46. Indiana
> Poverty rate: 15.2% (23rd highest)
> Unemployment rate: 4.8% (20th lowest)
> Obesity rate: 32.7% (7th highest)
> Pct. of adults with at least a bachelor’s degree: 24.7% (9th lowest)

A solid education improves employment opportunities and is itself a component of well-being. Indiana residents, who report one of the worst levels of well-being in the Gallup survey, are not especially well educated, nor do they have especially high incomes. Less than one-quarter of adults have at least a college degree, well below the over 30% of adults nationwide with such education. Like a number of other low well-being states, the annual median household income in Indiana of $49,446 is lower than the national median of $53,657.

The relatively poor availability of health professionals may also hinder well-being in the Hoosier State. There are only 107 primary care physicians and 47 dentists per 100,000 people respectively, each well below the national ratios. This may at least partially explain the low level of immunization among children in the state, which at just 66% is also below the national rate of 72%.

47. Ohio
> Poverty rate: 15.8% (20th highest)
> Unemployment rate: 4.9% (22nd lowest)
> Obesity rate: 32.6% (8th highest)
> Pct. of adults with at least a bachelor’s degree: 26.6% (15th lowest)

Individuals in low income and poor well-being states are actually among the least likely Americans to report a binge drinking habit. In Ohio, however, 18% of adults drink excessively on a regular basis, higher than the national share of 16%.

Unlike many low well-being states, Ohio has an above-average ratio of primary care physicians relative to the population, at 130 per 100,000 people. Despite the relatively strong access to health services, however, Ohioans still report some of the nation’s worst health outcomes, which are likely major drivers of the low reported well-being in the state. The state ranks in the worst 10 for heart attacks, diabetes diagnoses, cancer deaths, and infant mortality.

48. Oklahoma
> Poverty rate: 16.6% (14th highest)
> Unemployment rate: 4.2% (15th lowest)
> Obesity rate: 33.0% (6th highest)
> Pct. of adults with at least a bachelor’s degree: 24.2% (8th lowest)

Taking care to stay healthy is often essential for well-being. Due to relatively poor socioeconomic factors and low access to health services, this is far more difficult in Oklahoma than in other states. The state’s jobless rate of 4.2% is relatively low, but the poverty rate of 16.6% is one of the higher rates nationwide. Poor health care can lead to a higher rate of teen pregnancy, which is often associated with preterm delivery and developmental delays and illness of the infant. In Oklahoma, there are 38.5 teen births per 1,000 teenage women each year, the second highest rate after Arkansas. With just 85.2 primary care physicians per 100,000 people in the state, the third lowest ratio, accessing proper health services in Oklahoma is difficult compared to other states. Like in many low well-being states, obesity and heart disease are relatively common in Oklahoma. A third of state adults are obese, the sixth highest obesity rate of all states. Also, there are 228.1 deaths due to heart disease per 100,000 people annually, the second highest rate in the United States.

49. Kentucky
> Poverty rate: 19.1% (5th highest)
> Unemployment rate: 5.4% (20th highest)
> Obesity rate: 31.6% (12th highest)
> Pct. of adults with at least a bachelor’s degree: 22.2% (4th lowest)

As is the case with most states reporting the lowest levels of well-being, the cost of living in Kentucky is low. Still, Kentuckians are relatively poor and financial hardship is commonplace for many residents. The typical household earns $42,958 annually, the fifth lowest median income nationwide. The state’s poverty rate of 19.1% is also among the highest in the United States. Along with low incomes, low levels of education contribute to residents’ overall low well-being — as it can put a cap on income levels and hinder healthy living. Of Kentucky adults, 84.5% have at least a high school diploma, and 22.2% have at least a bachelor’s degree, each some of the lowest such rates nationwide. Insufficient sleep, which afflicts 38.9% of adults in Kentucky, is one example of an unhealthy behavior that could stem from financial hardship and lead to poor outcomes down the road. There are 229 cancer deaths per 100,000 people in Kentucky a year, the highest incidence of any state.

50. West Virginia
> Poverty rate: 18.3% (7th highest)
> Unemployment rate: 6.7% (the highest)
> Obesity rate: 35.7% (2nd highest)
> Pct. of adults with at least a bachelor’s degree: 19.2% (the lowest)

West Virginia residents report the poorest well-being of all states on the Gallup survey. Unhealthy behaviors among West Virginians can partially explain the state’s last-place rank. State adults are the least likely Americans to visit the dentist. Also, 35.7% of adults in the state are obese and 26.7% smoke, the second highest and highest such rates of any state. Obesity and tobacco use are two factors that can increase the risk of heart-related ailments. High blood pressure, heart attacks, and diabetes are each more common in West Virginia than in any other state.

West Virginia is home to some of the nation’s worst economic and social indicators as well, which likely exacerbate the unhealthy behaviors and health outcomes. Fewer than one in five adults have at least a bachelor’s degree in West Virginia, the lowest college attainment rate nationwide. At 6.7%, West Virginia’s unemployment rate is also the highest of all states. While the state’s poverty rate of 18.3% is seventh worst, living in the state is relatively affordable and the percentage of the population with access to healthy food is among the highest in the United States.