The Least Healthy County in Every State

March 29, 2018 by Sam Stebbins

Source: BrianAJackson / iStock

Americans who eat right, exercise regularly, and abstain from bad habits like smoking and excessive drinking are far more likely to live long, healthy lives. While this should come as a surprise to no one, unhealthy lifestyles remain common in certain parts of the country — and the serious toll they are taking is apparent in any number of reported health outcomes.

While lifestyle choices can have profound health implications, other factors, often outside of an individual’s control, can also have a significant impact on personal health. For a variety of reasons — limited access to healthy dietary and lifestyle options chief among them — lower-income Americans are more likely to report poor health outcomes than those who are financially secure. As a result, an area’s economy and job market are often closely tied to the health of a population.

Whether the causes are behavioral, economic, or some mix of the two, every state is home to at least one county where residents are far less likely to be in good health than residents across the state, and often the nation, as a whole.

24/7 Wall St. reviewed county-level data on behaviors and health outcomes from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program, to identify the least healthy county in every state. In some counties, residents are about three times more likely to die prematurely than residents across the state as a whole.

Click here to see the least healthy county in every state.
Click here to see our detailed findings and methodology.

Source: Public Domain / Wikimedia Commons

1. Alabama
> Least healthy county: Wilcox
> Population without health insurance 12.3%
> Population with limited access to healthy food 32.2%
> Obesity rate: 42.6%

Located about 80 miles southwest of the state capital Montgomery, Wilcox County is the least healthy county of a relatively unhealthy state. Across Alabama, there are 469 deaths before age 75 — mostly due to preventable causes — per 100,000 people, the third highest annual premature death rate among states. In Wilcox County, the rate is much higher at 645 premature deaths per 100,000 people.

The high premature death rate is largely attributable to unhealthy behaviors. For example, obesity can lead to a number of serious, often deadly, diseases and conditions, including diabetes, heart disease and certain cancers. In Wilcox County, 42.6% of the adult population is obese, well above the state obesity rate of 34.7% and U.S. rate of 28.0%.

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Source: Public Domain / Wikimedia Commons

2. Alaska
> Least healthy census area: Kusilvak
> Population without health insurance 22.9%
> Population with limited access to healthy food 27.1%
> Obesity rate: 27.5%

Low-income Americans have fewer healthy options related to diet and lifestyle than wealthier Americans. Partially as a result, poorer parts of the country are often less healthy. Alaska’s Kusilvak Census Area, with a 36.0% poverty rate — more than triple the poverty rate across Alaska as a whole — is no exception. An estimated 38% of adults in the census area are in fair or poor health, by far the largest share of any part of the state. To compare, statewide just 13.4% of adults are being in similarly poor health.

The area’s poor health outcomes may be partially attributable to the large share of residents without access to medical care. Americans with health insurance are more likely to make regular doctor visits and receive preventative treatment. In Kusilvak, 22.9% of the population lacks health insurance, more than double the 11.0% U.S. uninsured rate.

Source: John Phelan / Wikimedia Commons

3. Arizona
> Least healthy county: Apache
> Population without health insurance 17.5%
> Population with limited access to healthy food 26.6%
> Obesity rate: 33.7%

Residents of Apache County, Arizona, are more likely to have unhealthy behaviors and poor health outcomes than those in any other county in the state. Adults in Apache County report an average of 5.6 physically unhealthy days and 5.5 mentally unhealthy days each month — well above the respective statewide averages of 4.0 days and 3.9 days.

The area’s poor health outcomes are partly attributable to some bad habits. For example, 21.6% of adults in Apache County smoke compared to 14.7% of adults across the state. Additionally, Medicare enrollees in the county are far less likely to receive regular checkups, which is partially reflected in the county’s state-leading preventable hospitalization rate.

Source: Mor / Flickr

4. Arkansas
> Least healthy county: Phillips
> Population without health insurance 9.6%
> Population with limited access to healthy food 31.1%
> Obesity rate: 43.6%

Nearly 44% of adults in Phillips County, Arkansas, are obese, one of the highest obesity rates of any U.S. county. For reference, 34.6% of adults in Arkansas and 28.0% of all American adults are obese. Sedentary lifestyles can increase the risk of obesity, and in Phillips County, 37.0% of adults get no exercise beyond getting up and going to work. This is well above the 32.3% of inactive adults in Arkansas, which itself is the second highest physical inactivity rate among states.

