An enormous amount of time and money is spent keeping Americans healthy. Governments at all levels and individuals invest many resources on anything from medical expenses to the costs of insurance, health research, nutritional programs, and exercise facilities. Environmental factors also play a role. A great deal of how healthy Americans are depends on where they live.
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. The health of Americans varies tremendously not just between states, but within each state. In some areas in even the healthiest states, certain health outcomes are on par with that of developing nations.
The report ranked each state’s counties based on the incidence of premature death and self-reported levels of health — that is, how long and how well residents live. Premature death rates, measured as the number of years lost prior to age 75 per 100,000 people annually, range from 28,822 years in Sioux County, North Dakota, to 6,078 years in Windham County, Connecticut. These counties are each the least healthy in their respective states. By contrast, just 3,081 years are lost per 100,000 people annually in Valley County, Idaho, one of the healthiest areas in the nation.
The quality of life, measured by several self-reported levels of well-being, also varies considerably across the United States. Of all counties reviewed, Brooks County, Texas, residents report nearly the lowest quality of life, with 40% reporting fair or poor health. This is in stark contrast with Douglas, Colorado, where just 7% of adults report such low levels of health.
How long and how well people live are a consequence of health factors, which include behavioral indicators such as exercise habits, smoking rates, obesity, and alcohol consumption; and socioeconomic indicators such as violent crime rates, unemployment, teen birth rates, the ratio of residents to physicians, and child poverty rates. In an interview with 24/7 Wall St., Bridget Catlin, co-director of the County Health Rankings & Roadmaps program at the University of Wisconsin, explained that these are factors that community leaders and county residents can improve.
No single factor can explain poor health outcomes in an area, and the circumstances leading to such adverse health outcomes are often extremely complicated. A few indicators stand out, however. Low incomes and poverty, for example, are very common in these less healthy areas. Of the 50 counties on this list, only Windham County, Connecticut, has a child poverty rate lower than the national share of 20%.
“When you are struggling trying to make ends meet it’s difficult to focus on being sure that you have healthy food on the table,” Catlin said.
Premature death rates are lowest in suburban and urban areas, and in large cities in particular, preventable deaths have declined in recent years. Premature death rates in rural areas, by contrast, have gone up over the past several years.
Like people, health care services are also few and far between in rural places. In 36 states, the ratio of primary care physicians to residents in the least healthy county is worse than the national level, for example.
Catlin noted that poor access to health care is only one reason for the worse health outcomes in rural areas. These counties also tend to have fewer job opportunities, and with smaller tax bases, the funding for health and many other institutions and services is often lower. Of the 50 states, the unemployment rate in the least healthy county exceeds the national rate in all but seven counties. In all but one case, the jobless rate is higher than the state’s.
Poor access to services is not limited to rural areas, nor is it a consequence of distance alone. The lack of health insurance also restricts access to medical care and is far more common in the least healthy counties. Nationwide, 17% of Americans under 65 years old do not have health insurance. The percentage is higher in over half of these areas.
In a number of states, the least healthy county also overlaps at least one Indian reservation, where poor economic conditions, unhealthy behaviors, and the resulting negative health outcomes are far more common than elsewhere. According to A Program of Partnership With Native Americans, a national charity, economic and living conditions on most reservations are very poor compared to other U.S. areas. Numerous problems are facing these communities. The pressures to adopt a Western lifestyle over traditional ways of life, for example, have led to particularly detrimental health consequences.
To identify the least healthy county in every state, 24/7 Wall St. reviewed county-level data 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 maternal health — 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. Data was compiled from over 20 different sources, and is of the most recent year available. A total of 3,140 counties were considered.
These are the least healthy counties in each state.