Special Report

The Healthiest States in America

Source: Nathan Masters / iStock

20. Iowa
> Premature death rate (per 100,000): 6,733 (16th lowest)
> Adult obesity rate: 35.3% (7th highest)
> Adult smoking rate: 16.6% (23rd highest)
> Median household income: $59,955 (25th highest)

Iowa makes the list of healthiest states in the country based on a wide range of factors. Only 9.6% of the population reported 14 or more days of poor physical health in a month — the second smallest share of all states — compared to a national average of 12.0%.

The low uninsured rate in the state — just 4.7% of Iowans do not have health insurance, the sixth smallest share in the country — may also be a major factor. People without health insurance are more likely than those with insurance to delay going to the doctor or forgo taking care of their health altogether.

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19. Wyoming
> Premature death rate (per 100,000): 7,412 (23rd lowest)
> Adult obesity rate: 29.0% (14th lowest)
> Adult smoking rate: 18.8% (16th highest)
> Median household income: $61,584 (20th highest)

Wyoming has one of the lowest rates of cancer-related deaths, the second leading cause of death in the United States after heart disease. There are 169.5 cancer deaths per 100,000 people in Wyoming, the sixth lowest rate in the country and way below the U.S. average of 189.3 per 100,000 people.

Diabetes, a disease that affects about a tenth of the U.S. population, is also relatively uncommon in Wyoming. An estimated 8.7% of adults in Wyoming have been diagnosed, the fifth lowest percentage in the country.

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18. Maryland
> Premature death rate (per 100,000): 7,689 (23rd highest)
> Adult obesity rate: 30.9% (25th highest)
> Adult smoking rate: 12.5% (5th lowest)
> Median household income: $83,242 (the highest)

One factor contributing to Maryland’s better-than-average health outcomes and behaviors may be income. The higher the income, the lower the likelihood of disease and premature death, as wealthier people can afford healthier diets and have more access to high-quality health care. Maryland has the highest median household income and the fourth lowest poverty rate in the country.

It also has a relatively small share of adults who drink excessively — 14.6%, compared to a U.S. average of 18.2%. Over time, excessive drinking can lead to serious problems, such as hypertension, heart disease, stroke, liver disease, and digestive problems.

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17. Nebraska
> Premature death rate (per 100,000): 6,555 (11th lowest)
> Adult obesity rate: 34.1% (15th highest)
> Adult smoking rate: 16.0% (24th lowest)
> Median household income: $59,566 (25th lowest)

Compared to the rest of the country, relatively few people in Nebraska report frequent mental or physical distress. Only 11.2% of the state’s adult population reported 14 or more days of poor mental health in one month, the 10th smallest share in the country. There is a strong correlation between frequent mental distress and diagnosed mental disorders, such as depression and anxiety, according to the United Health Foundation. About 10.2% reported 14 or more days of poor physical health in one month, the sixth smallest share in the United States.

Nebraskans also have relatively healthy behaviors. For example, from 2015 to 2017 there were just 7.2 drug-related deaths per 100,000 residents a year, less than half the national rate and the lowest rate in the country.

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16. Idaho
> Premature death rate (per 100,000): 6,669 (15th lowest)
> Adult obesity rate: 28.4% (12th lowest)
> Adult smoking rate: 14.7% (16th lowest)
> Median household income: $55,583 (15th lowest)

Idaho has a low rate of preventable hospitalizations, a measure that reflects how efficiently people use outpatient services as well as the overall quality of health care in a state. There are 32.3 preventable hospitalizations per 1,000 Medicare enrollees — the fourth lowest rate — compared to the national rate of 49.4 per 1,000. Public health funding may also play a role in Idaho’s ranking among the healthiest states. The state spends an average of $150 per person on public health annually, the fourth largest amount, compared to a national average of $87 per person. The money is used to pay for programs promoting physical activity, healthy nutrition, and smoking prevention.

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