Obesity can lead to a number of serious, often deadly, diseases and conditions, including heart disease, diabetes, and certain types of cancer. And the prevalence of obesity across the county may partially explain the far higher than typical premature death rate. There are 691 deaths before age 75 for every 100,000 people in the county annually compared to 458 deaths per 100,000 across Arkansas.

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Source: Bobak Ha'Eri / Wikimedia Commons

5. California
> Least healthy county: Kern
> Population without health insurance 9.7%
> Population with limited access to healthy food 13.4%
> Obesity rate: 31.6%

Seated by Bakersfield, a city about 100 miles north of Los Angeles, Kern County is the least healthy county in California. Some 24% of adults in the county are in fair or poor health, well above the 16.0% of American adults and 17.5% of Californian adults.

Though some outcomes are worse than typical in the county, unhealthy behaviors are not especially common in Kern relative to the U.S. as a whole. For example, 23.6% of county adults never exercise in their free time, a greater share than the 17.9% of inactive California adults, but roughly in line with the U.S. share. Similarly, 16.2% of adults in Kern are smokers, a larger share than the 11.0% of adults in the state but slightly below the 17.0% of American adults nationwide.

Source: JERRYE AND ROY KLOTZ MD / Wikimedia Commons

6. Colorado
> Least healthy county: Costilla
> Population without health insurance 15.8%
> Population with limited access to healthy food 6.1%
> Obesity rate: 22.1%

Adults in Costilla County, Colorado, report an average of 4.8 physically unhealthy days and 4.4 mentally unhealthy days per month. Statewide, adults report an average of 3.4 physically unhealthy days and 3.6 mentally unhealthy days a month. Poor health outcomes are often the result of unhealthy behavior, and adults in Costilla County are more likely to smoke and less likely to lead active lives than adults both state and nationwide.

Financially insecure Americans can afford fewer healthy options related to diet and lifestyle, and as a result, poorer Americans are often less healthy than those with greater financial resources. With an annual median household income of $26,610, Costilla County is the poorest in Colorado.

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Source: JJBers / Flickr

7. Connecticut
> Least healthy county: Windham
> Population without health insurance 6.0%
> Population with limited access to healthy food 11.6%
> Obesity rate: 29.2%

Connecticut is a relatively healthy state, and even in Windham County, the least healthy county in the state, residents typically report better health outcomes and behaviors than most Americans. For example, the county’s 16.4% adult smoking rate of is higher than the state’s rate of 13.4% but lower than the national rate of 17.0%. Additionally, Windham County residents are more likely to receive regular and preventative medical care as just 6.0% of the population lacks health insurance, compared to 11.0% of the U.S. population.

Still, Windham County’s 29.2% obesity rate is higher than the U.S. obesity rate of 28.0% and the highest of any county in Connecticut.

Source: JERRYE & ROY KLOTZ MD / Wikimedia Commons

8. Delaware
> Least healthy county: Kent
> Population without health insurance 6.9%
> Population with limited access to healthy food 13.3%
> Obesity rate: 33.6%

Kent County is the least healthy of the three counties in Delaware. Over one-third of county adults are obese, the largest share in the state and well above the 28% nationwide obesity rate. Regular exercise is one way to reduce the risk of obesity, and in Kent County, 30.3% of adults are never physically active in their free time, the largest share in the state and well above the 26.1% inactivity rate across Delaware as a whole. The county’s high inactivity rate may be partially attributable to a lack of access. Just 62.0% of the county’s population has access to places for physical activity like parks or gyms compared to 86.3% of Delaware residents.

Source: Excel23 / Wikimedia Commons

9. Florida
> Least healthy county: Putnam
> Population without health insurance 17.2%
> Population with limited access to healthy food 20.4%
> Obesity rate: 37.9%

Smoking is the leading cause of preventable death in the United States, and in Putnam County, Florida, one in every four adults are smokers. In comparison, just 17.0% of American adults and 15.5% of Florida adults smoke. The high smoking rate likely partially explains the greater incidence of premature death in the county. There are 524 deaths before age 75 for every 100,000 people in the county, far more than the premature death rate across Florida as a whole of 332 per 100,000.

