Special Report

The Least Healthy County in Every State

Detailed Findings & Methodology

More often than not, a population reporting worse health outcomes than is typical across the state and nation as a whole also reports a relatively high incidence rate of unhealthy behaviors. In every county on this list, the premature death rate — that is, the number of people who die before age 75, largely of preventable causes, for every 100,000 residents, is higher than the corresponding statewide rate.

Smoking is the leading cause of preventable death in the United States, and nonsmokers live an average 10 years longer than smokers. Perhaps not surprisingly, all but five counties on this list have a higher adult smoking rate than the average across their home state as a whole.

Regular exercise is another lifestyle choice that can be critical to both good physical and mental well-being. In all but one county on this list, adults are more likely to have totally sedentary lifestyles than the adult population across the state as a whole. Not only are those with physically inactive lifestyles more likely to report poor mental and physical health, but also they are at greater risk of obesity — which itself is a risk factor for a number of serious, often deadly, conditions and diseases, including cancer, stroke, and diabetes.

Poor health outcomes among the counties on this list are often attributable to much more than just unhealthy behaviors. An area’s economy and job market also play a considerable role in the overall health of its population. Americans with health insurance are more likely to make regular visits to the doctor and receive necessary preventative care and treatment — and the majority of Americans with health insurance are insured through their employer. As a result, a high jobless rate can translate to poorer health outcomes, and every county on this list has a higher unemployment rate than its respective state.

An area’s economy affects socioeconomic status, which also plays a role in a population’s overall health. Poorer Americans can afford fewer healthy options related to diet and lifestyle, and a result, are more likely to be in suboptimal health. Each county on this list has a higher poverty rate than its home state as a whole. In Oglala Lakota County, the least healthy in South Dakota and one of the least healthy nationwide, over half of the population lives below the poverty line.

Some states have healthier populations than others, and as a result, not every county on this list is unhealthy relative to the U.S. as a whole. For example, nationwide, 16.0% of adults are in fair or poor health. The comparable share of adults is lower than average in the least healthy county in five states — Connecticut, New Hampshire, Iowa, Maine, and Hawaii. With the exception of Maine, the least healthy county in each of those states also reports a lower uninsured rate than the national average as well as a lower adult smoking rate.

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 and 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. We also considered poverty rates, educational attainment rates, and median household incomes from the U.S. Census Bureau’s 2016 American Community Survey. All ACS data were five year estimates.

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