21. Massachusetts: Hampden County
> Uninsured rate: 3.3% (county) 2.8% (state)
> Adults in fair or poor health: 18.4% (county) 13.8% (state)
> Obesity rate: 27.6% (county) 24.3% (state)
> Smoking rate: 18.3% (county) 13.6% (state)
Hampden County is the least healthy county in Massachusetts, a state with a relatively healthy population. The county’s 27.6% adult obesity rate — while well above the 24.3% statewide rate — is lower than the 28.0% national rate. County residents are also more likely to make regular doctor visits than the typical American as just 3.3% of the population are uninsured, less than a third of the 10.5% national uninsured rate.
Some unhealthy habits are relatively common in the county, however. For example, adults in Hampden are less likely to exercise and more likely to smoke than adults across the state and nation as a whole.
22. Michigan: Wayne County
> Uninsured rate: 8.8% (county) 5.2% (state)
> Adults in fair or poor health: 18.8% (county) 17.4% (state)
> Obesity rate: 33.1% (county) 31.3% (state)
> Smoking rate: 20.5% (county) 20.4% (state)
Almost one in 10 residents of Wayne County, which contains Detroit, do not have health insurance, twice the state uninsured rate. Lack of insurance may prevent people from seeing a doctor when they should. About one in five adult residents report being in poor or fair health, the seventh highest share of the 83 counties in Michigan.
In addition, the adult obesity, smoking, and inactivity rates are higher in Wayne than the state as a whole.
23. Minnesota: Mahnomen County
> Uninsured rate: 14.9% (county) 4.4% (state)
> Adults in fair or poor health: 21.4% (county) 12.0% (state)
> Obesity rate: 34.0% (county) 27.3% (state)
> Smoking rate: 23.8% (county) 15.2% (state)
An estimated 21.4% of adults in Mahnomen County are in fair or poor health, by far the largest share of any of Minnesota’s 87 counties. Additionally, county adults report an average of 4.3 mentally unhealthy days and 4.6 physically unhealthy days per month, well above the averages across the state of 3.2 days and 3.0 days, respectively.
Poor outcomes are largely attributable to bad habits. For example, Mahnomen is the only county in the state where more than one in every five adults smoke. Further, 28.4% of county adults report completely sedentary lifestyles, compared with less than 20% of adults across the state.
24. Mississippi: Holmes County
> Uninsured rate: 19.1% (county) 12.0% (state)
> Adults in fair or poor health: 35.1% (county) 22.2% (state)
> Obesity rate: 40.8% (county) 35.3% (state)
> Smoking rate: 27.1% (county) 22.7% (state)
With a poverty rate of almost 47%, more than double the state poverty rate, Holmes is the second poorest county in Mississippi. Living in poverty can have a negative effect on health because people may not be able to afford medical treatment if they need it and have enough means to buy healthy foods. The average number of both mentally and physically unhealthy days a month adults in Holmes report is the highest of all 82 counties in the state.
Two unhealthy behaviors that are significantly more common among residents in Holmes than in other counties are sedentary lifestyles and smoking. More than 40% of adults do not exercise, Holmes has the ninth highest smoking rate of U.S. countries and significantly higher than the national inactivity rate of 23% and state rate of 34%.
25. Missouri: Pemiscot County
> Uninsured rate: 14.5% (county) 9.1% (state)
> Adults in fair or poor health: 26.8% (county) 18.5% (state)
> Obesity rate: 35.5% (county) 31.8% (state)
> Smoking rate: 27.4% (county) 22.1% (state)
Adults in Pemiscot County, Missouri, report an average of five mentally unhealthy days and nearly six physically unhealthy days per month, far more than the state average of four days for each measure.
The relatively poor health among county residents is likely connected to the county’s economic conditions. Low-income Americans can afford less health care and fewer healthy options related to diet and lifestyle, and the stress associated with poverty can have negative effects on overall health. In Pemiscot County, 28.5% of the population lives below the poverty line, more than double the 13.4% state poverty rate.