Unhealthy areas are often also poor, and Putnam County is no exception. Some 27.0% of the county population lives below the poverty line, compared to the respective 16.1% and 15.1% state and national poverty rates.

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Source: Robbie Honerkamp / Wikimedia Commons

10. Georgia
> Least healthy county: Clay
> Population without health insurance 17.2%
> Population with limited access to healthy food 29.3%
> Obesity rate: 30.7%

Nearly 40% of Clay County, Georgia, residents live in poverty, well more than double the state and national poverty rates of 17.8% and 15.1%, respectively. Low-income Americans have fewer options relating to healthy diets and lifestyle, and as a result, are often more likely to report poor health outcomes. In Clay County, adults are more likely to be obese than the typical adult in Georgia. They also spend more time on average than adults statewide in poor physical or mental health.

A large share of Clay County adults also report some bad habits. For example, more than one in four adult residents are smokers, compared to 17.9% of adults in the state and 17.0% of adults nationwide.

Source: Thinkstock

11. Hawaii
> Least healthy county: Hawaii
> Population without health insurance 5.9%
> Population with limited access to healthy food 13.4%
> Obesity rate: 22.8%

Hawaii is a relatively healthy state. Despite ranking as the least healthy county in the state, Hawaii County is healthier than the U.S. as a whole in several measures. For example, just 22.8% of adults in Hawaii County are obese, slightly higher than the statewide obesity rate of 22.3% but well below the nationwide rate of 28.0%. The low obesity rate is likely attributable in part to a physically active population. Only 20% of adults in the county never engage in physical activity in their free time, in line with the statewide share and below the 23.0% U.S. physical inactivity rate.

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Source: Ian Poellet / Wikimedia Commons

12. Idaho
> Least healthy county: Benewah
> Population without health insurance 15.8%
> Population with limited access to healthy food 16.6%
> Obesity rate: 29.9%

In Benewah County, just 13.6% of adults have a bachelor’s degree compared to 26.2% of adults across Idaho. Adults with a college education are more likely to live longer, healthier lives than those with lower educational attainment. The county’s low educational attainment may therefore partially explain some unhealthy behaviors and outcomes among county residents. For example, adults living in Benewah County are less likely to exercise regularly and more likely to smoke than the typical adult in Idaho. Additionally, there are 521 deaths before age 75 for every 100,000 people in Benewah County, well above the statewide premature death rate of 307 per 100,000.

13. Illinois
> Least healthy county: Alexander
> Population without health insurance 6.8%
> Population with limited access to healthy food 23.3%
> Obesity rate: 28.0%

The least healthy county in a given state often also is poor, and Alexander County, Illinois, is no exception. Over one-third of the county population lives below the poverty line, more than double the 14.0% statewide and 15.1% nationwide poverty rates.

In Alexander, 27.3% of adults are in fair or poor health, a far greater share than the 17.2% of adults in the state and the 16.0% of adults nationwide. This widespread poor health not only is due to limited resources to afford healthy diets and lifestyles, but also to some unhealthy behaviors. An estimated 23.7% of area adults smoke, well above the statewide smoking rate of 15.8%.

Source: Public Domain / Wikimedia Commons

14. Indiana
> Least healthy county: Crawford
> Population without health insurance 12.0%
> Population with limited access to healthy food 14.8%
> Obesity rate: 31.7%

About 30% of adults in Crawford County, Indiana, get no exercise beyond getting up and going to work, a greater share than the 26.8% of adults across the state who are physically inactive. Regular physical exercise can help promote longer, healthier lives, and in Crawford County, premature death is relatively common. There are 431 deaths before age 75 for every 100,000 people in the county every year, compared to a statewide premature death rate of 392 per 100,000.

Higher educational attainment is linked to healthier lives, as those with a college degree often have a greater sense of control over their lives and are better equipped to make healthy decisions. In Crawford County, just 9.8% of adults have a bachelor’s degree, well below the statewide bachelor’s degree attainment rate of 24.6%.

