Special Report

Healthiest County in Every State

Samuel Stebbins, Evan Comen

Published: May 9, 2017 3:17 pm

Last Updated: January 12, 2020 12:11 pm

Average life expectancy for Americans can vary by as much as 15 years, depending on where one is born. While the average person born in Montgomery County, Maryland is expected to live for 83.3 years, the life expectancy for a person born in McDowell County, Virginia is just 68.4 years — closer to the life expectancy of India or the Philippines than the United States.

Because health outcomes are the result of several factors — including healthy behavior, access to care, quality of care, socioeconomic factors, genetics, environment and others — Americans’ overall health varies considerably by geography.

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To identify the healthiest county in every state, 24/7 Wall St. reviewed county-level health data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

Click here to see the healthiest county in every state.

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 are measured as the number of people who die before age 75 per 100,000 people annually. Nationwide, the premature mortality rate is 333 deaths per 100,000 people. All but three counties on this list have a lower premature death rate than the national average.

County Health Rankings measures how well residents live based on a number of behavioral metrics, including how active a given population is, the smoking rate, excessive drinking rate, STD diagnosis rate, and obesity rate.

While health outcomes are far worse in some states than others, even in the least healthy states there are counties that are relatively healthy compared to the nation. While the average life expectancy in 66 of the 67 counties in Alabama — one of the least healthy states — is shorter than the average life expectancy nationwide of 78.5 years, in Shelby County, life expectancy is 79.2 years. Such standout counties tend to be home to the wealthiest, most-insured populations in a given state.

Individuals with health insurance are more likely to schedule regular checkups and receive other forms of preventive medical care. All but six counties on this list have a lower uninsured rate than their home state.

Even with insurance, health care and healthy lifestyles can be expensive — and every county on this list has a higher median household income than its respective state. Of the 50 counties on this list, five have a median household income above $100,000 and all have a higher median household income than the $53,889 national value.

To identify the healthiest 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 health behaviors, clinical care, social and economic factors, and physical environment measures. Data were compiled from more than 20 different sources and are for the most recent year available. A total of 3,140 counties were considered.

These are the healthiest counties in every state.

Source: Brian Norwood / Flickr

1. Alabama
> Healthiest county: Shelby
> Smoking rate: 14.0%
> Obesity rate: 30.1%
> Median household income: $70,187

Across Alabama, 21.2% of adults are in fair or poor health, one of the highest shares of any state. Not all parts of the state are unhealthy, however. Only 14.2% of adults in Shelby County, located just southeast of Birmingham, report being in fair or poor health, compared to the 15.0% of adults who do nationwide.

The positive self-reported health outcomes may partially be the result of residents who are less likely to engage in certain unhealthy behaviors. Of county adults, only 14.0% smoke and 14.7% drink excessively, well below the 18.0% national share for both behaviors.

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Source: Thinkstock

2. Alaska
> Healthiest county: Juneau
> Smoking rate: 15.9%
> Obesity rate: 28.6%
> Median household income: $85,746

Only 11.4% of adults in the City and Borough of Juneau, the state’s capital report being in fair or poor health, slightly less than the comparable 13.7% statewide and 15.0% national figures. Better than typical health outcomes are partially attributable to healthier lifestyles. For example, only 14.2% of area adults get no exercise beyond getting up and going to work. In comparison, 18.6% of adults in Alaska and 22.0% of American adults report similarly infrequent physical activity.

Healthier lifestyles in Juneau may be explained by the numerous opportunities for exercise available to residents in the region. The Census estimates that every Juneau resident has adequate access to places for physical activity such as parks and recreation centers. Meanwhile, only 67% of Alaskans and 84% of Americans benefit from such access.

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3. Arizona
> Healthiest county: Maricopa
> Smoking rate: 13.0%
> Obesity rate: 25.4%
> Median household income: $54,229

Maricopa County, which encompasses Phoenix, Arizona’s largest city, is the healthiest of all 15 counties in the state. Area residents are more likely to have access to areas for physical activities, such as parks and recreation centers, than the state population as a whole.

Regular physical activity can help reduce the risk of obesity, and obesity is slightly less prevalent in Maricopa County than it is across Arizona and the United States as a whole. Some 25.4% of Maricopa adults are obese compared to 26.1% of Arizona adults and 28.0% of American adults.

Source: https://www.flickr.com/photos/arkansasoutside/

4. Arkansas
> Healthiest county: Benton
> Smoking rate: 16.3%
> Obesity rate: 30.1%
> Median household income: $56,239

Unhealthy behavior is one of the leading causes of poor health. About one in every four adults Arkansas are smokers, and over 34% of adults are obese. In comparison, of all U.S. adults, 18.0% smoke and 28.0% are obese.

People living in Benton County, situated in the northwest corner of the state, tend to live healthier lives than is typical across Arkansas. Only 16.3% of county residents smoke and 30.1% are obese, each the lowest shares of any county in the state.

