Healthiest County in Every State
June 5, 2018 by Sam StebbinsPhysical and mental health are perhaps the most important aspects of every American’s life, and can dictate overall well-being and quality of life. But health outcomes and behaviors vary widely across the country, and Americans are far more likely to live long, healthy lives in some parts of the country than in others.
Positive health outcomes are often the result of healthy behaviors. Maintaining a healthy weight through a balanced diet and regular exercise, abstinence from smoking and excessive drinking, and regular doctor visits — while by no means a guarantee — will greatly increase one’s chances for a long and healthy life.
While the components of a healthy lifestyle are no mystery, the likelihood of practicing healthy behaviors appears to hinge largely on circumstances that at first glance may not seem related to health — such as income and educational attainment.
To identify the healthiest counties in each state, 24/7 Wall St. reviewed county-level health data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. In almost every state, even in those characterized by unhealthy habits and poor health outcomes, there is at least one county where residents are much more likely to be in good health than is typical nationwide.
Click here to see the healthiest county in every state.
Click here to see our detailed findings and methodology.
1. Alabama: Shelby County
> Smoking rate: 16.9% (state: 21.5%)
> Obesity rate: 29.2% (state: 34.7%)
> Adults w/ active lifestyles: 75.7% (state: 71.0%)
> Median household income: $72,310 (state: $44,758)
Based on a range of measures of behaviors and health outcomes, Shelby is the healthiest of all 67 of Alabama counties. Just 14.6% of adults in the county report being in fair or poor health, the smallest share in the state and well below the 21.4% share of adults across the state as a whole. The county’s good health outcomes are due in part to residents’ healthy lifestyles. Shelby is one of only three counties in Alabama where fewer than the national average of 17% of adults smoke. Additionally, adults in Shelby County are more likely to regularly engage in physical activity than the typical adult in Alabama.
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2. Alaska: Borough of Juneau
> Smoking rate: 18.0% (state: 19.0%)
> Obesity rate: 28.8% (state: 29.4%)
> Adults w/ active lifestyles: 85.0% (state: 80.7%)
> Median household income: $87,436 (state: $74,444)
The Borough of Juneau — which is home to Alaska’s capital — is the healthiest of all of Alaska’s boroughs. Just 11.9% of adults in Juneau report being in fair or poor health, one of the smallest shares in the state and below the state rate of 13.4%. This may partially be attributable to the fact that residents tend to lead healthier lifestyles than the typical Alaskan. Some 85.0% of adults in the Borough of Juneau lead an active lifestyle, outpacing the 80.7% of Alaskan adults overall. Getting physical exercise can decrease the likelihood of heart disease and other life-threatening conditions.
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3. Arizona: Maricopa County
> Smoking rate: 13.7% (state: 14.7%)
> Obesity rate: 26.3% (state: 26.7%)
> Adults w/ active lifestyles: 81.0% (state: 79.8%)
> Median household income: $55,676 (state: $51,340)
Maricopa County, seated by the city of Phoenix, is the healthiest in Arizona. Just 14.6% of adults report being in fair or poor health, well below the 17.8% of adults across the state.
Regular exercise can be an important component of a healthy lifestyle, and adults in Maricopa are slightly more likely than the typical Arizona adult to regularly engage in physical activity. The higher exercise rates may be due to greater access. Some 92% of Maricopa County’s population has access to places for physical activity like gyms and parks compared to 86% of Arizona’s population. Higher-income households can afford a wider range of options related to healthy diets and lifestyles, and in Maricopa County, the typical household earns $55,676 compared to the statewide median of $51,340.
4. Arkansas: Benton County
> Smoking rate: 17.6% (state: 23.6%)
> Obesity rate: 30.8% (state: 34.6%)
> Adults w/ active lifestyles: 73.6% (state: 67.7%)
> Median household income: $59,016 (state: $42,336)
Smoking cigarettes or other tobacco products can be one of the most physically harmful activities a person can do. An estimated 480,000 Americans die annually as a result of smoking, and the average smoker lives 10 fewer years than the average non-smoker. As the healthiest county in Arkansas, the smoking rate in Benton County is much lower than the state as whole. Just 17.6% of county adults smoke, less than all but one other county and far below the state’s 23.6% smoking rate.
Leading a healthy lifestyle can be expensive, and Benton County residents are better equipped to handle those costs than Arkansas residents overall. The county’s median household income of $59,016 a year is well above the state’s median household income of $42,336.
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5. California: Marin County
> Smoking rate: 9.7% (state: 11.0%)
> Obesity rate: 18.1% (state: 22.7%)
> Adults w/ active lifestyles: 88.0% (state: 82.1%)
> Median household income: $100,310 (state: $63,783)
Marin is healthiest county in California and one of the healthiest in the United States. Adults in the county report an average of just 3.0 physically unhealthy days and 3.3 mentally unhealthy days per month, compared to an average of 3.5 physically unhealthy days and 3.5 mentally unhealthy days across the state. Each also is at least half a day less than the national averages.
Marin’s better health outcomes are linked to healthy behavior as the county is one of just 25 nationwide where fewer than one in every 10 adults smoke. Residents are also more likely to be able to afford a wider range of options related to healthy diets and lifestyles. The typical Marin household earns just over $100,000 a year, well above the statewide median income of $63,783 and the national median of $55,322.