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Source: Joanna Poe / Flickr

15. Iowa
> Least healthy county: Appanoose
> Population without health insurance 7.0%
> Population with limited access to healthy food 13.2%
> Obesity rate: 35.8%

More than one in every three adults in Appanoose County, Iowa, get no physical exercise beyond getting up and going to work, the largest share of any county in the state and well above the 23.0% physical inactivity rate nationwide. Sedentary lifestyles can increase the likelihood of obesity, and in Appanoose County 35.8% of adults are obese, a larger share than both the 31.8% state and 28.0% national obesity rates.

Obesity can lead to a number of serious and often deadly diseases and conditions, including heart disease, diabetes, and certain cancers. The county’s high obesity rate may partly explain the higher likelihood of premature death in the area. For every 100,000 county residents there are 429 deaths before age 75, compared to 313 premature deaths per 100,000 statewide.

Source: usacetulsa / Wikimedia Commons

16. Kansas
> Least healthy county: Labette
> Population without health insurance 10.2%
> Population with limited access to healthy food 16.2%
> Obesity rate: 36.1%

Unhealthy behaviors are relatively common in Labette County, Kansas. For example, more than one in five adults in the county smoke, compared to the 17.2% smoking rate across Kansas as a whole. Additionally, more than one in three adults in the county never engage in physically activities in their free time, compared the statewide 24.6% physical inactivity rate. Likely due in part to a high physical inactivity rate, 36.1% of adults in Labette County are obese. In comparison, 32.4% of adults in Kansas and 28.0% of adults nationwide are obese.

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Source: W.marsh / Wikimedia Commons

17. Kentucky
> Least healthy county: Leslie
> Population without health insurance 8.1%
> Population with limited access to healthy food 19.1%
> Obesity rate: 43.3%

Like many counties on this list, Leslie County is poor. An estimated 32.5% of the county population lives below the poverty line, more than double the U.S. poverty rate of 15.1%. Low-income Americans have fewer healthy options related to diet and lifestyle, and as a result often report suboptimal health. In Leslie County, 43.3% of adults are obese, the largest share in the state and one of the largest in the country.

The area’s low incomes are attributable in part to a lagging economy. Some 13.0% of the county’s workforce are out of a job, well above Kentucky’s unemployment rate of 5.0%.

Source: Billy Hathorn / Wikimedia Commons

18. Louisiana
> Least healthy parish: East Carroll
> Population without health insurance 13.9%
> Population with limited access to healthy food 34.1%
> Obesity rate: 38.4%

Americans with health insurance are more likely to make regular doctor visits and receive preventative care and treatment when necessary. In the East Carroll Parish, about 14% of residents lack health insurance, well above the U.S. uninsured rate of 11.0%. The high uninsured rate may partly explain some of the area’s poor health outcomes. For example, 38.2% of adults in East Carroll are in fair or poor health, the largest share of any parish in Louisiana and more than double the 16.0% share of adults nationwide.

Most Americans receive health coverage through their employer, and a better job market might serve to improve coverage — and health outcomes — in East Carroll. An estimated 11.7% of the area’s workers are unemployed, more than double the 4.9% U.S. unemployment rate.

Source: Magicpiano / Wikimedia Commons

19. Maine
> Least healthy county: Washington
> Population without health insurance 15.7%
> Population with limited access to healthy food 16.5%
> Obesity rate: 29.7%

Americans with health insurance are more likely to make regular doctor visits and receive preventative care and treatment, and consequently, they are more likely to be in better health. In Washington County, Maine, 15.7% of the population lacks health insurance, the highest uninsured rate of any county in the state. Greater insurance coverage would likely improve outcomes in the county. There are 439 deaths before age 75 for every 100,000 people in Washington County annually, the highest premature death rate of any county in Maine.

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Source: User:JGHowes, photographer / Wikimedia Commons

20. Maryland
> Least healthy county equivalent: Baltimore City
> Population without health insurance 8.2%
> Population with limited access to healthy food 23.2%
> Obesity rate: 33.6%

The independent city of Baltimore is the least healthy county or county equivalent in Maryland. There are about 610 deaths before age 75 for every 100,000 people in the city, by far the highest premature death rate in the state. Additionally, indicative of widespread poor maternal health, about 11.7% of all newborns in Baltimore are dangerously underweight, the largest such share in Maryland. Some underweight births are likely to teen mothers who are prone to complications, as Baltimore also has the highest teen birth rate in the state.

