31. New Mexico
> Least healthy county: McKinley
> Population without health insurance 19.0%
> Population with limited access to healthy food 27.2%
> Obesity rate: 35.1%
Americans on the low extreme of the income spectrum are more likely to report poor health outcomes, and with a 38.1% poverty rate, McKinley County, New Mexico, is one of the poorest parts in the country. More than one in every four adults in the county are in fair or poor health, well above the comparable 20.8% share across the state and 16.0% of American adults nationwide.
Serious financial hardship can limit access to healthy foods and lead to unhealthy, caloric-heavy diets, which in turn can increase the likelihood of obesity. In Mckinley County, more than one in every three adults are obese, compared to 28.0% of adults nationwide and 24.4% of adults statewide.
32. New York
> Least healthy county: Bronx
> Population without health insurance 11.1%
> Population with limited access to healthy food 16.1%
> Obesity rate: 30.0%
Several unhealthy practices are relatively common in Bronx County — a county coterminous with the Bronx borough of New York City. There are 1,150 cases of chlamydia for for every 100,000 Bronx residents, by far the highest sexually transmitted disease diagnosis rate of any of the state’s 62 counties. Additionally, 31.1% of adults in the Bronx get no physical exercise outside of work, well above the 25.4% statewide inactivity rate.
Unhealthy behaviors often have unfavorable consequences. A reported 26.8% of adults in the Bronx are in fair or poor health, a far larger share than the 16.1% share of New York adults and 16.0% share nationwide.
33. North Carolina
> Least healthy county: Robeson
> Population without health insurance 19.6%
> Population with limited access to healthy food 21.7%
> Obesity rate: 38.6%
Nearly 30% of adults in Robeson County are in fair or poor health, the largest share of any of North Carolina’s 100 counties. Poor health is often the result of unhealthy behavior, and in Robeson, 27.2% of adults smoke, a far greater share than both the state and national smoking rates of 17.9% and 17.0%, respectively.
Adults in Robeson County are also far less likely to exercise than the typical American or North Carolinian. Sedentary lifestyles are a risk factor for obesity, and 38.6% of county adults are obese, compared to 29.6% of adults in the state and 28.0% of adults nationwide.
34. North Dakota
> Least healthy county: Sioux
> Population without health insurance 15.1%
> Population with limited access to healthy food 16.3%
> Obesity rate: 34.9%
An estimated 38.3% of adults in Sioux County are smokers, by far the highest smoking rate of any county in North Dakota and the fourth highest smoking rate of any U.S. county. Smoking is the leading cause of preventable death in the United States and premature death is more common in Sioux County than in any other U.S. county. There are 1,143 deaths before age 75 for every 100,000 Sioux County residents annually, more than three times the statewide premature death rate of 318 per 100,000.
The area’s high premature mortality rate may also be attributable to inadequate health insurance coverage. Some 15.1% of county residents are uninsured, well above the 8.7% statewide uninsured rate.
> Least healthy county: Adams
> Population without health insurance 9.3%
> Population with limited access to healthy food 17.9%
> Obesity rate: 31.5%
Residents of Adams County, Ohio, are far less likely to lead physically active lifestyles than the typical American. Some 29.4% of adults in Adams County never engage in physical activities, well above the respective state and national inactivity rates of 25.7% and 23.0%. The county’s physical inactivity rates may improve with greater access to exercise venues. Currently, just 40.2% of county adults have access to places like gyms and parks, less than half the comparable state and national shares.
Regular physical activity can improve both physical and mental health. Adults in Adams County spend more time every month in poor physical or mental health on average than adults across the state and the U.S. as a whole.