Healthiest County in Every State

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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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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.

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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.

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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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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.