Source: takomabibelot / Flickr

21. Massachusetts
> Least healthy county: Hampden
> Population without health insurance 4.0%
> Population with limited access to healthy food 10.5%
> Obesity rate: 27.6%

Massachusetts’ population is relatively healthy, and even Hampden, the least healthy county in the state, is about as healthy as the U.S. as a whole by several measures. For example, 18.3% of county adults are smokers, well above the statewide smoking rate of 13.6%, but only slightly higher than the national rate of 17.0%. Additionally, the county’s 27.6% obesity rate, though higher than the 24.3% state rate, is just under the 28.0% U.S. rate.

Hampden County residents are also far more likely to make regular doctor visits than most Americans as only 4.0% of the population lacks health insurance, well below the 11.0% U.S. uninsured rate.

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Source: Thinkstock

22. Michigan
> Least healthy county: Wayne
> Population without health insurance 8.4%
> Population with limited access to healthy food 21.0%
> Obesity rate: 33.1%

Wayne County, seated by the city of Detroit, is the least healthy county in Michigan. There are 487 deaths before age 75 for every 100,000 people in the county, well above the premature death rate across Michigan as a whole of 364 per 100,000. Poorer populations often report worse health outcomes, and Wayne County is one such example. About one in four county residents live in poverty, a far greater share than the 16.3% statewide poverty rate.

While the region’s high violent crime rate may partially explain the higher likelihood of premature death, unhealthy behaviors and conditions likely contribute to the higher rate as well. Obesity can lead to a number of serious, and sometimes deadly, diseases and conditions, and nearly one in three county adults are obese, well above the 28.0% U.S. obesity rate.

Source: Andrew Filer (afiler) / Wikimedia Commons

23. Minnesota
> Least healthy county: Mahnomen
> Population without health insurance 9.0%
> Population with limited access to healthy food 14.0%
> Obesity rate: 34.0%

Minnesota is a relatively healthy state. Still, not all parts of the state are especially healthy. In Mahnomen County for example, 21.4% of adults are in fair or poor health, a larger share than the 16.0% share of adults nationwide and a far larger share than the 12.0% of adults across Minnesota as a whole. The area’s poor health outcomes may be partially attributable to some bad habits. An estimated 23.8% of adults in the county are smokers compared to just 17.0% of American adults and 15.2% of adults in the state. On average, nonsmokers live 10 years longer than smokers, and the high smoking rate in Mahnomen County likely contributes to a greater incidence of premature death. There are 511 deaths before age 75 per 100,000 people in the county annually, well above the premature death rate across Minnesota of 263 per 100,000.

Source: NatalieMaynor / Flickr

24. Mississippi
> Least healthy county: Holmes
> Population without health insurance 15.3%
> Population with limited access to healthy food 34.6%
> Obesity rate: 40.8%

Holmes County is the least healthy county in one of the least healthy states. Across Mississippi, there are 497 deaths — largely due to preventable causes — before age 75 for every 100,000 people, the highest premature death rate of any state. In Holmes County, there are 662 premature deaths per 100,000 residents.

Obesity can increase the risk serious and often deadly diseases and conditions, including hypertension, stroke, and cancer. In Holmes County, 40.8% of adults are obese, well above the statewide obesity rate of 35.3% and the nationwide rate of 28.0% U.S. The area’s high obesity rate may be partially the result of a lack of access to facilities to exercise. Just 29.2% of county residents have access to places like gyms or parks, well below the 83.0% share of Americans nationwide.

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Source: Kbh3rd / Wikimedia Commons

25. Missouri
> Least healthy county: Pemiscot
> Population without health insurance 13.0%
> Population with limited access to healthy food 24.6%
> Obesity rate: 35.5%

Adults in Pemiscot County, Missouri, are among the least likely to regularly engage in healthy physical activity in the country. Across the United States, 23.0% of adults get no physical exercise beyond getting up and going to work. In Pemiscot County, the adult inactivity rate is 39.4%, the highest in Missouri. The prevalence of sedentary lifestyles may be due in part to a lack of access to venues for exercise. Just 52.6% of county residents have access to places like parks or gyms, well below the 77.4% state and 83.0% national access rates.

