41. South Dakota
> Least healthy county: Oglala Lakota
> Population without health insurance 18.2%
> Population with limited access to healthy food 27.5%
> Obesity rate: 41.2%
Oglala Lakota County is the least healthy county in South Dakota and one of the least healthy places in the United States. There are 998 deaths before age 75 for every 100,000 county residents annually, the third highest premature death rate of any U.S. county. The county’s high premature death rate almost would certainly improve with healthier lifestyles. Currently, 41.2% of county adults smoke, the second highest smoking rate of any U.S. county. Additionally, 41.2% of county adults are obese compared to the 30.6% state and 28.0% U.S. obesity rates.
Unhealthy areas are often poor, and Oglala Lakota County is no exception. Over half of the county population lives below the poverty line, more than triple the 15.1% U.S. poverty rate.
> Least healthy county: Lake
> Population without health insurance 11.5%
> Population with limited access to healthy food 21.4%
> Obesity rate: 34.9%
More than one in five residents of Lake County, Tennessee, regularly struggle to put food on the table, largely due to financial constraints. Individuals faced with food insecurity are more likely to have unhealthy diets of fast food and heavily processed convenience store foods that can drive up the likelihood of obesity. A smaller 15.4% share of Tennessee residents are food insecure and the difference has likely contributed to the discrepancy in health outcomes. For example, 34.9% of Lake County residents are obese compared to 32.4% of state residents. Obesity can dramatically shorten life expectancy, and there are 658 deaths before age 75 for every 100,000 county residents compared to the statewide premature death rate of 441 per 100,000.
> Least healthy county: Brooks
> Population without health insurance 18.7%
> Population with limited access to healthy food 11.3%
> Obesity rate: 28.1%
Some 37.8% of adults in Brooks County, Texas, are in fair or poor health, nearly the largest share of any county in the United States. Poorer Americans are more likely than higher income Americans to be in suboptimal health, and more than one in three county residents live below the poverty line, more than double the 15.1% U.S. poverty rate.
In addition to low incomes, unhealthy lifestyles also contribute to poor health outcomes. Adults in Brooks County are more likely to smoke and less likely to exercise than the typical American or Texan adult.
> Least healthy county: San Juan
> Population without health insurance 19.9%
> Population with limited access to healthy food 19.8%
> Obesity rate: 30.6%
Utah is a relatively healthy state. Even San Juan County, the least healthy county in the state, ranks better than the U.S. as a whole in a number of behavioral measures. For example, though smoking and sedentary lifestyles are more common in San Juan County than across Utah as a whole, they are less common than across the United States as a whole.
Despite relatively healthy behaviors, some health outcomes in the county are worse than typical. For example, 20.9% of adults in San Juan County are in fair or poor health, compared to 16.0% of adults nationwide and 12.1% of adults in Utah.
> Least healthy county: Essex
> Population without health insurance 6.5%
> Population with limited access to healthy food 14.1%
> Obesity rate: 28.8%
Essex County is relatively rural. It is the northeasternmost county in Vermont, with Canada along its northern border and New Hampshire to the east. Despite ranking as the least healthy county in the state, it is about as healthy or healthier than the U.S. as a whole by several measures. For example, the county’s 28.8% obesity rate, while higher than the 24.7% statewide rate, is roughly in line with the 28.0% rate nationwide. Similarly, 16.3% of adults in Essex County are in fair or poor health, high compared to the 12.5% share of Vermont adults, but closely aligned with the comparable 16.0% national share.
Adults in Essex County are also less likely to smoke or drink to excess than the typical American adult.