Special Report

The Least Healthy County in Every State

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11. Hawaii: Hawaii County
> Uninsured rate: 6.0% (county) 3.8% (state)
> Adults in fair or poor health: 15.3% (county) 14.0% (state)
> Obesity rate: 22.8% (county) 22.3% (state)
> Smoking rate: 15.0% (county) 13.1% (state)

There are only five counties in Hawaii. Though Hawaii County ranks as the least healthy of the five, unhealthy behaviors in the county are not much more common than they are across the state as a whole. For example, the county’s inactivity rate — 20% of county adults do not exercise — is the highest in the state by a slim margin and is better than the 23.0% share of adults nationwide with sedentary lifestyles.

Outcomes are also not especially poor in Hawaii County. Just 15.3% of adults in Hawaii County report being in fair or poor health, only slightly higher than the 14.0% share of adults across the state as a whole. For reference, 16.0% of adults nationwide report being in suboptimal health.

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12. Idaho: Benewah County
> Uninsured rate: 15.2% (county) 10.1% (state)
> Adults in fair or poor health: 16.5% (county) 15.3% (state)
> Obesity rate: 29.9% (county) 28.6% (state)
> Smoking rate: 16.0% (county) 14.5% (state)

While several unhealthy behaviors are more common among residents of Benewah County than the average for the state, the shares are not significantly higher. In some cases, such as drinking excessively, the rate is lower than both the state and national average.

Still, one in seven do not have health coverage, higher than the state uninsured rate of 10%. People with no health insurance see doctors less frequently, even when feeling unwell.

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13. Illinois: Alexander County
> Uninsured rate: 8.8% (county) 6.8% (state)
> Adults in fair or poor health: 27.3% (county) 17.2% (state)
> Obesity rate: 28.0% (county) 28.0% (state)
> Smoking rate: 23.7% (county) 15.8% (state)

Of the 102 counties in Illinois, Alexander County is the only one where more than one in every five adults smoke. Smokers die, on average, about 10 years before nonsmokers, and Alexander County residents are more likely to die before age 75 than residents of every other county in the state.

Adults with higher educational attainment typically lead healthier lifestyles, and in Alexander County, just 10.7% of adults have a bachelor’s degree, the smallest share of any county in the state.

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14. Indiana: Crawford County
> Uninsured rate: 8.0% (county) 8.2% (state)
> Adults in fair or poor health: 19.2% (county) 17.7% (state)
> Obesity rate: 31.7% (county) 32.0% (state)
> Smoking rate: 22.5% (county) 21.1% (state)

With the exception of the average number of unhealthy days in a month, Crawford County ranks only marginally worse than other counties in the state. For example, nearly 22.5% of adults smoke, compared with the state smoking rate of 21%.

Still, almost a third of the adult population in Crawford County is obese and does not exercise. This may help explain why people report, on average, more than four physically unhealthy days in a month, the fourth highest average number out of all 92 counties in the state.

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15. Iowa: Appanoose County
> Uninsured rate: 8.4% (county) 4.7% (state)
> Adults in fair or poor health: 14.7% (county) 13.1% (state)
> Obesity rate: 35.8% (county) 31.8% (state)
> Smoking rate: 16.4% (county) 16.7% (state)

Appanoose County is the only county in Iowa where more than one in every three adults get no exercise beyond getting up and going to work. The prevalence of sedentary lifestyles may be partially attributable to lack of opportunities. Only 66.6% of area residents have access to areas for physical activity like parks and recreation centers, well below the 83.0% of Iowa residents.

Americans with health insurance are far more likely to make regular doctor visits and receive preventative medical care. In Appanoose County, 8.4% of residents are uninsured, compared with 4.7% of Iowa residents.

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