Inactivity is a risk factor for obesity, and 35.5% of adults in Pemiscot County are obese, compared to 31.8% adults in Missouri and 28.0% of adults nationwide.

Source: Andrew Filer / Flickr

26. Montana
> Least healthy county: Big Horn
> Population without health insurance 23.2%
> Population with limited access to healthy food 17.7%
> Obesity rate: 37.9%

Teen pregnancy can have serious health implications for both mother and child, and in Big Horn County, Montana, it is a considerable problem. There are 87 teen births for every 1,000 females age 15-19 in the county, three times the teen birth rate across Montana of 28 per 1,000. Smoking is another health concern in the county. More than one in four county adults are smokers, compared to 18.5% of adults in Montana and 17.0% of adults nationwide.

Many of those in need of medical treatment in Big Horn County are unlikely to receive it as 23.2% of residents are without health insurance, well above the 14.2% state and more than double the 11.0% U.S. uninsured rate.

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Source: Public Domain / Wikimedia Commons

27. Nebraska
> Least healthy county: Thurston
> Population without health insurance 17.3%
> Population with limited access to healthy food 18.8%
> Obesity rate: 43.3%

The adult obesity rate in Thurston County is 43.3%, the highest of any county in Nebraska and one of the highest in the United States. Obesity is a risk factor for a number of diseases and conditions that are often deadly, especially when left untreated, and county residents are less likely to make regular doctor visits than the typical American. An estimated 17.3% of the county population lacks health insurance, compared to the national uninsured rate of 11.0% and the state rate of 9.4%.

Thurston County’s high obesity and uninsured rates likely contribute to the area’s suboptimal health outcomes. Some 22.6% of adults in the county are in fair or poor health, a far greater share than the 14.2% of adults in Nebraska and 16.0% of adults nationwide.

28. Nevada
> Least healthy county: Mineral
> Population without health insurance 13.3%
> Population with limited access to healthy food 17.6%
> Obesity rate: 29.2%

Smoking is the leading cause of preventable death in the United States, and more than one in five adults in Mineral County, Nevada, are smokers, well above the 16.5% statewide smoking rate. Adults in the county are also less likely to engage in physical activities than the typical Nevadan or American. The area’s inactive lifestyles are likely attributable in part to environmental conditions. Just 8.5% of the county population has access to places for physical activity like parks and gyms. In comparison, 91.8% of the population in Nevada and 83.0% of the U.S. population have such access.

Source: Ken Lund / Flickr

29. New Hampshire
> Least healthy county: Coos
> Population without health insurance 9.8%
> Population with limited access to healthy food 12.3%
> Obesity rate: 29.8%

New Hampshire is a relatively healthy state, and even in Coos County, the least healthy in the state, residents are more likely to be in good health than the typical American. For example, 14.3% of county adults are in fair or poor health. Though the county’s share of adults in suboptimal health is higher than the 13.6% statewide share, it is considerably lower than the 16.0% nationwide share. Additionally, the county’s smoking rate and share of newborns who are dangerously underweight — a condition often indicative of poor maternal health — are lower than the comparable national rates.

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Source: Public Domain / Wikimedia Commons

30. New Jersey
> Least healthy county: Cumberland
> Population without health insurance 12.7%
> Population with limited access to healthy food 12.9%
> Obesity rate: 34.7%

An estimated 29.3% of adults in Cumberland County get no physical exercise beyond getting up and going to work — the largest share of any of the 21 counties in New Jersey. Regular exercise can be critical to physical health, and adults in the county spend an average of 4.2 days a month in poor physical health, also the most of any county in the state. Sedentary lifestyles can also lead to an increased risk of obesity, and 34.7% of Cumberland County adults are obese, well above the 28.0% U.S. obesity rate and the 25.9% statewide rate.

Source: Public Domain / Wikimedia Commons

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.

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Source: Deberarr / iStock

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.

Source: Gerry Dincher / Wikimedia Commons

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.