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Source: Thinkstock

5. California
> Healthiest county: Marin
> Smoking rate: 10.0%
> Obesity rate: 18.9%
> Median household income: $93,257

Californians tend to lead far healthier lives than most Americans. In Marin County, situated directly across the Golden Gate Bridge from San Franciso, adults are more likely to be physically active and less likely to smoke or be obese than adults in nearly every other county in the United States. Healthy outcomes can be the result of healthy behaviors, and in Marin County, only 11.0% of adults report being in fair or poor health, well below the 17.8% share of adults statewide. Marin County adults also report fewer physically or mentally unhealthy days per month than adults across the state and nation.

Source: Thinkstock

6. Colorado
> Healthiest county: Douglas
> Smoking rate: 10.3%
> Obesity rate: 17.0%
> Median household income: $102,964

Because regular physical activity can help reduce one’s risk of obesity, it is likely not a coincidence that Colorado — the state with the most physically active residents in the country — also has the lowest obesity rate.

In Douglas County, located in between Denver and Colorado Springs, people are even healthier than residents statewide. Douglas County is one of only five counties nationwide where more than nine in 10 adults are regularly physically active. Only 17% of county adults are obese, a smaller share than nearly all U.S. counties. Positive outcomes are often the result of healthy behavior, and only 7.9% of adults in Douglas County report being in fair or poor health, the smallest share of any U.S. county.

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Source: Thinkstock

7. Connecticut
> Healthiest county: Middlesex
> Smoking rate: 12.4%
> Obesity rate: 24.1%
> Median household income: $79,893

Middlesex County, located south of Hartford along the Connecticut River and Long Island Sound, is the healthiest county in Connecticut. Only one in 10 adults in the county are in fair or poor health, the smallest share in the state and well below the comparable statewide figure of 14.3%.

Health outcomes in an area are often partly attributable to the level of access to medical care. Only 5.5% of Middlesex County residents lack health insurance, a far smaller share than the 8.0% uninsured rate statewide and the 14.0% uninsured rate nationwide.

Source: Thinkstock

8. Delaware
> Healthiest county: New Castle
> Smoking rate: 15.8%
> Obesity rate: 27.7%
> Median household income: $65,476

There are only three counties in Delaware. As a result, the state’s healthiest county, New Castle, closely resembles the state as a whole in a number of health behaviors and outcomes. About 16% of adults in New Castle County report being in fair or poor health, only a slightly smaller share than the 17% of adults across Delaware who report the same.

Similarly, only a slightly larger share of adults in New Castle County are physically active than the comparable share statewide. Active lifestyles may partially explain the area’s 27.7% obesity rate, which is also slightly better than the 29.4% statewide obesity rate.

Source: Thinkstock

9. Florida
> Healthiest county: St. Johns
> Smoking rate: 13.4%
> Obesity rate: 21.9%
> Median household income: $66,194

St. Johns County, located just south of Jacksonville between the St. Johns River and the Atlantic Ocean, is the healthiest county in Florida. Only 10.5% of adults in St. Johns are in fair or poor health, well below the 17.1% statewide share.

Healthy outcomes in the area are partially attributable to certain socioeconomic advantages. For example, only 12.9% of county residents struggle to access healthy food, either due to insufficient income or proximity to grocery stores — a smaller share than the 16.2% of Floridians. In addition, only 13.2% of St. Johns of residents lack health insurance, well below the 20.2% statewide uninsured rate.

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Source: John Trainor / Wikimedia Commons

10. Georgia
> Healthiest county: Oconee
> Smoking rate: 13.1%
> Obesity rate: 28.8%
> Median household income: $72,182

Unsafe environments contribute to greater levels of stress, violence, and can lower overall health in a community. By contrast, safe communities are often also home to relatively healthy people. In Oconee County, Georgia, there are about 109 violent crimes a year for every 100,000 residents, less than a third of the corresponding statewide violent crime rate of 374 incidents per 100,000 residents.

Oconee County residents are also less likely to engage in behaviors known to increase the risk of poor health outcomes than is typical statewide. Just 13.1% of county adults smoke, and only 11.1% of driving deaths involve alcohol — well below the 17.7% and 23.4% state figures.

Source: Thinkstock

11. Hawaii
> Healthiest county: Honolulu
> Smoking rate: 11.7%
> Obesity rate: 22.3%
> Median household income: $74,460

The healthiest county in Hawaii is Honolulu, which includes the capital city of Honolulu and comprises the island of O’ahu as well as several smaller outlying islands to the northwest.

Since prohibiting smoking in enclosed and partly enclosed areas statewide with the Clean Indoor Air Act in 2006, Hawaii’s smoking rate has declined dramatically to 14.1%. Just 11.7% of Honolulu adults smoke, less than the statewide rate and far less than the 18.0% national figure. Lower smoking rates likely contribute to a lower than average premature mortality rate across the state and county as a whole.

