1. Alabama: Wilcox County
> Uninsured rate: 14.9% (county) 9.4% (state)
> Adults in fair or poor health: 30.4% (county) 21.4% (state)
> Obesity rate: 42.6% (county) 34.7% (state)
> Smoking rate: 24.3% (county) 21.5% (state)
Of the 67 counties in Alabama, Wilcox ranks as the least healthy. Nearly 43% of adults in the central Alabama county are obese, well above the 35% share of adults statewide and one of the highest obesity rates of any county in the country.
Low-income Americans tend to have less access to quality health care. Economic conditions partially explain the poor health outcomes in Wilcox County, where 31.9% of the population lives below the poverty line — more than double the 14.6% national poverty rate.
2. Alaska: Kusilvak Census Area
> Uninsured rate: 23.6% (census area) 13.7% (state)
> Adults in fair or poor health: 37.9% (census area) 13.4% (state)
> Obesity rate: 27.5% (census area) 29.4% (state)
> Smoking rate: 42.8% (census area) 19.0% (state)
Unhealthy behaviors, particularly smoking, likely contribute to Kusilvak’s ranking as Alaska’s least healthy census area. Almost 43% of adults are regular smokers, the highest share of U.S. counties.
Kusilvak adult residents report on average about seven unhealthy physical days in a month, the most of all counties in the United States and higher than the national average of nearly four unhealthy days a month. Nearly 38% of adults in the county report being in poor or fair health, the fourth-largest share in the country and nearly triple the statewide share of over 13%. Nationwide, 16% of adults report being in poor or fair health.
3. Arizona: Apache County
> Uninsured rate: 22.9% (county) 10.1% (state)
> Adults in fair or poor health: 26.2% (county) 17.8% (state)
> Obesity rate: 33.7% (county) 26.7% (state)
> Smoking rate: 21.6% (county) 14.7% (state)
More than one in every five residents in Apache County, Arizona, do not have health insurance, the largest uninsured rate of any county in the state. People with health insurance are more likely to make regular doctor visits and receive diagnosis and treatment for different ailments, from bacterial infection to chronic conditions and other serious diseases. The lower likelihood of regular doctor visits in Apache County may partially explain why the county’s premature death rate is nearly the highest in the state.
Unhealthy habits also are relatively common in Apache County. County adult residents are more likely to smoke and less likely to lead physically active lifestyles than the typical Arizona resident.
4. Arkansas: Phillips County
> Uninsured rate: 13.1% (county) 7.9% (state)
> Adults in fair or poor health: 30.7% (county) 24.5% (state)
> Obesity rate: 43.6% (county) 34.6% (state)
> Smoking rate: 26.5% (county) 23.6% (state)
Phillips County is located along the banks of the Mississippi River in Southeast Arkansas. A relatively high share of adult county residents — higher than statewide — smoke regularly and lead a sedentary lifestyles, both leading causes of disease and disability. In addition, nearly 44% of the county’s adult population is obese, the 13th largest obesity rate of any U.S. county.
For different reasons, poverty is associated with unhealthy behaviors, which can result in an increased risk of disease or mortality. Nearly 31% of county adults say they are in fair or poor health, far more than the 16% share nationwide and the 25% share statewide.
5. California: Kern County
> Uninsured rate: 11.2% (county) 7.2% (state)
> Adults in fair or poor health: 24.0% (county) 17.5% (state)
> Obesity rate: 31.6% (county) 22.7% (state)
> Smoking rate: 16.2% (county) 11.0% (state)
Unhealthy behaviors are relatively common in Kern County, California. Of adults in the county, 23.6% report getting no exercise beyond getting up and going to work — a far larger share than the 17.9% of adults across the state who lead sedentary lifestyles. Adults in the county are also more likely to smoke, drink to excess, and be obese than adults across the state as a whole.
Low educational attainment may partially explain the prevalence of unhealthy behaviors. Higher educational attainment can lead to a better sense of control over one’s life and to healthier lifestyles, and just 15.8% of adults in Kern County have a bachelor’s degree, less than half the statewide bachelor’s degree attainment rate of 33.6%.