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Source: Aesopposea / Wikimedia Commons

35. Ohio
> 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.

Source: Public Domain / Wikimedia Commons

36. Oklahoma
> Least healthy county: Adair
> Population without health insurance 22.6%
> Population with limited access to healthy food 18.5%
> Obesity rate: 41.9%

Nearly 42% of adults in Adair County are obese, the largest share of any county in Oklahoma and one of the largest shares of any U.S. county. Poorer populations are often at an elevated risk of obesity as unhealthy, calorie-heavy foods are often less expensive than healthier fresh fruits and vegetables and lean meats. In Adair County, slightly more than 30% of the population lives in poverty, well above the state and U.S. poverty rates of 16.5% and 15.1%, respectively. Obesity can take a daily toll on physical and mental health, and adults in Adair County report an average of 5.9 physically unhealthy days and 5.8 mentally unhealthy days per month, each the most of any county in the state.

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Source: Finetooth / Wikimedia Commons

37. Oregon
> Least healthy county: Jefferson
> Population without health insurance 12.7%
> Population with limited access to healthy food 13.7%
> Obesity rate: 35.2%

Americans with health insurance are typically in better health than the uninsured as they are more likely to schedule regular doctor visits and receive preventative care and treatment. In Jefferson County, the least healthy county in Oregon, 12.7% of the population lacks health insurance, the largest share of any county in the state. Likely partially due to the high uninsured rate, premature, largely preventable death is far more common in Jefferson County than it is across the state as a whole.

Most Americans receive health insurance through their employers, but in Jefferson, 6.7% of workers are out of a job, well above the 4.9% state and national unemployment rates. Improved economic conditions would likely increase health insurance coverage rates and lead to better health outcomes across the county population.

Source: Thinkstock

38. Pennsylvania
> Least healthy county: Philadelphia
> Population without health insurance 11.0%
> Population with limited access to healthy food 21.0%
> Obesity rate: 29.4%

Seated by, and coterminous with the city of Philadelphia, Philadelphia County is the least healthy county in Pennsylvania. Several unhealthy habits are relatively common among Philadelphia residents. For example, 22.1% of adults in the county drink excessively on a regular basis, higher than the excessive drinking rate statewide of 20.5% and nationwide of 18.0%. Additionally, despite nearly every Philadelphia resident having access to places for physical activities like gyms and parks, adults in the county are less likely to have active lifestyles than the typical adult in Pennsylvania.

Source: Thinkstock

39. Rhode Island
> Least healthy county: Providence
> Population without health insurance 8.0%
> Population with limited access to healthy food 13.5%
> Obesity rate: 28.1%

Rhode Island is a relatively healthy state, and even in Providence, the least healthy county in the state, outcomes are not much worse than they are nationwide. For example, 16.5% of adults in Providence County are in fair or poor health, more than the 14.8% of adults across the state but only slightly higher than the 16.0% share nationwide. Similarly, 28.1% of county adults are obese, compared to 28.0% of adults nationwide and 27.2% of adults across Rhode Island. Adults in Providence County are also only slightly less likely to lead physically active lives than those across both the state and the U.S. as a whole.

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Source: Public Domain / Wikimedia Commons

40. South Carolina
> Least healthy county: Marlboro
> Population without health insurance 14.4%
> Population with limited access to healthy food 23.2%
> Obesity rate: 36.6%

About one in every four adults in Marlboro County, South Carolina, are in fair or poor health, well above the respective 19.1% and 16.0% state and national shares. The area’s poor health outcomes are likely attributable in part to some unhealthy behaviors. For example, adults in Marlboro County are more likely to smoke and less likely to exercise regularly than the typical American or South Carolinian adult. Physical inactivity rates in the county would likely improve with greater access to venues for physical activity. Virtually no residents of the county along the state’s northern border have access to places for exercise like gyms and parks.

Source: Thinkstock

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.