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Source: Thinkstock

12. Idaho
> Healthiest county: Blaine
> Smoking rate: 12.3%
> Obesity rate: 19.2%
> Median household income: $60,088

By most measures of health and wellness, Blaine County is the healthiest in Idaho. Just 12.5% of adults in the county do not exercise, and only 19.2% are obese — each the smallest share in the state and far less than the 22.0% inactivity and 28.0% obesity national rates. Healthy habits increase the odds of a longer life. For every 100,000 Blaine residents, fewer than 200 die before the age of 75, compared to the statewide premature mortality rate of 310 deaths per 100,000 residents.

While Blaine County residents are the healthiest of any Idaho county, many are at risk of incurring large out-of-pocket health expenses in the event of a medical emergency. Nearly 21% of Blaine County residents do not have health insurance, a much larger share than the 16% state uninsured rate and the 14% national rate.

Source: Nyttend / Wikimedia Commons

13. Illinois
> Healthiest county: Monroe
> Smoking rate: 13.0%
> Obesity rate: 33.2%
> Median household income: $70,859

Unlike most counties on this list, Monroe trails its home state in a number of measures of health-related behavior. For example, 27.2% of adults in the county get no physical exercise beyond getting up and going to work, a larger share than the 21.2% of Illinois adults who are inactive. Similarly, about a third of adults in Monroe are obese compared to 27.3% of adults across the state.

Monroe’s status as the healthiest county in the state is largely due to self reported health outcomes. For example, only 9.9% of adults report being in fair or poor health, the smallest share of any of the state’s 102 counties. In comparison, 15.6% of adults across Illinois report being in fair or poor health.

Source: Thinkstock

14. Indiana
> Healthiest county: Hamilton
> Smoking rate: 12.8%
> Obesity rate: 25.9%
> Median household income: $86,222

While Indiana is one of the least healthy states, residents of Hamilton County report some of the healthiest behaviors and outcomes of any county nationwide. Just 12.8% of county adults smoke, far less than the statewide smoking rate of 20.6% and the nationwide rate of 18.0%. Additionally, only 16.3% of Hamilton County adults lead sedentary lives, compared to 26.3% of adults statewide and 22.0% of U.S. adults nationwide. Healthy behaviors can increase longevity, and likely reduce the incidence of premature death in the region. Hamilton County residents die at a rate of just 209 of every 100,000 before the age of 75, far less than the state premature mortality rate of 387 incidents per 100,000 people.

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Source: Josejuan05 / Wikimedia Commons

15. Iowa
> Healthiest county: Sioux
> Smoking rate: 14.5%
> Obesity rate: 29.0%
> Median household income: $61,627

Sioux County is one of the wealthiest counties in Iowa. The typical household in the county earns $61,627 a year, roughly $7,000 more than the statewide median household income. Because some elements of a healthy lifestyle can be quite costly, the relatively high incomes likely help explain the relatively healthy outcomes. Just 9.0% of county residents lack reliable access to healthy food, the lowest food insecurity rate of any county in the state. Healthy behaviors tend to increase longevity and lower the risk of premature death. The premature death rate — preventable deaths before age 75 — is 198 per 100,000 residents in Sioux County, the lowest premature mortality rate in Iowa. By comparison, 333 Americans die prematurely per 100,000 people.

Source: Ichabod / Wikimedia Commons

16. Kansas
> Healthiest county: Johnson
> Smoking rate: 11.0%
> Obesity rate: 24.8%
> Median household income: $76,113

Only 8.9% of adults in Johnson County, Kansas report being in fair or poor health, the smallest share in the state and the 10th smallest of all U.S. counties. People with health insurance tend to be healthier overall, as those with access to care are more likely to make regular doctor visits and receive preventive medical care. In Johnson County, only 7.6% of residents are uninsured, the smallest share in the state.

Healthy behaviors likely contribute to healthy outcomes in Johnson County. Only 11.0% of adults in the county smoke, compared to 17.7% of adults statewide. Additionally, only 24.8% of county adults are obese — well below the statewide 30.8% obesity rate.

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Source: W.marsh / Wikimedia Commons

17. Kentucky
> Healthiest county: Oldham
> Smoking rate: 17.2%
> Obesity rate: 28.0%
> Median household income: $85,452

Based on a range of behavioral and health outcome measures, Oldham is the healthiest county in Kentucky. Like many counties on this list, healthy outcomes in the area are likely due in part to good access to care. For example, only 5.8% of county residents lack health insurance, the smallest share in the state and less than half the 14.0% national uninsured rate. Even with insurance health care can be expensive, and in Oldham, the typical household earns $85,452 a year, about $40,000 more than the statewide median income.

