6. Colorado: Costilla County
> Uninsured rate: 14.9% (county) 7.5% (state)
> Adults in fair or poor health: 29.0% (county) 14.3% (state)
> Obesity rate: 22.1% (county) 20.5% (state)
> Smoking rate: 18.8% (county) 15.6% (state)
Costilla County is located on Colorado’s border with New Mexico. As the least healthy county in one of the healthiest states in the United States it ranks better in several measures of health than the nation as a whole, particularly in the adult obesity and inactivity rates. Relative to state rates, however, Costilla ranks worse.
Another factor contributing to Costilla County’s least healthy rank is the high share of uninsured residents. Of county residents, nearly 15% have no health insurance, compared with 10% nationwide and over 7% statewide. Research has shown that uninsured adults have worse access to care, receive poorer quality of care, and experience worse health outcomes than insured adults.
7. Connecticut: Windham County
> Uninsured rate: 5.3% (county) 5.5% (state)
> Adults in fair or poor health: 12.9% (county) 13.8% (state)
> Obesity rate: 29.2% (county) 25.2% (state)
> Smoking rate: 16.4% (county) 13.3% (state)
Due in large part to the prevalence of some unhealthy behaviors, Windham, a county situated in the northeast corner of Connecticut, ranks as the least healthy of the eight counties in the state. An estimated 22.3% of adults in Windham County drink excessively, the largest share of any county in the state and well above the 18.4% state excessive drinking rate. Adults in Windham are also less likely to exercise and more likely to smoke than in other countries in the state.
Unhealthy habits often lead to unhealthy outcomes, and 29.2% of adults in Windham County are obese, the largest share in the state.
8. Delaware: Kent County
> Uninsured rate: 7.6% (county) 5.4% (state)
> Adults in fair or poor health: 16.9% (county) 15.8% (state)
> Obesity rate: 33.6% (county) 30.6% (state)
> Smoking rate: 18.2% (county) 17.7% (state)
Delaware only has three counties, but Kent has the highest share of adults reporting unhealthy habits. One in three adult residents do not exercise. Kent is also the county with the highest adult smoking rate.
These unhealthy behaviors are likely contributing to poor health outcomes in the county. People report on average more than 3.5 physically unhealthy days a month, more than in the other two counties. In addition, one in six residents report being in poor or fair health, also the highest share among the three counties.
9. Florida: Putnam County
> Uninsured rate: 16.8% (county) 12.9% (state)
> Adults in fair or poor health: 24.6% (county) 18.5% (state)
> Obesity rate: 37.9% (county) 25.9% (state)
> Smoking rate: 24.9% (county) 15.5% (state)
In Putnam County, adults report an average of about five physically unhealthy days and five mentally unhealthy days per month. The statewide average is less than four days for each. Putnam County’s adult obesity rate of 37.9% is also well above the obesity rate across Florida as a whole of 25.9%.
Outcomes like these are largely attributable to some relatively common unhealthy habits in the county. For example, about one in every four adults in the county smoke, the highest smoking rate of any county in Florida.
10. Georgia: Clay County
> Uninsured rate: 24.8% (county) 13.4% (state)
> Adults in fair or poor health: 33.0% (county) 18.8% (state)
> Obesity rate: 30.7% (county) 30.2% (state)
> Smoking rate: 26.9% (county) 17.9% (state)
Clay County’s rank as the least healthy of the 159 counties Georgia may be explained by the fact that no other county has a higher smoking rate. Almost 27% of adults light a cigarette on regular basis, compared with 17% nationwide. The county has half as many primary care physicians as the average for the state. Lack of doctors can restrict or severely hamper access to regular health care.
Clay County has a population of just over 3,000 people, and one in three adults report being in poor or fair health, the second highest share in the state.