6. Colorado: Douglas County
> Smoking rate: 9.5% (state: 15.6%)
> Obesity rate: 17.5% (state: 20.5%)
> Adults w/ active lifestyles: 89.7% (state: 84.9%)
> Median household income: $105,759 (state: $62,520)
Leading a healthy lifestyle includes being physically active and eating healthy foods. Affording a healthy lifestyle can be difficult for low-income individuals, as quality health care, healthy foods, and access to places for physical activity can be expensive. This may not be a problem for the typical resident of Douglas County, Colorado, where the median annual household income is $105,759 — more than $40,000 higher than the statewide median.
Nearly 90% of Douglas County adults report leading an active lifestyle, which trails just two other counties in Colorado. The county also has the lowest adult smoking rate in the state at just 9.5%.
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7. Connecticut: Middlesex County
> Smoking rate: 11.3% (state: 13.3%)
> Obesity rate: 24.1% (state: 25.2%)
> Adults w/ active lifestyles: 81.5% (state: 79.6%)
> Median household income: $79,837 (state: $71,755)
Connecticut has a relatively healthy population, and by most metrics, every county in the state is healthier than the U.S. as a whole. Middlesex County is the healthiest county in the state. Adults in Middlesex are less likely to smoke, more likely to exercise, and less likely to be obese than the typical adult in the state and the country as a whole.
Higher levels of educational attainment can give individuals a greater sense of control over their life and better equip them to make healthy decisions. As a result, college-educated Americans are typically in better health than those with lower educational attainment. In Middlesex County, 40.9% of adults have a bachelor’s degree, compared to 38.0% of Connecticut adults and 30.3% of adults nationwide.
8. Delaware: New Castle County
> Smoking rate: 16.8% (state: 17.7%)
> Obesity rate: 29.2% (state: 30.6%)
> Adults w/ active lifestyles: 75.5% (state: 73.9%)
> Median household income: $66,283 (state: $61,017)
New Castle is one of just three Delaware counties, and it has some clear advantages that make it the healthiest place in the state. Some 75.5% of New Castle County residents report that they lead a active lifestyle, a higher rate than both other counties. This high rate of active adults may stem from the fact that 96.4% of county residents say they have a place where they could go to get exercise, well ahead of anywhere else in the state.
New Castle County also has the lowest rate of uninsured residents in Delaware. Insurance can help defray the high cost of some necessary medical procedures and may make people more likely to seek preventive health care than those who would otherwise have to pay for it out of pocket.
9. Florida: St. Johns County
> Smoking rate: 13.4% (state: 15.5%)
> Obesity rate: 22.4% (state: 25.9%)
> Adults w/ active lifestyles: 81.6% (state: 76.2%)
> Median household income: $69,523 (state: $48,900)
Just 11.3% of adults in St. Johns County are in fair or poor health, well below the 18.5% share of adults across Florida as a whole. These better health outcomes may be partially attributable to widespread health insurance coverage in the county. Americans with health insurance are more likely to make regular doctor visits and receive preventative medical care, and just 10.1% of St. Johns’ population lacks health insurance compared to 16.3% of Florida residents.
Excessive alcohol consumption is never healthy. Still, higher-income Americans are more likely to drink excessively than those at the other end of the income spectrum, and St. Johns is no different. With the typical household making over $20,000 more than the typical household statewide, county adults are more likely to binge drink or drink heavily than the typical Florida adult.
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10. Georgia: Oconee County
> Smoking rate: 14.4% (state: 17.9%)
> Obesity rate: 29.0% (state: 30.2%)
> Adults w/ active lifestyles: 78.6% (state: 75.9%)
> Median household income: $75,946 (state: $51,037)
Better-educated adults often are better informed to make healthier lifestyle choices. Oconee County is the healthiest county in Georgia. It is also one of the best educated. Some 46.6% of county adults have a bachelor’s degree, much higher than Georgia’s bachelor’s attainment rate of 29.4%.
Higher educational attainment rates may contribute not only to better health outcomes, but to higher incomes as well. Oconee County’s median household income of $75,946 is more than $20,000 higher than the median income across the state, likely allowing its residents to have greater access to medical care and healthier foods.
11. Hawaii: Honolulu County
> Smoking rate: 11.2% (state: 13.1%)
> Obesity rate: 22.2% (state: 22.3%)
> Adults w/ active lifestyles: 79.8% (state: 79.9%)
> Median household income: $77,161 (state: $71,977)
Honolulu is the healthiest county in one of the healthiest states. The county’s obesity rate of 22.2% and Hawaii’s rate of 22.3% are each well below the national obesity rate of 28.0%. Additionally, just 12.3% of adults in the county and 14.0% of adults in Hawaii are in fair or poor health, each below the 16.0% share of adults nationwide.
These relatively positive health outcomes may be partially due to widespread health insurance coverage. Americans with health insurance are more likely to make regular doctor visits and receive preventative care, and just 4.4% of the Honolulu County population and 4.8% of Hawaiians lack health insurance, less than half the 11.0% nationwide uninsured rate.
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12. Idaho: Ada County
> Smoking rate: 11.8% (state: 14.5%)
> Obesity rate: 25.6% (state: 28.6%)
> Adults w/ active lifestyles: 84.5% (state: 79.8%)
> Median household income: $58,099 (state: $49,174)
Residents of Ada County, Idaho, are more likely to make healthy lifestyle choices than the average Idaho resident. The smoking rate of 11.8% is the lowest in the state, and it has one of the lowest rates of physical inactivity in the country, as 15.5% of county adults lead sedentary lifestyles, compared to the national share of 23.0%.