People in Oldham are also less likely to engage in certain risky behaviors than people across Kentucky as a whole. More than one in four Kentucky adults smoke, the largest share of any state. In Oldham, only 17.2% of the adult population smokes, also less than the national 18.0% smoking rate. Access to care and healthy behaviors partially explain why Oldham’s life expectancy of 78.9 years is the highest in Kentucky.

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18. Louisiana
> Healthiest parish: Cameron
> Smoking rate: 16.8%
> Obesity rate: 31.5%
> Median household income: $64,231

Living in one of the wealthiest counties in Louisiana, Cameron Parish residents are more likely to be able to afford a healthy lifestyle than residents in most other counties in the state. The typical Cameron Parish household earns $64,231 a year, nearly $20,000 more than the statewide median household income and the second most of any parish in the state. Just 7.3% of the parish population lacks reliable access to healthy food, the smallest share in the state. Area adults also report a lower smoking rate than both the state and nation. While Cameron Parish’s 31.5% obesity rate is higher than the 28.0% national rate, it is one of the lowest of any parish in Louisiana.

Source: Rapidfire / Wikimedia Commons

19. Maine
> Healthiest county: Cumberland
> Smoking rate: 13.0%
> Obesity rate: 22.7%
> Median household income: $60,051

Cumberland County is located in southern Maine and encompasses the city of Portland as well as a stretch of Atlantic coastline. As is the case with many counties on this list, Cumberland residents are relatively active. Only 15.2% of adults in the county report leading totally sedentary lives, the smallest share in the state and well below the 22.0% national physical inactivity rate. County residents’ active lifestyles are facilitated by easy access to parks and recreation centers. About 84% of county residents have adequate access to such locations for physical activities, well above the 67.7% share of Maine residents.

Regular physical activity can decrease the risk of certain deadly diseases and conditions and at 80 years, life expectancy in Cumberland is the highest of any county in Maine.

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Source: Thinkstock

20. Maryland
> Healthiest county: Howard
> Smoking rate: 10.0%
> Obesity rate: 21.7%
> Median household income: $110,238

An affluent suburb of the Baltimore metro area, Howard is the healthiest county in Maryland. Nearly one in five county households earn at least $200,000 annually, the second largest share in the state and among the largest in the country. With such high incomes, Howard County residents are more likely to be able to afford healthy lifestyles than residents statewide. Just 7.5% of county residents lack reliable access to healthy food, only 16.3% of adults do not exercise, and just 5.2% do not have health insurance. By comparison, 12.7% of Maryland residents are food insecure, 21.5% do not exercise, and 8.9% are uninsured.

Just 182 in every 100,000 Howard County residents dies before the age of 75, far less than the statewide premature mortality rate of 319 deaths per 100,000 residents.

Source: Thinkstock

21. Massachusetts
> Healthiest county: Middlesex
> Smoking rate: 11.8%
> Obesity rate: 22.6%
> Median household income: $85,118

Middlesex is the healthiest county in Massachusetts and one of the healthiest nationwide. Just 11.8% of adults in the county smoke, a much smaller share than the 14.0% state and 18.0% national rates. While nationwide 28.0% of adults are obese, and in Massachusetts 24.1% of adults are obese, in Middlesex County the obesity rate is 22.6%, one of the lowest in the country.

Massachusetts has the lowest uninsured rate in the country, and in Middlesex County the share of residents with health insurance is even higher. Just 3.2% of Middlesex County residents do not have health insurance, the third smallest share of any county nationwide.

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Source: rossograph / Wikimedia Commons

22. Michigan
> Healthiest county: Ottawa
> Smoking rate: 14.6%
> Obesity rate: 27.6%
> Median household income: $58,989

Ottawa County is located just west of Grand Rapids along the shore of Lake Michigan. Only 11.5% of adults in Michigan’s healthiest county report being in fair or poor health, well below the 16.8% statewide share. Favorable health outcomes in the county are partially the product of residents less likely to engage in unhealthy behaviors. Only 14.6% of county adults smoke, for example, compared to more than one in five adults statewide.

The incidence of sexually-transmitted disease is frequently used to gauge risky behavior in an area. In Ottawa, there are about 260 new cases of chlamydia for every 100,000 county residents in a given year, well below the 447 per 100,000 resident statewide STD incidence rate.

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23. Minnesota
> Healthiest county: Carver
> Smoking rate: 12.4%
> Obesity rate: 23.0%
> Median household income: $86,323

Carver is the healthiest county in one of the healthiest states. Some 91.7% of county adults report being in good or excellent health, the largest share in Minnesota and the third largest share of any county nationwide. County adults spend an average of 2.5 days in poor physical health each month, half a day less than the statewide average and more than a full day less than the national figure. For every 100,000 people nationwide, 333 die prematurely before the age of 75 annually. In Carver County, the premature mortality rate is 193 deaths per 100,000 residents, among the lowest of any county.

