Special Report

The Least Healthy County In Every State

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Massachusetts: Hampden
> Adults in fair or poor health: 18.3% (county) 14.4% (state)
> Adult obesity rate: 31.2% (county) 24.7% (state)
> Adult smoking rate: 15.4% (county) 13.7% (state)
> Adults with no health insurance: 3.1% (county) 2.7% (state)
> County population: 467,871
> Largest city: Springfield

Hampden County is the least healthy county in Massachusetts, a state with a relatively healthy population. The county’s 31.2% adult obesity rate — while well above the 24.7% statewide rate — is only slightly higher than the 29.0% national rate. County residents are also more likely to make regular doctor visits than the typical American as just 3.1% of the population are uninsured, less than a third of the 8.8% 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.

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Michigan: Clare
> Adults in fair or poor health: 17.2% (county) 17.4% (state)
> Adult obesity rate: 37.3% (county) 32.0% (state)
> Adult smoking rate: 20.2% (county) 19.3% (state)
> Adults with no health insurance: 11.3% (county) 5.5% (state)
> County population: 30,651
> Largest city: Clare

More than one in 10 adult residents of Clare County do not have health insurance, more than twice the state uninsured rate. Lack of insurance may prevent people from seeing a doctor when they should to get treatment or to receive preventive care. About 17.2% of adult residents report being in poor or fair health, one of the highest such shares of the 83 counties in Michigan.

In addition, the adult obesity and inactivity rates are higher in Clare than the state as a whole, at 37.3% and 31.2% compared to 32.0% and 23.4%, respectively.

Minnesota: Mahnomen
> Adults in fair or poor health: 20.0% (county) 12.1% (state)
> Adult obesity rate: 38.7% (county) 27.9% (state)
> Adult smoking rate: 25.2% (county) 14.5% (state)
> Adults with no health insurance: 14.0% (county) 4.5% (state)
> County population: 5,501
> Largest city: Mahnomen

An estimated 20.0% of adults in Mahnomen County, Minnesota, are in fair or poor health, by far the largest share of any of the state’s 87 counties. Additionally, county adults report an average of just over four mentally and physically unhealthy days per month, well above the average across the state of about three days a month.

Poor outcomes are likely attributable in large part to bad habits. For example, Mahnomen is the only county in the state where one in every four adults smoke. Further, 27.9% of county adults report completely sedentary lifestyles, compared to 20.1% of adults across the state.

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Mississippi: Holmes
> Adults in fair or poor health: 37.6% (county) 24.1% (state)
> Adult obesity rate: 46.3% (county) 36.8% (state)
> Adult smoking rate: 27.8% (county) 22.2% (state)
> Adults with no health insurance: 16.1% (county) 12.3% (state)
> County population: 17,737
> Largest city: Durant

With a poverty rate of 42.4%, more than double the state poverty rate, Holmes is the poorest county in Mississippi, which itself is the poorest state in the country. Living in poverty can have a negative effect on health because people may have less access to health care and may not have the means to buy healthy foods. The average number of mentally and physically unhealthy days a month adults in Holmes report is the highest and second highest of all 82 counties in the state, respectively.

Two unhealthy behaviors that are more common among residents in Holmes than in most other state counties are sedentary lifestyles and smoking. About 41.6% of adults do not exercise, compared to 31.9% in Mississippi as a whole. Holmes also has the highest smoking rate of all counties in the state at 27.8%, higher than the state rate of 22.2%.

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Missouri: Dunklin
> Adults in fair or poor health: 30.4% (county) 18.0% (state)
> Adult obesity rate: 41.1% (county) 32.2% (state)
> Adult smoking rate: 25.8% (county) 20.8% (state)
> Adults with no health insurance: 15.6% (county) 9.3% (state)
> County population: 30,027
> Largest city: Kennett

Adults in Dunklin County, Missouri, report an average of about five and a half mentally unhealthy days and over six physically unhealthy days per month, far more than the state average of about four days for each measure.

The relatively poor health among county residents is likely partly connected to economic conditions in the county. 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 Dunklin County, 25.7% of the population live below the poverty line, the fourth highest poverty rate in Missouri and almost double the 13.7% state poverty rate.

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