The county’s lower smoking and obesity rates likely contribute to residents overall health. The county’s obesity rate is 3 percentage points below that of the state as a whole. Just 11.6% of adults in the county report they are in either fair or poor health, the lowest rate of any Idaho county by over a full percentage point. Residents also report an average of 3.1 unhealthy days over the past month, the lowest of any county in Idaho.
13. Illinois: DuPage County
> Smoking rate: 12.5% (state: 15.8%)
> Obesity rate: 24.2% (state: 28.0%)
> Adults w/ active lifestyles: 81.5% (state: 77.8%)
> Median household income: $81,521 (state: $59,196)
Tobacco use is the leading cause of preventable death in the United States, and DuPage County’s 12.5% smoking rate is well below the statewide smoking rate of 15.8%. The county’s relatively low smoking rate may partially explain the lower than typical premature death rate. There are 212 deaths before age 75 in the county for every 100,000 residents, well below the statewide premature death rate of 324 per 100,000.
High-income areas tend to be home to healthier populations as wealthier household can afford a wider range of healthy options related to diet and lifestyle. In DuPage, the typical household earns $81,521 a year, well above the median household income statewide of $59,196.
14. Indiana: Hamilton County
> Smoking rate: 12.8% (state: 21.1%)
> Obesity rate: 26.9% (state: 32.0%)
> Adults w/ active lifestyles: 83.6% (state: 73.2%)
> Median household income: $87,782 (state: $50,433)
Hamilton County outpaces Indiana as a whole in a number of key health indicators. Some 83.6% of county adults lead an active lifestyle, more than 10% higher than the state as a whole. Hamilton is the only county in Indiana in which more than 80% of adults leads an active lifestyle.
Adults in the county are also much less likely to smoke. The Hamilton County smoking rate of 12.8% is the lowest of any county in the state by 3.5 percentage points and well below the state’s 21.1% smoking rate. County adults also report just 2.6 days of being physically unhealthy in the last month, the lowest figure in Indiana.
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15. Iowa: Sioux County
> Smoking rate: 12.4% (state: 16.7%)
> Obesity rate: 28.5% (state: 31.8%)
> Adults w/ active lifestyles: 77.7% (state: 75.3%)
> Median household income: $63,466 (state: $54,570)
Sioux County residents are less like to die before age 75 then residents of any other county in Iowa. There were 211 premature deaths in the county for every 100,000 residents in 2016, compared to 313 deaths per 100,000 residents across the state as a whole. The lower premature death rate is attributable in part to the absence of some bad habits. Tobacco use is the leading cause of preventable death in the United States, and just 12.4% of county adults are smokers compared to 16.7% of adults in the state.
16. Kansas: Johnson County
> Smoking rate: 12.0% (state: 17.2%)
> Obesity rate: 26.6% (state: 32.4%)
> Adults w/ active lifestyles: 82.1% (state: 75.4%)
> Median household income: $78,186 (state: $53,571)
Johnson County, Kansas residents reported an average of 2.3 physically unhealthy days in the last month. Just 8.9% say they are in fair or poor health. Both of those figures are the best of any county in Kansas. Johnson County, which borders Missouri and sits just outside of Kansas City, has significantly lower smoking and obesity rates than the state as a whole.
Being near a major metropolitan area like Kansas City means there are more high-paying jobs available to county residents. The proximity to Kansas City likely contributes to the county’s relatively high median household income of $78,186. Higher incomes can contribute to better health outcomes, as healthy lifestyle choices can be cost prohibitive.
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17. Kentucky: Oldham County
> Smoking rate: 15.9% (state: 24.5%)
> Obesity rate: 28.0% (state: 33.7%)
> Adults w/ active lifestyles: 76.0% (state: 71.9%)
> Median household income: $86,324 (state: $44,811)
Nearly one in every four adults in Kentucky smoke, the second highest smoking rate of any state in the country. In Oldham County, just 15.9% of the adult population smokes, by far the smallest share of any county in the state. Partly due to healthier lifestyles, just 12.9% of area adults are in fair or poor health, compared to 21.3% of adults in Kentucky.
Adults with higher educational attainment are more likely to have a greater sense of control over their lives and are better equipped to make healthier choices. In Oldham County, 39.8% of the adult population has a bachelor’s degree or higher, well above the statewide bachelor’s degree attainment rate of 22.7%.
18. Louisiana: St. Tammany Parish
> Smoking rate: 17.2% (state: 22.8%)
> Obesity rate: 29.4% (state: 34.7%)
> Adults w/ active lifestyles: 76.8% (state: 70.4%)
> Median household income: $63,686 (state: $45,652)
St. Tammany Parish, Louisiana, is the healthiest parish in one of the least healthy states. It has the second lowest premature death rate in the state, and the parish’s good health is due at least in part to its active population. Only 23.2% of the parish’s adults live sedentary lifestyles, compared to the nearly 30% of Louisiana adults who do.
In addition to being more active, St. Tammany Parish adults tend to smoke much less frequently than state residents on average. Some 17.2% of parish adults smoke, compared to 22.8% of adults statewide.
19. Maine: Cumberland County
> Smoking rate: 12.8% (state: 19.8%)
> Obesity rate: 23.8% (state: 29.0%)
> Adults w/ active lifestyles: 84.4% (state: 78.6%)
> Median household income: $61,902 (state: $50,826)
Adults in Cumberland County, Maine, report an average of 3.0 physically unhealthy days per month, well below the 4.2 day average across the state as a whole. Additionally, adults in the county report just 3.8 mentally unhealthy days per month compared to the average of 4.4 days across the state as a whole.
