits, with just 10.9% reporting a smoking habit, less than half Tennessee’s smoking rate of 22.6%.

Collin County, Texas
> Pct. without health insurance:
15.9%
> Pct. food insecure: 15.3%
> Obesity rate: 25.7%
> 2013 unemployment rate: 5.7%

While 421.6 violent crimes were reported per 100,000 people across Texas — higher than the national rate — there were just 170.3 violent crimes per 100,000 Collin County residents. Similarly, while Texas had the worst health insurance coverage of all states with 25.2% of residents going without health insurance, less than 16% of Collin County residents did not have health insurance. Relatively strong socioeconomic and clinical care factors such as these helped the county lead the health ranking in the state. Less than 4,000 years of life were lost per 100,000 people in Collins due to premature death, far lower than both the state and national estimates.

Cache County, Utah
> Pct. without health insurance:
15.1%
> Pct. food insecure: 15.9%
> Obesity rate: 22.4%
> 2013 unemployment rate: 3.6%

Just 4.6% of Cache County residents were smokers, lower than even the 9.4% of Utah residents who smoked, itself the lowest smoking rate compared to all states. Also, only 6.3% of Cache County residents reported either binge drinking or heavy drinking in the past 30 days, lower than the 9.3% of Utah residents who reported doing so, which again was nearly the lowest compared to other states. Such healthy habits may have helped lengthen and improve the quality of life in the county.

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Chittenden County, Vt.
> Pct. without health insurance:
6.7%
> Pct. food insecure: 12.5%
> Obesity rate: 21.0%
> 2013 unemployment rate: 3.5%

Strong levels of education in Chittenden County helped residents earn higher incomes, find better jobs, and support healthier behaviors. About 88% of Vermont ninth graders graduated high school in four years. This was the second-highest rate nationwide but still less than the 91% graduation rate in Chittenden County. Nearly 80% of 25-44 year old area residents had completed at least some college, also higher than the state’s rate and one of the higher figures in the country. The county is home to the some of the state’s wealthiest residents. Only 7.8% of residents rated their lives as fair or poor, far lower than both the state and national shares.

Arlington County, Va.
> Pct. without health insurance:
10.4%
> Pct. food insecure: 9.4%
> Obesity rate: 17.5%
> 2013 unemployment rate: 3.6%

Arlington County had the highest health ranking in Virginia largely due to a strong food environment and physically active residents. All residents lived reasonably close to a park or recreational facility, and less than 14% of residents were physically inactive, one of the lowest percentages. Partly as a result, the county obesity rate of 17.5% was more than 10 percentage points lower than the state’s obesity rate and one of the lower rates nationwide.

San Juan County, Wash.
> Pct. without health insurance:
21.9%
> Pct. food insecure: 12.7%
> Obesity rate: 17.5%
> 2013 unemployment rate: 5.9%

As in the healthiest county in most states, San Juan County boasted strong socioeconomic characteristics, which helped lower the incidence of many unhealthy behaviors. The county had a teen birth rate of 12.4 births per 1,000 teenage girls, for example, far less than half the rate for the state, which itself was relatively low compared to the nation. While a relatively high 21.9% of people in San Juan County did not have health insurance, area residents had healthy behaviors. For example, 13.4% were smokers and 17.5% were considered obese, each lower than the respective state rates and among the lower figures nationwide.

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Jefferson County, W.Va.
> Pct. without health insurance:
14.7%
> Pct. food insecure: 11.4%
> Obesity rate: 31.4%
> 2013 unemployment rate: 4.6%

Similar to the healthiest counties in many other states, Jefferson County’s state-leading health ranking was supported primarily by strong socioeconomic factors. For example, while 26.3% of children across the state lived in poverty — the 10th highest state rate — 14.9% of Jefferson County children lived below the poverty line. In addition, there were just 130 violent crimes per 100,000 county residents, less than half of West Virginia’s violent crime rate of 311.2 per 100,000 state residents. Factors such as these helped raise the quality of life among residents. Less than 16% of residents rated their own health as poor or fair, versus the nation-leading 21.5% of state residents.

Ozaukee County, Wis.
> Pct. without health insurance:
5.8%
> Pct. food insecure: 8.2%
> Obesity rate: 25.3%
> 2013 unemployment rate: 5.5%

Unintended pregnancies, which can be the result of risky sexual activity, can have long-term social and economic consequences. There were just 6.2 pregnancies per 1,000 female Ozaukee residents 15-19 years old, versus the state figure of 27.5, which itself was among the lower rates in the nation. Area residents also had strong educational attainment rates — more than 81% of adults 25-44 years old had completed at least some college, far higher than both the state and national rates. These factors helped area residents report a relatively high quality of life and improve overall health.

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Teton County, Wyo.
> Pct. without health insurance:
21.4%
> Pct. food insecure: 12.6%
> Obesity rate: 13.2%
> 2013 unemployment rate: 5.3%

An estimated 7,360 years of life were lost annually due to premature death in Wyoming, one of the highest such figures nationwide. In Teton County, however, residents live longer, healthier lives, with an estimated 3,853 years of life lost per 100,000 people due to premature death. Healthy behaviors largely account for the health of residents. Less than one in 10 area residents were smokers, for example, far lower than both the state and national smoking rates. And just 13.2% were obese, due in part to very good access to exercise facilities — more than 97% lived near locations offering exercise opportunities.