Life expectancy in the U.S. has dropped a full year in the first half of 2020  — the biggest decrease since World War II — largely due to the COVID-19 pandemic. The disease has had a large impact on older Americans and people with certain health conditions that increase the risk for severe illness from COVID-19.  

Some of the components of a healthy lifestyle that people have control over are sticking to a nutritious and well-balanced diet, regularly exercising, and refraining from harmful habits like smoking. But there are large populations across the country that, for different reasons, fail to adhere to these guidelines. And the consequences are evident among across the U.S., from state to state, and from county to county.

To identify the least healthy county in every state, 24/7 Tempo reviewed data on behaviors and outcomes in all 3,142 U.S. counties and county equivalents from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

The overall health of a population is closely linked to certain social and economic conditions. Unfortunately, access to health care as well as to healthy diets and lifestyles appear to be out of reach for many low-income Americans.

In 48 of the 50 counties on this list, the poverty rate exceeds the statewide poverty rate – in several cases it is more than double — and many of the least healthy counties in their state also rank as the poorest county in that state. Not only can low-income Americans afford fewer healthy options, but poverty itself is associated with stress that can undermine both physical and mental health.

Americans who do not lead healthy lifestyles may be at increased risk of certain serious diseases and conditions, including heart disease, diabetes, and certain cancers. These are the states where cancer kills the most people.

In many of the counties on this list, whose residents tend to report less healthy behaviors, residents also tend to report more days of feeling physically and mentally unwell a month than the average statewide. Similarly, all but one of the counties on the list have a premature death rate — number of deaths before age 75 per 100,000 population — that is much higher than the rate of their home state.

Click here to see the least healthy county in every state
Click here to read our detailed methodology