Higher-income individuals can afford a greater range of healthy options related to diet and lifestyle, and the typical household in Cumberland County earns $61,902 a year, compared to the $50,826 the typical household across the state as a whole earns.
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20. Maryland: Howard County
> Smoking rate: 9.7% (state: 13.7%)
> Obesity rate: 22.7% (state: 29.2%)
> Adults w/ active lifestyles: 83.5% (state: 77.8%)
> Median household income: $113,800 (state: $76,067)
Howard County is Maryland’s healthiest county. Adults there averaged fewer than 2.4 physically unhealthy days in the last month, the lowest rate of any county in the state. Howard County is also the wealthiest county in Maryland and one of the most affluent in the nation, with a median annual household income of $113,800. Living an active and healthy lifestyle can often be expensive, so the high median income in Howard County may contribute to the good health outcomes found there.
Howard County residents are also more likely to make healthy choices than the rest of Maryland’s population. For instance, Howard County’s smoking rate of 9.7% is a full 4 percentage points below the statewide smoking rate.
21. Massachusetts: Middlesex County
> Smoking rate: 11.3% (state: 13.6%)
> Obesity rate: 22.5% (state: 24.3%)
> Adults w/ active lifestyles: 79.7% (state: 78.5%)
> Median household income: $89,019 (state: $70,954)
Just 24.3% of adults in Massachusetts are obese, nearly the smallest share of any state in the country. In Middlesex County, an even smaller 22.5% share of adults are obese. Remaining physically active is one way to help maintain a healthy weight, and in Middlesex County, 79.7% of adults regularly engage in physical activity, above both the state and national shares of 78.5% and 77.0%, respectively.
Healthy counties are often wealthier than counties with less healthy residents, and Middlesex County is no exception. The typical area household earns $89,019 a year, well above the statewide median of $70,954.
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22. Michigan: Ottawa County
> Smoking rate: 14.8% (state: 20.4%)
> Obesity rate: 29.3% (state: 31.3%)
> Adults w/ active lifestyles: 79.7% (state: 76.8%)
> Median household income: $61,367 (state: $50,803)
Engaging in good health behaviors such as exercising, eating healthily, and avoiding excessive alcohol and tobacco use can improve one’s chances of avoiding premature death. In Ottawa County, the smoking rate of 14.8% is well below the state rate of 20.4%.
In addition to being the healthiest county in Michigan, Ottawa County is also one of the safest.
Injury through violence or accident is the third leading cause of death for people ages 1 to 44. Ottawa County has one of the lowest injury mortality rates in the state at 47 people per 100,000.
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23. Minnesota: Carver County
> Smoking rate: 11.6% (state: 15.2%)
> Obesity rate: 22.3% (state: 27.3%)
> Adults w/ active lifestyles: 83.9% (state: 80.2%)
> Median household income: $88,638 (state: $63,217)
Carver County, Minnesota, is the healthiest county in one of the healthiest states. Minnesota’s premature death rate of 263 deaths before age 75 for every 100,000 people is the lowest of any state. In Carver County, premature death is even more rare. There are 181 premature deaths per 100,000 people in the county.
The lower premature death rate in the county is partially attributable to healthy habits. Adults in Carver County are less likely to smoke or be obese and more likely to regularly exercise than the typical adult in both Minnesota and the United States as a whole.
24. Mississippi: Madison County
> Smoking rate: 15.1% (state: 22.7%)
> Obesity rate: 29.8% (state: 35.3%)
> Adults w/ active lifestyles: 71.9% (state: 66.0%)
> Median household income: $65,924 (state: $40,528)
At $65,924, the median annual household income in Madison County is more than 50% higher than that of Mississippi. Higher incomes can contribute to better health outcomes, as people are able to spend the money necessary to keep themselves in good physical condition and to afford appropriate medical care.
Many high-income individuals are likely employed and have health insurance through their employer. Madison County has one of the lowest uninsured rates in Mississippi at 10.9%. Some 14.8% of Mississippi residents have no health insurance.
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25. Missouri: St. Charles County
> Smoking rate: 16.8% (state: 22.1%)
> Obesity rate: 25.9% (state: 31.8%)
> Adults w/ active lifestyles: 75.9% (state: 74.2%)
> Median household income: $75,603 (state: $49,593)
Ranking as the healthiest county in Missouri, St. Charles County is home to a relatively small share of adults in suboptimal health. Just 12.0% of county adults report being in fair or poor health compared to 16.0% of American adults and 18.5% of adults in the state.
Still, adults in the county are more likely to engage in certain unhealthy behaviors than is typical. For example, 21.5% of adults drink excessively, compared to 19.5% of adults in the state and 18.0% of adults nationwide. Additionally, though county adults are more likely to exercise regularly than the typical adult in Missouri, they are less likely to exercise than the typical American adult.
26. Montana: Gallatin County
> Smoking rate: 14.6% (state: 18.5%)
> Obesity rate: 15.6% (state: 25.0%)
> Adults w/ active lifestyles: 86.6% (state: 79.2%)
> Median household income: $57,021 (state: $48,380)
Gallatin County’s obesity rate, which at just 15.6% is nearly 10 percentage points below Montana’s obesity rate of 25.0%, is the lowest in the state. The Montana county with the next closest obesity rate is 6 percentage points higher.