Source: Ditch Fisher / Wikimedia Commons

24. Mississippi
> Healthiest county: Rankin
> Smoking rate: 15.6%
> Obesity rate: 31.5%
> Median household income: $58,801

Mississippi is one of the least healthy states in the country. So while Rankin is the healthiest county in the state, county residents are less healthy than Americans on average. For example, Mississippi has a major obesity problem. While the obesity rate in Rankin County of 31.5% is one of the smallest in the state, it is still higher than the 28.0% national figure.

Mississippi also has the highest premature mortality rate in the country. For every 100,000 residents, 496 die prematurely before the age of 75 each year, far more than the national premature mortality rate of 333 deaths per 100,000 Americans. While Rankin County’s premature mortality rate of 364 deaths per 100,000 residents is the second lowest in the state, it is still greater than the national figure.

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Source: Creative Commons / Wikimedia Commons

25. Missouri
> Healthiest county: Platte
> Smoking rate: 18.4%
> Obesity rate: 30.8%
> Median household income: $68,254

Though Missouri is one of the least healthy states in the country, some parts of the state are healthier than the country as a whole. Platte county has a premature death rate of just 253 per 100,000 residents annually, less than the statewide premature mortality rate of 386 deaths per 100,000 residents and the national rate of 333 premature deaths per 100,000 Americans.

Though Platte is the healthiest county in Missouri, many area residents struggle with obesity. An estimated 30.8% of Platte residents are obese, the same share as Missouri as a whole and a higher share than the 28.0% national obesity rate. Similarly, while the county’s 18.4% smoking rate is lower than the 22.3% statewide figure, it is still a larger share than the 18.0% of American adults who smoke.

Source: Thinkstock

26. Montana
> Healthiest county: Gallatin
> Smoking rate: 13.5%
> Obesity rate: 15.5%
> Median household income: $55,553

Gallatin County is situated in the southwestern corner of Montana and contains a slight portion of Yellowstone National Park. With access to several national parks and forests, just 13.0% of county adults do not exercise, a smaller share than both the 20.5% state and 22.0% national inactivity rates. Additionally, only 13.5% of adults in the county smoke, less than both the 18.9% state and 18.0% national rates.

Healthy behaviors reduce the risk of premature death. In Gallatin County, 216 people die before the age of 75 per 100,000 people annually, less than the state premature mortality rate of 345 deaths per 100,000 residents and the national rate of 333 deaths per 100,000 Americans.

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Source: Public Domain / Wikimedia Commons

27. Nebraska
> Healthiest county: Polk
> Smoking rate: 14.2%
> Obesity rate: 29.5%
> Median household income: $57,312

Based on a number of self-reported measures of health outcomes, the typical Nebraskan is healthier than the typical American. For example, adults in Nebraska report an average of only 3.1 physically unhealthy days and 3.0 mentally unhealthy days a month compared to national averages of 3.6 and 3.7 days, respectively. In Polk County, residents are even healthier. Adults in Polk report an average of only 2.6 physically unhealthy days and 2.7 mentally unhealthy days a month.

Better self-reported outcomes in the county are likely the result of healthy behaviors. The shares of adults who smoke and drink to excess in Polk are lower than the comparable statewide shares.

Source: Thinkstock

28. Nevada
> Healthiest county: Douglas
> Smoking rate: 14.7%
> Obesity rate: 21.4%
> Median household income: $58,535

Nevada is not an especially healthy state, and even the state’s healthiest county trails the nation as a whole in a number of important measures. Adults in Douglas County spend an average of 3.9 days a month in poor mental health and the same amount of time in poor physical health. By contrast, adults nationwide spend 3.7 days in poor mental health and 3.6 days in poor physical health each month on average.

Health insurance coverage helps people access needed medical care, as it encourages individuals to make regular visits to their doctor and receive preventive care. But unlike many relatively healthy areas, the 14.6% of county adults who lack insurance is slightly larger share than the 14.0% of American adults who are uninsured.

Source: Wikimedia Commons

29. New Hampshire
> Healthiest county: Rockingham
> Smoking rate: 13.9%
> Obesity rate: 26.1%
> Median household income: $81,198

Located in one of the healthiest states, Rockingham County, New Hampshire is also among the healthiest areas in the nation. An estimated 90.5% of county adults report being in good or excellent health, the largest share in New Hampshire and much larger than the 85.0% national figure.

While Rockingham is the healthiest county in New Hampshire, the community has not completely resisted the opioid epidemic that has swept much of the Northeast. Roughly 62 in every 100,000 county residents die from injuries annually, the same as the national injury mortality rate. Nationwide, the leading cause of injury death is poisoning — primarily from opioid overdose.

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30. New Jersey
> Healthiest county: Hunterdon
> Smoking rate: 10.9%
> Obesity rate: 22.3%
> Median household income: $105,444

Hunterdon is not only the healthiest county in New Jersey, but also one of the healthiest in the United States. Some 91% of adults in Hunterdon report being in good health, a larger share than in all but 10 other counties nationwide.

