By many health measures, the United States, a nation of over 320 million, is an anomaly. Despite health spending approaching $10,000 per person — which amounts to twice and even three times the spending in other affluent nations — the United States ranks 28th in life expectancy among wealthy countries, according to the most recent Organization for Economic Co-operation and Development data.
Understanding the obstacles the United States faces in achieving better health requires a review of the regional differences in the behaviors, health care, and socioeconomic conditions that can affect health. 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 U.S. counties — even in the healthiest states — health outcomes are surprisingly poor, especially for one of the wealthiest nations on earth. In Collier County, Florida, the premature mortality rate — people dying of largely preventable causes before age 75 — is 216 deaths per 100,000 residents. In Union County, Florida, the rate is 924 premature deaths per 100,000 people.
How long and how well people live are consequences of many health factors, which include behavioral indicators such as exercise habits, smoking, obesity, and alcohol consumption rates; and socioeconomic indicators such as violent crime, unemployment, child poverty, and teen birth rates, as well as the ratio of residents to physicians.
Much of the recent conversation about health care in the United States has been about access to health coverage. In an interview with 24/7 Wall St., Marjory Givens, deputy director of data and science at the County Health Rankings & Roadmaps program, pointed out that this is only one element explaining regional differences in health outcomes. “Access to affordable healthcare is an important element for helping communities to live long and well. But health is so much more than healthcare, and there are many other important elements in the local community that are important to be attentive to, like good jobs, quality education, [and] affordable housing,” said Givens.
Education in particular appears to have wide-reaching implications on health outcomes in a given area. “If you don’t have a quality education that allows you to get a good-paying job, the opportunities are limited to you, and that will influence the choices you can make,” Givens added. Each state’s least healthy county has a lower rate of college attainment than its state’s share.
In a number of states, the least healthy county also overlaps at least one Native American reservation, where poor economic conditions, unhealthy behaviors, and the resulting negative health outcomes are far more common than elsewhere. “Historically … Native American communities have experienced historical trauma and discrimination,” Givens noted. “[T]hese are communities that have experienced disinvestment, and high rates of unemployment and poverty, and these are issues that shape your health and well-being.” In 11 of the 50 counties on this list, at least 40% of the population is American Indian or Alaskan.
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 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 compiled is for the most recent year available. Counties and county equivalents were considered.
This is the least healthy county in each state.