Gallatin’s relatively low obesity rate could be partially attributable to the fact that it also has the highest rate of adults who lead an active lifestyle in Montana. Some 86.6% of county adults are active, the highest rate of any county in Montana, and well above the statewide rate of 79.2%.
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27. Nebraska: Cedar County
> Smoking rate: 12.6% (state: 17.0%)
> Obesity rate: 31.2% (state: 30.7%)
> Adults w/ active lifestyles: 71.1% (state: 77.3%)
> Median household income: $54,391 (state: $54,384)
Some 12.6% of adults in Cedar County smoke, the lowest rate of any county in Nebraska and well below the statewide smoking rate of 17.0%. Smoking is one of the leading causes of preventable death in the United States. Tobacco use can increase a person’s risk of developing certain cancers and other life threatening diseases.
Smoking is one of several types of unhealthy behavior that can cause infants to born with low birth weight. Some 6.8% of babies in Nebraska are born weighing under 2.5 kilograms, or about 5.5 pounds. But in Cedar County, the low birthweight rate is much lower, at 3.6%.
28. Nevada: Douglas County
> Smoking rate: 13.6% (state: 16.5%)
> Obesity rate: 22.8% (state: 26.8%)
> Adults w/ active lifestyles: 82.2% (state: 77.8%)
> Median household income: $59,769 (state: $53,094)
A greater share of Douglas County residents make healthy choices than Nevada’s population as a whole. Adults in the county are more likely to lead an active lifestyle and less likely to smoke. In fact, Douglas County has the lowest smoking rate of any county in Nevada.
Douglas County also has one of the lowest rates of preventable hospitalizations in the state. Some 33 out of every 1,000 Medicare recipients were hospitalized for preventable reasons, compared to the state rate of 42 preventable hospitalizations per every 1,000 Medicare recipients.
29. New Hampshire: Grafton County
> Smoking rate: 14.4% (state: 18.0%)
> Obesity rate: 24.2% (state: 27.9%)
> Adults w/ active lifestyles: 78.9% (state: 79.4%)
> Median household income: $58,107 (state: $68,485)
There are more primary care physicians per capita in Grafton County than anywhere else in New Hampshire. The county’s concentration of 194 primary care doctors per 100,000 residents is more than double the New Hampshire concentration and one of the highest concentrations of primary care doctors of any county in the nation.
Access to primary care physicians may result in more residents getting regular checkups and catching and treating illnesses before they become life-threatening. In Grafton, there are 39 preventable hospitalizations per 1,000 medicare enrollees per year on average, compared to the state rate of 47 per 1,000 and the national rate of 49 per 1,000. Grafton County also has the lowest obesity rate of any New Hampshire County. It is the only place in the state where fewer than one in four residents are obese.
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30. New Jersey: Hunterdon County
> Smoking rate: 13.1% (state: 14.0%)
> Obesity rate: 21.4% (state: 25.9%)
> Adults w/ active lifestyles: 82.4% (state: 76.7%)
> Median household income: $108,177 (state: $73,702)
Adults in Hunterdon County, New Jersey, tend to feel better than adults anywhere else in the state. Over the past 30 days, adults in the county reported 2.7 physically unhealthy days, the lowest rate in the state. Just 10.6% of county adults report being in either fair or poor health, compared to 16.5% of New Jersey adults overall.
Hunterdon County’s relatively low obesity rate is likely one of the reasons county adults feel relatively healthy. Obesity can lead to a number of poor health outcomes, including high blood pressure, heart disease, and stroke. The county’s adult obesity rate of 21.4% is much lower than the statewide rate of 25.9%.
31. New Mexico: Los Alamos County
> Smoking rate: 10.0% (state: 16.6%)
> Obesity rate: 20.4% (state: 24.4%)
> Adults w/ active lifestyles: 86.4% (state: 80.6%)
> Median household income: $105,902 (state: $45,674)
The typical household in Los Alamos County earns $105,902 a year, the most of any county in New Mexico and more than double the statewide median household income of $45,674. Higher income Americans can afford a greater range of healthy options related to diet and lifestyle, and Los Alamos County is also the healthiest county in the state. County residents report having an average of 2.8 physically unhealthy days per month, more than a day less than anywhere else in the state. With the lowest premature death rate in the state, Los Alamos County residents are also more likely to live to age 75 than residents of any other New Mexico county.
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32. New York: Saratoga County
> Smoking rate: 15.5% (state: 14.2%)
> Obesity rate: 27.1% (state: 25.0%)
> Adults w/ active lifestyles: 76.1% (state: 74.6%)
> Median household income: $74,080 (state: $60,741)
Saratoga County is New York’s the healthiest county, even though some key health indicators are worse than statewide levels. For example, the county’s smoking rate of 15.5% and obesity rate of 27.1% are higher than New York’s smoking and obesity rates overall.
Still, just 11.2% of Saratoga County residents report being in either fair or poor health, the lowest share of any county in New York. Also, a greater share of county residents have health insurance than anywhere else in New York. Americans with health insurance coverage are more likely to make regular doctor visits and receive preventative medical care.
33. North Carolina: Orange County
> Smoking rate: 14.2% (state: 17.9%)
> Obesity rate: 22.7% (state: 29.6%)
> Adults w/ active lifestyles: 81.3% (state: 75.7%)
> Median household income: $61,130 (state: $48,256)
Orange County’s obesity rate of 22.7% is the lowest of any county in North Carolina and considerably lower than the statewide rate of 29.6%. Also, relatively few babies in the county are born dangerously underweight — which can be indicative of good overall maternal health. Some 7.3% of babies born in Orange County are born underweight, less than in most North Carolina counties and lower than the state’s low birthweight rate of 9.0%.