Good health outcomes may partially be the product of access to care. Only 6.2% of county residents are uninsured, less than half the statewide 12.6% uninsured rate. Even with insurance, health care can be expensive. This is not likely a major problem for many in the county, however, as the typical area household earns $105,444 a year, far more than the $72,222 median income across New Jersey and the $53,889 national median.

Source: Daniel Schwen / Wikimedia Commons

31. New Mexico
> Healthiest county: Los Alamos
> Smoking rate: 11.2%
> Obesity rate: 19.9%
> Median household income: $101,934

While New Mexico is one of the least healthy states in the country, Los Alamos County, just northwest of Santa Fe, is one of the healthiest in the country. In Los Alamos, 156 people die before the age of 75 per 100,000 people annually, one of the smallest shares of U.S. counties and well below the corresponding premature death rates of 374 per 100,000 residents statewide and 333 per 100,000 people nationwide. A lower premature death rate may be partially attributable to greater access to medical care. Only 4% of county residents are uninsured — well below the state and national uninsured rates of 17.1% and 14.0%, respectively.

Healthy behaviors also likely play a role in the county’s low premature death rate. Adults in Los Alamos are less likely to smoke and more likely to have a physically active lifestyle than adults across the state.

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32. New York
> Healthiest county: Nassau
> Smoking rate: 11.7%
> Obesity rate: 23.5%
> Median household income: $99,465

Nassau County is located in Long Island, adjacent to the Queens borough of New York City. The healthiest county in New York state, only 11% of county adults report being in fair or poor health, a far smaller share than the 16.2% share of adults statewide.

Residents are also less likely to engage in risky behaviors, which may partially explain positive health outcomes in the county. The incidence of sexually-transmitted disease is frequently used to gauge risky behavior in an area. In Nassau, there are only about 257 new cases of chlamydia annually for every 100,000 residents, about half the corresponding statewide STD rate. The typical adult living in the area is also less likely to smoke or drink excessively than the typical adult in New York state.

Source: Thinkstock

33. North Carolina
> Healthiest county: Orange
> Smoking rate: 15.6%
> Obesity rate: 23.3%
> Median household income: $59,290

While North Carolina is one of the least healthy states, residents of Orange County are healthier than most Americans on average. Just 16.7% of county adults get no exercise besides getting up and going to work, a smaller share than the national inactivity rate of 22.0% and the 24.0% statewide inactivity rate.

Active lifestyles are likely one reason why Orange County has the lowest rate of premature death in the state. In Orange County, 236 people die before the age of 75 per 100,000 people annually, far less than the state premature mortality rate of 363 deaths per 100,000 residents.

Source: https://www.flickr.com/photos/sierragoddess/

34. North Dakota
> Healthiest county: Stark
> Smoking rate: 16.0%
> Obesity rate: 29.6%
> Median household income: $72,099

In Stark County, North Dakota, adults report an average of only 2.4 physically unhealthy days and 2.7 mentally unhealthy days a month — each about half a day less than the comparable statewide averages. Life expectancy at birth in Stark County is 80.1 years, longer than the life expectancy of 79.3 years for North Dakota as a whole and 78.5 years nationwide.

Like many counties on this list, people in Stark County are relatively affluent. The typical county household earns $72,099 annually, more than the statewide median income of $60,557.

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35. Ohio
> Healthiest county: Delaware
> Smoking rate: 13.8%
> Obesity rate: 28.1%
> Median household income: $91,955

Life expectancy at birth in Delaware County is 81.1 years, well above the 77.4 year life expectancy statewide. Longer lives in the area are likely partially attributable to healthy behaviors. County adults are more likely to be physically active and less likely to smoke than adults across Ohio as a whole.

Favorable health outcomes are also often the result of access to exercise venues and medical care. In Delaware County, 89.4% of residents have access to places for physical activity such as parks or recreation centers, compared to only 83.2% of Ohio residents. Similarly, only 5.3% of county residents are uninsured compared to 9.9% of the state population.

Source: katsrcool / Wikimedia Commons

36. Oklahoma
> Healthiest county: Canadian
> Smoking rate: 14.9%
> Obesity rate: 35.0%
> Median household income: $64,505

Located just west of Oklahoma City and bisected by Interstate 40, Canadian is the healthiest county in Oklahoma. County adults report an average of 3.4 physically unhealthy and 3.5 mentally unhealthy days per month, versus the comparable statewide average of 4.4 and 4.1 days.

County residents benefit from a high overall level of health, despite some relatively common unhealthy behaviors. For example, 14.8% drink excessively. In comparison, 13.9% of Oklahomans are excessive drinkers. Further, unlike in many other health areas, 35.0% of adults in Canadian County are obese compared to the statewide obesity rate of 32.7%.