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Source: Flickr user chiacomo / Wikimedia Commons

42. Tennessee
> 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.

Source: 25or6to4 / Wikimedia Commons

43. Texas
> 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.

Source: Ken Lund / Flickr

44. Utah
> 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.

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Source: Doug Kerr from Albany, NY, United States / Wikimedia Commons

45. Vermont
> 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.

Source: Sarah Stierch / Wikimedia Commons

46. Virginia
> Least healthy county equivalent: Petersburg City
> Population without health insurance 12.2%
> Population with limited access to healthy food 27.8%
> Obesity rate: 45.3%

The independent city of Petersburg is the least healthy county or county equivalent in Virginia. An estimated 45.3% of area adults are obese, by far the largest share in the state and the fifth largest share nationwide. Sedentary lifestyles are a risk factor for obesity, and an estimated 27.0% of adults in Petersburg City get no exercise outside of work, a far greater share than the 22.3% of adults in Virginia and the 23.0% of adults nationwide.

Obesity can lead to a number of serious and often deadly diseases and conditions including stroke, cancer, and heart disease, and the area’s high obesity rate may partly explain its high premature death rate. There are 765 deaths before age 75 for every 100,000 Petersburg City residents a year, more than double the statewide premature death rate.

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Source: Kevmin / Wikimedia Commons

47. Washington
> Least healthy county: Ferry
> Population without health insurance 11.9%
> Population with limited access to healthy food 18.0%
> Obesity rate: 28.3%

Adults in Ferry County spend an average of nearly an entire day more per month in poor mental or physical health than the typical adult across Washington as a whole.

Americans with health insurance coverage are more likely to make regular doctor visits and receive preventative care and treatment. In Ferry County, 11.9% of the population is uninsured, compared to 11.0% of Americans and 7.6% of Washingtonians. Most Americans receive health coverage through their employer, and a better job market might serve to improve coverage — and health outcomes — in Ferry County. An estimated 10.8% of the area’s workers are unemployed, more than double the 4.9% U.S. unemployment rate and well above the 5.4% state jobless rate.

Source: NASKWV / Flickr

48. West Virginia
> Least healthy county: McDowell
> Population without health insurance 9.4%
> Population with limited access to healthy food 22.3%
> Obesity rate: 44.6%

McDowell County is the least healthy county in West Virginia and one of the least healthy counties in the United States. Adults in McDowell County spend an average of nearly six days every month in poor mental health, the most time of any U.S. county, and 6.4 days feeling in poor physically unhealthy, the third most. Being overweight can strain mental and physical health, and 44.6% of county adults are obese, well above the 35.5% state and 28.0% U.S. obesity rates — and the eighth highest of any county in the country.

Poor health outcomes are often the product of unhealthy behaviors, and adults in McDowell County are more likely to smoke and less likely to exercise than adults in both West Virginia and the U.S. as a whole.

Source: Royalbroil / Wikimedia Commons

49. Wisconsin
> Least healthy county: Menominee
> Population without health insurance 10.3%
> Population with limited access to healthy food 18.7%
> Obesity rate: 45.1%

Obesity can lead to a number of serious often fatal diseases and conditions, including cancer, stroke, and hypertension, and 45.1% of adults in Menominee County are obese, the fifth largest share of any U.S. county and by far the largest share in Wisconsin. Poor outcomes are often attributable to unhealthy behavior. About 20% of county adults regularly drink excessively, and about 30% never exercise — higher than the comparable 18% and 23% U.S. rates, respectively.

The counties on this list are often poor, and Menominee County is no exception. Some 33.1% of the population lives below the poverty line, the largest share of any county in the state and more than double the 15.1% U.S. poverty rate.

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Source: Chevsapher / Wikimedia Commons

50. Wyoming
> Least healthy county: Fremont
> Population without health insurance 18.9%
> Population with limited access to healthy food 13.7%
> Obesity rate: 29.7%

Though it ranks as the least healthy county in Wyoming, Fremont County is not especially unhealthy relative to the U.S. as a whole. For example, 16.8% of county adults are in fair or poor health, which is only slightly larger than the 15.1% share across Wyoming and the 16.0% share nationwide. Similarly, 29.7% of adults in the county are obese, not much higher than the 28.5% and 28.0% of adults across the state and nation, respectively.

The overall health of a population is often tied to income. In Fremont County, the typical household earns $53,559 a year, only slightly less than the $59,143 state and $55,322 national median household incomes.

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.