North Carolina has one of the higher teen birth rates in the nation. There are 29.2 births per 1,000 girls ages 15 to 19 in the state. But Orange County’s teen birth rate is less than a quarter that of the state’s at 6.6 teen births per 1,000, one of the lowest rates in the state. Teen pregnancies can increase the risk of health complications for the mother and the child, including infections and low birth weights.
34. North Dakota: Traill County
> Smoking rate: 14.8% (state: 19.8%)
> Obesity rate: 33.2% (state: 31.8%)
> Adults w/ active lifestyles: 76.8% (state: 76.2%)
> Median household income: $55,764 (state: $59,114)
Nearly one in every five North Dakota adults smoke. Yet in Traill County, just 14.8% of adults are smokers, one of the lower rates in the state. Traill County adults also report an average of just 2.7 physically unhealthy days and 2.6 mentally unhealthy days per month, some of the lowest unhealthy days a month statewide.
In Traill County, 3.2% of babies born were underweight. That is the lowest rate of underweight babies being born in the state. Underweight children can face serious health issues in their infancy.
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35. Ohio: Delaware County
> Smoking rate: 13.6% (state: 22.5%)
> Obesity rate: 27.3% (state: 31.6%)
> Adults w/ active lifestyles: 81.3% (state: 74.3%)
> Median household income: $94,234 (state: $50,674)
Delaware County residents report better health outcomes than residents in any other county in Ohio. Some 10.4% of adults report they are in either fair or poor health, the lowest rate in Ohio and well below the 17.0% share of adults in the state. County residents also report less than 3.0 days of poor physical health on average per month — the fewest days of any Ohio county and a full day less than the average adult in Ohio as a whole.
The counties are this list tend to be relatively affluent and Ohio’s healthiest county is no exception. Delaware County’s median household income of $94,234 a year is nearly double that of Ohio as a whole and the highest of any county in the state.
36. Oklahoma: Kingfisher County
> Smoking rate: 15.6% (state: 19.6%)
> Obesity rate: 31.8% (state: 33.2%)
> Adults w/ active lifestyles: 72.0% (state: 70.1%)
> Median household income: $62,912 (state: $48,038)
Nearly one in every three adults in Oklahoma are obese. In Kingfisher County the obesity rate is slightly lower at 31.8%. People with better educations tend to be better equipped to make healthier lifestyle choices, and the county has the highest high school graduation rate in Oklahoma at 91.7%.
The median household income in Kingfisher County of $62,912 a year is nearly $15,000 higher than the statewide median. Higher incomes can help residents of the county afford medical care and treatment to improve their health outcomes. In Kingfisher, residents are more likely to live to age 75 and less likely to be in fair or poor health than is typical across Oklahoma as a whole.
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37. Oregon: Benton County
> Smoking rate: 14.0% (state: 16.2%)
> Obesity rate: 24.4% (state: 27.2%)
> Adults w/ active lifestyles: 88.9% (state: 84.2%)
> Median household income: $52,015 (state: $53,270)
No county in Oregon has a lower share of babies born with low birth weights than Benton County. Oregon already has one of the lowest shares of low birth weights in the nation at 6.3%, but Benton County’s is even lower at 5.4%, meaning fewer children are at risk from the health issues associated with low birth weights, like brain and respiratory issues as well as a greater risk of infection.
Oregon residents are some of the most physically active in the country, as 84.2% of adults lead an active lifestyle. Benton County has the greatest share of physically active adults in the state, with 88.9% of adult reporting that they get regular physical exercise.
38. Pennsylvania: Chester County
> Smoking rate: 13.6% (state: 18.0%)
> Obesity rate: 22.3% (state: 29.6%)
> Adults w/ active lifestyles: 82.2% (state: 76.0%)
> Median household income: $88,995 (state: $54,895)
Chester County is one of the most physically active counties in Pennsylvania. Only one county has a greater share of adults with an active lifestyle than Chester County’s 82.2%. Active lifestyles, which can help people maintain a healthy weight, is likely contributing to the county’s relatively low 22.3% obesity rate.
Both high physical activity and low obesity rates likely improve residents’ assessment of their own health. Only 11.2% of adults in the county report being in either fair or poor health. And the average adult has just 3.0 physically unhealthy days per month, each the lowest such figures in the state.
39. Rhode Island: Bristol County
> Smoking rate: 12.5% (state: 14.4%)
> Obesity rate: 23.8% (state: 27.2%)
> Adults w/ active lifestyles: 77.5% (state: 75.9%)
> Median household income: $73,096 (state: $58,387)
Adults with greater educational attainment tend to be better equipped to make better decisions regarding their health, and in Bristol County, Rhode Island, 46.4% of adults have a bachelor’s degree compared to 32.5% of adults in the state as a whole. Bristol County residents also have many more primary care doctors per capita than anywhere else in the state. There are 181 primary care physicians for every 100,000 county residents, nearly double the next highest concentration in a county in Rhode Island.
Adults in Bristol County are less likely to smoke and less likely to be obese than the typical Rhode Island adult. Additionally, just 10.2% of adults in the county are in fair or poor health, the smallest share of any county in the state.