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37. Oregon
> Healthiest county: Washington
> Smoking rate: 12.3%
> Obesity rate: 24.0%
> Median household income: $66,754

Maintaining an active lifestyle can benefit both physical and mental health. In Washington County, Oregon, 87.6% of adults are regularly physically active in their leisure time compared to 84.7% of adults statewide. The greater physical activity rates may partially explain why county adults experience fewer unhealthy days each month. County adults report an average of 3.2 physically unhealthy days and 3.7 mentally unhealthy days a month, each the least time of any county in the state.

County residents’ relatively active lifestyles may also help explain the comparably low obesity rate. Only 24.0% of adults in Washington County are obese, compared to 26.4% of Oregon adults.

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38. Pennsylvania
> Healthiest county: Chester
> Smoking rate: 15.3%
> Obesity rate: 23.0%
> Median household income: $85,976

Located in southern Pennsylvania between Lancaster and Philadelphia, Chester is the healthiest county in the state. Chester County adults report an average of only 3.0 physically unhealthy days a month, the fewest of any county in the state. Like many counties on this list, Chester is relatively affluent. The typical county household earns $85,976 a year, over $30,000 more than the statewide median income of $55,702.

While higher incomes can make healthy living easier, engaging in relatively few unhealthy habits also helps. Only 15.3% of Chester County adults smoke, compared to 18.1% of adults across Pennsylvania.

Source: Thinkstock

39. Rhode Island
> Healthiest county: Bristol
> Smoking rate: 12.7%
> Obesity rate: 22.9%
> Median household income: $72,458

Unsafe environments contribute to greater levels of stress, violence, and can lower overall health in a community. By contrast, safe communities are often also home to relatively healthy people. In Bristol County, Rhode Island, there are only about 70 violent crimes a year for every 100,000 residents, less than a third of the corresponding statewide violent crime rate of 243 incidents per 100,000 residents. Adults in Bristol County are also less likely to be obese, less likely to smoke, and more likely to maintain active lifestyles than adults across the state as a whole.

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40. South Carolina
> Healthiest county: Beaufort
> Smoking rate: 14.1%
> Obesity rate: 22.0%
> Median household income: $57,048

Beaufort is a coastal county in southern South Carolina. Adults in Beaufort are more likely to maintain active lifestyles and less likely to be obese than adults in any other county in the state. Healthy lifestyles increase the likelihood of healthy outcomes, and only 12.6% of adults in the county report being in fair or poor health, the smallest such share in the state and well below the 17.0% share statewide.

Unlike most areas on this list, a larger than average share of adults in Beaufort lack health insurance. The county’s uninsured rate of 17.3% is higher than the state and national rates of 16.1% and 14.0%.

Source: AlexiusHoratius / Wikimedia Commons

41. South Dakota
> Healthiest county: Lincoln
> Smoking rate: 14.9%
> Obesity rate: 28.7%
> Median household income: $76,094

Lincoln County, South Dakota is the healthiest county in a relatively healthy state. Adults in the county report an average of only 2.5 physically unhealthy days and 2.4 mentally unhealthy days a month, fewer than the 3.1 and 2.5 respective statewide averages and well below the corresponding national averages of 3.6 and 3.7 days.

Those who are able to access care when they need it are more likely to live healthy lives. Only 6.0% of the Lincoln population lacks health insurance, well below the 11.6% statewide uninsured rate.

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Source: Thinkstock

42. Tennessee
> Healthiest county: Williamson
> Smoking rate: 14.7%
> Obesity rate: 25.9%
> Median household income: $96,565

Tennessee is one of the least healthy states in the country. Not all parts of the state are especially unhealthy, however. In Williamson County, only 11.9% of adults report being in fair or poor health, a smaller share than the 15.0% national figure and well below the 19.9% share of adults in fair or poor health across Tennessee.

People with higher incomes are frequently better equipped to lead healthy lives, and the typical household in Williamson County earns $96,565 a year — the most of any county in Tennessee and more than double the statewide median income.

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43. Texas
> Healthiest county: Collin
> Smoking rate: 12.6%
> Obesity rate: 24.6%
> Median household income: $84,735

Collin County, Texas is located just northwest of the Interstate 635 beltway around Dallas. County adults report an average of only 2.7 physically unhealthy days and 2.9 mentally unhealthy days a month, well below the comparable statewide averages of 3.6 days and 3.2 days, respectively.

Some 21.4% of Texas residents lack health insurance, the highest uninsured rate of any state. In Collin County, only 12.7% of residents are without health insurance, a smaller share than the 14.0% national uninsured rate.

Source: https://www.flickr.com/photos/58666217@N00/

44. Utah
> Healthiest county: Morgan
> Smoking rate: 8.7%
> Obesity rate: 22.0%
> Median household income: $74,314

People with health insurance coverage are more likely to schedule regular doctor visits and receive preventive medical care. In Morgan County, Utah, only 8.8% of residents lack health insurance, the lowest uninsured rate of any county in the state. Even with health insurance coverage, medical care and other aspects of a healthy lifestyle can be expensive, and Morgan is a relatively affluent county. The typical area Morgan County household earns $74,314 a year, about $11,400 more than the typical Utah household.