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40. South Carolina: Beaufort County
> Smoking rate: 12.5% (state: 20.0%)
> Obesity rate: 22.8% (state: 32.0%)
> Adults w/ active lifestyles: 83.9% (state: 75.2%)
> Median household income: $59,227 (state: $46,898)
Beaufort County performs much better than South Carolina as a whole in a number of key health indicators. Just one in eight county adults smoke compared to one in every five South Carolina adults. The county’s obesity rate is also more than 9 percentage points below the South Carolina obesity rate of 32.0%. Both the smoking and obesity rates are the lowest in the state.
Beaufort County also has a greater share of adults who are physically active than anywhere else in the state. Some 83.9% of adults in the county report that they maintain an active lifestyle, well ahead of any other county in South Carolina.
41. South Dakota: Lincoln County
> Smoking rate: 13.7% (state: 18.1%)
> Obesity rate: 29.2% (state: 30.6%)
> Adults w/ active lifestyles: 80.1% (state: 78.5%)
> Median household income: $77,455 (state: $52,078)
South Dakota residents report feeling better about their health than those in almost all other states. Of all 50 states, South Dakota has the lowest share of adults reporting being in fair or poor health at 11.8%. Lincoln County’s share of adults in fair or poor health is even lower at 9.7%, one of the lowest rates in the state.
Lincoln County adults also report having an average of less than 2.5 physically unhealthy days per month, the lowest figure in the state. Adults in the county also report fewer than 2.5 mentally unhealthy days in the same time period, lower than in all but one other county in South Dakota.
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42. Tennessee: Williamson County
> Smoking rate: 15.2% (state: 22.1%)
> Obesity rate: 23.9% (state: 32.4%)
> Adults w/ active lifestyles: 79.2% (state: 69.9%)
> Median household income: $100,140 (state: $46,574)
Affording a healthy lifestyle can be costly as paying quality health care, healthy foods, and access to places for physical activity can add up. But this is likely less of a problem for Williamson County residents. Williamson County’s median household income is more than double the median household income across Tennessee.
Smoking is the leading cause of preventable death in the United States and obesity is a risk factor for a number of potentially deadly diseases and conditions. Both the obesity rate and smoking rate in Williamson County are well below the corresponding statewide rates. Partially as a result, Williamson County residents are more than twice as likely to live to at least age 75 than the typical Tennessee resident.
43. Texas: Collin County
> Smoking rate: 12.1% (state: 14.3%)
> Obesity rate: 26.2% (state: 28.4%)
> Adults w/ active lifestyles: 80.5% (state: 75.7%)
> Median household income: $86,188 (state: $54,727)
Collin County ranks near the top of Texas’ 254 counties in a number of key health indicators. It is one of just a handful of Texas counties in which adult residents report fewer than 3.0 physically unhealthy days per month. The county’s 12.1% adult smoking rate also is the second lowest of any county in the state.
Collin County’s high median income is likely a contributing factor to the better health outcomes as healthy lifestyles can be expensive. The county’s median household income of $86,188 a year is significantly higher than the median income of $54,727 across Texas as a whole.
44. Utah: Morgan County
> Smoking rate: 8.5% (state: 8.8%)
> Obesity rate: 22.1% (state: 25.3%)
> Adults w/ active lifestyles: 84.3% (state: 82.6%)
> Median household income: $80,865 (state: $62,518)
Utah is one of the healthier states in the country, and Morgan County stands out as the healthiest county in the state. Americans with higher educational attainment are better equipped to make healthy lifestyle choices, and the educational attainment rate in Morgan County is the highest in Utah. Some 80.9% of county residents have at least some post-secondary education. Morgan also has the lowest percentage of uninsured residents of all the counties in Utah, meaning residents are more likely to make regular doctor visits and receive preventative medical care. Just 8.2% of county residents have no insurance compared to 11.6% of the state population.
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45. Vermont: Addison County
> Smoking rate: 13.3% (state: 17.0%)
> Obesity rate: 23.6% (state: 24.7%)
> Adults w/ active lifestyles: 81.3% (state: 80.5%)
> Median household income: $61,020 (state: $56,104)
Smoking is the leading cause of preventable death in the United States and just 13.3% of adults in Addison County report smoking tobacco, compared to 17.0% of adults in Vermont. Obesity is a risk factor for a number of potentially deadly diseases and conditions and the county also has one of the lowest obesity rates in the state at 23.6%.
Healthy lifestyles reduce the likelihood of premature death in the county. There are 236 deaths before age 75 per 100,000 county residents, well below Vermont’s premature death rate of 291.2 deaths before age 75 for every 100,000 residents and the lowest premature death rate in the state.
46. Virginia: Loudoun County
> Smoking rate: 11.3% (state: 15.3%)
> Obesity rate: 21.5% (state: 28.3%)
> Adults w/ active lifestyles: 82.5% (state: 77.7%)
> Median household income: $125,672 (state: $66,149)
Loudoun County in Virginia is just outside of Washington, D.C. This gives residents access to many high paying jobs near the nation’s capital. The median household income in Loudoun County is $125,672 a year, nearly $60,000 higher than the median income across Virginia and the highest median nationwide.
Loudoun County residents report having fewer days of poor mental and physical health over the past month than anywhere else in Virginia. The average county resident reported having 2.6 physically unhealthy days and 2.8 mentally unhealthy days in that time period.