Certain unhealthy habits are also relatively rare in Morgan. For example, only 8.7% of residents smoke, less than half the 18.0% national smoking rate.

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Source: Thinkstock

45. Vermont
> Healthiest county: Addison
> Smoking rate: 12.6%
> Obesity rate: 23.0%
> Median household income: $59,688

Located in western Vermont, and bisected by U.S. Route 7, Addison is the healthiest county in the state. Adults in Addison County report an average of 2.9 physically unhealthy and 3.1 mentally unhealthy days a month, less than the 3.5- and 3.6-day averages among adults statewide.

Like many counties on this list, adults in Addison are more likely to maintain physically active lifestyles and less likely to smoke or be obese than adults across the state. The county’s life expectancy at birth of 80 years is also roughly half a year longer than life expectancy for Vermont as a whole.

Source: Thinkstock

46. Virginia
> Healthiest county: Arlington
> Smoking rate: 12.2%
> Obesity rate: 16.1%
> Median household income: $105,763

Located across the Potomac River just southwest from Washington D.C., Arlington County is the healthiest in Virginia. Arlington residents are among the most affluent nationwide, which likely helps in maintaining healthy and active lifestyles and therefore contributes to healthy outcomes. The typical Arlington household earns $105,763 a year, nearly twice the $53,889 national median household income.

The Census estimates that 100% of Arlington residents have access to opportunities for physical activity, compared to 81% of residents statewide. With numerous locations for outdoor recreation, just 13.4% of Arlington adults do not exercise and only 16.1% are obese — far less than the state inactivity and obesity rates of 21.4% and 27.2%, respectively.

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47. Washington
> Healthiest county: King
> Smoking rate: 10.1%
> Obesity rate: 22.2%
> Median household income: $75,302

Living in a dense, urban environments can have numerous health benefits, as residents may be more likely to commute by walking or bicycling and have more access to recreational opportunities. Roughly one-third of the King County population lives in Seattle, the largest city in Washington state. An estimated 98.1% of county residents have access to opportunities for physical activity, and 86.5% exercise regularly — each the largest share in the state. Such healthy behavior can significantly reduces the risk of premature death. For every 100,000 King County residents, 235 die before the age of 75 annually, less than the statewide premature mortality rate of 286 deaths per 100,000 residents.

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48. West Virginia
> Healthiest county: Putnam
> Smoking rate: 20.4%
> Obesity rate: 34.6%
> Median household income: $56,774

With a life expectancy of just 75.4 years — three years less than the average American — West Virginia is one of the least healthy states. While Putnam is the healthiest county in the state, the typical resident is still less healthy than the typical American. The county’s 20.4% smoking rate is the lowest in the state, for example, yet it is still higher than the 18.0% national figure.

Despite being in the healthiest county in West Virginia, Putnam County residents are at a greater risk of premature death than Americans on average. In Putnam County, 369 people die before the age of 75 per 100,000 people annually, less than the state figure of 471 premature deaths per 100,000 residents, but more than the national premature mortality rate of 333 per 100,000 Americans.

Source: Thinkstock

49. Wisconsin
> Healthiest county: Ozaukee
> Smoking rate: 14.1%
> Obesity rate: 27.1%
> Median household income: $76,433

Ozaukee County is the healthiest county in Wisconsin, and among the healthiest of all U.S. counties. Just 14.1% of area adults smoke, a smaller share than the both the 17.3% state and 18.0% national rates. While 22.0% of Americans and 20.4% of Wisconsin residents to not exercise, the inactivity rate for Ozaukee County is just 18.9%. Healthy living in Ozaukee is likely made possible by high income among area residents. An estimated 10.4% of county households earn at least $200,000 a year, the largest share in Wisconsin.

Overall, the risk of premature death in Ozaukee County is the lowest in the state. Some 212 per 100,000 residents die before the age of 75, far less than the state premature mortality rate of 301 deaths per 100,000 residents.

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50. Wyoming
> Healthiest county: Teton
> Smoking rate: 14.3%
> Obesity rate: 12.7%
> Median household income: $75,325

Spanning parts of Yellowstone National and Grand Teton National Park, Teton County provides an estimated 97.8% of its residents with adequate access to locations for physical activity, the largest share in Wyoming. Most Teton residents take advantage of the numerous recreational opportunities, as only 10.8% of county adults do not exercise — less than half the 22.4% state inactivity rate and the seventh smallest share of any county nationwide. Healthy behavior, including low inactivity and smoking rates, has likely contributed to the long life expectancy in the county. The life expectancy at birth in Teton County is 82 years, four years longer than the 78-year life expectancy for Wyoming as a whole and one of the longest of any U.S. county.