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47. Washington: King County
> Smoking rate: 9.4% (state: 13.9%)
> Obesity rate: 21.7% (state: 27.0%)
> Adults w/ active lifestyles: 86.3% (state: 82.9%)
> Median household income: $78,800 (state: $62,848)
The smoking rate in King County is lower than that of any other county in Washington state. At 9.4%, it is the only county in Washington with a smoking rate below 10%. King County also has the second smallest share of obese adults. The county’s 21.7% obesity rate is well below the state obesity rate of 27.0%.
This healthy habits and lifestyle choices may be some of the reasons why King County residents tend to have better physical and mental health than residents anywhere else in the state. County residents report an average of 3.0 physically unhealthy days and 3.2 mentally unhealthy days in the last month, both the lowest of any county in Washington.
48. West Virginia: Jefferson County
> Smoking rate: 18.8% (state: 24.8%)
> Obesity rate: 36.0% (state: 35.5%)
> Adults w/ active lifestyles: 76.7% (state: 70.8%)
> Median household income: $69,753 (state: $42,644)
The smoking rate in Jefferson County is a full 6 percentage points lower than the smoking rate of 24.8% across West Virginia. The county leads the state in the share of adults who lead a physically active lifestyle. Some 76.7% of county adults regularly exercise.
Health problems can often be made worse if people are unable to afford treatment. Jefferson County’s median household income is more than 50% higher than West Virginia’s median.
49. Wisconsin: Ozaukee County
> Smoking rate: 12.4% (state: 17.1%)
> Obesity rate: 25.6% (state: 30.6%)
> Adults w/ active lifestyles: 81.5% (state: 78.9%)
> Median household income: $78,415 (state: $54,610)
Ozaukee County leads Wisconsin in a number of key health indicators. Its smoking rate is just 12.4%, and just 4.0 girls per 1,000 age 15 to 19 give birth per year on average. However, the county is one of the worst in the United States in one key health factor. More than one in every four county adults drink excessively.
No state comes close to Wisconsin’s rate of excessive drinking of 26.2%. Excessive drinking is never healthy, but heavy drinking can be expensive, and those who drink excessively are more likely to have substantial disposable income. Ozaukee County’s median household income of $78,415 a year is significantly higher than the state’s median of $54,610. This means that, though a high share of county adults drink heavily, they can likely afford quality health care and other aspects of a healthy lifestyle.
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50. Wyoming: Teton County
> Smoking rate: 14.1% (state: 18.9%)
> Obesity rate: 13.3% (state: 28.5%)
> Adults w/ active lifestyles: 88.3% (state: 76.3%)
> Median household income: $75,594 (state: $59,143)
The obesity rate in Teton County of 13.3% is well below Wyoming’s statewide obesity rate of 28.5%. Obesity increases the risk of a number of health issues, including heart attack, stroke, and high blood pressure. The relatively high rate of adults, 88.3%, who lead an active lifestyle likely contributes to this low obesity rate.
In addition to making healthy decisions, Teton County residents are also have among the best mental health. The average county adult has 3.1 mentally unhealthy days within the last month, the fewest such days among all counties in Wyoming.
Detailed Findings & Methodology
County Health Rankings & Roadmaps used a combination of self-reported and objective measures to gauge health outcomes on a county by county basis. One self-reported measure asked adults to assess their own personal health. In each county on this list, the share of adults who assess their health as fair or poor is below the corresponding share across the state as a whole.
A less subjective gauge of health outcomes is the premature death rate — measured as the number of deaths before age 75, mostly of preventable causes — for every 100,000 people. With only one exception, Traill County, North Dakota, adults in every county on this list are more likely to make it to age 75 than the typical adult in the state as a whole.
Desirable health outcomes across a population are typically the result of healthy behaviors. According to the Centers for Disease Control and Prevention, tobacco use is the leading cause of preventable death in the United States, and Saratoga County, New York, is the only county on this list with a higher smoking rate than the state as a whole. And only four counties on this list have a higher smoking rate than the United States as a whole.
A county’s obesity rate is another strong indicator of both behaviors and health outcomes. Americans who consume a balanced diet and keep within their recommended daily caloric intake are at a greatly reduced risk of obesity. Obesity is also a risk factor for many diseases and conditions, including diabetes, heart disease, and certain cancers. All but four counties on this list are home to a smaller share of obese adults than the state as a whole.
Income and education are two non-behavioral factors that appear closely related to overall health. High-income households can afford more healthy options related to diet, lifestyle, and medical care, and the counties on this list tend to be relatively affluent. Only three of the healthiest counties have a lower median household income than their home state as a whole, and Benton County, Oregon and Cedar County, Nebraska are the only counties on this list with a median income below the $55,322 national median.
Studies have also shown that Americans with greater educational attainment have a greater sense of control of their lives, are better equipped to make healthy choices, and are generally healthier than those with lower education levels. Indeed, only five counties on this list are home to a smaller share of adults with a bachelor’s degree or higher than their home state as a whole.
Almost without exception, the counties on this list ranking worse than the nation as a whole in a given measure are located in especially unhealthy states.
To identify the healthiest 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, quality of life, and maternal health — and overall health factors. The health factors component is itself a weighted composite of health behaviors, clinical care, social and economic factors, and physical environment measures. Data was compiled from more than 20 different sources and is for the most recent year available. A total of 3,142 counties were considered. In the case of ties, counties that ranked higher in behavioral measures were given preference. Median household income and the share of adults with a bachelor’s degree are five-year estimates from the U.S. Census Bureau’s 2016 American Community Survey.
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