The United States is far from being the healthiest country in the world. The country struggles with obesity and heart disease, and life expectancy is worse than in countries such as Slovenia and Chile.

However, according to one study, the country’s state of health may be turning around. In this year’s edition of America’s Health Rankings, the country improved in more than two-thirds of the health measures considered by the report.

Click here to see america’s most healthy states

Click here to see america’s least healthy states

The United Health Foundation’s America’s Health Rankings report examined factors such as healthy behaviors, quality of health care, health policy, the presence of diseases and deaths from illnesses across the nation. The differences in health on a state level vary considerably. This year, Hawaii is the healthiest state in the country, while Mississippi is the least healthy state.

Most of the nation’s least healthy states suffer from the worst rates of diabetes, deaths from cancer and deaths from cardiovascular disease. In healthier states, such outcomes are far less common. For instance, eight of the 10 healthiest states also had among the 10 fewest cardiovascular deaths per 100,000 people.

The toll of poor health can cost, or significantly shorten, people’s lives. The Centers for Disease Control tracked premature death, which measures the number of years lost when people do not live to age 75. In the healthiest states, this number is quite low, with nearly all states in the bottom 15 nationwide. In America’s least healthy states, this number is far higher, with all but one state among the 10 worst nationwide. In the nation’s least healthy state, Mississippi, there were 10,821 years lost per 100,000 people, nearly twice the number of the country’s third healthiest state, Minnesota.

Behavior plays a major role in determining whether people stay healthy. In an interview with 24/7 Wall St., Dr. Reed Tuckson, external clinical advisor to United Health Foundation’s America’s Health Rankings, explained, “At the end of the day you’re not going to be able to turn around the diseases if you don’t deal with the risk factors.”

Nine of the 10 least healthy states in the nation had among the 10 worst obesity rates in the country. Similarly, nine of the 10 least healthy states had among the worst levels of physical inactivity. Smoking was also more common in the least healthy states.

Money also clearly plays a role in determining health. The healthiest states are often among the nation’s wealthiest, and each had a median household income well-above the national median. At the other end, nearly all of the nation’s least healthy states had among the lowest incomes. The three least healthy states — Mississippi, Arkansas and Louisiana — were also the nation’s three poorest by median income. Residents’ ability to pay for health care, as well as the ability to afford a good education, which can affect good health decisions, are possible reasons for this relationship.

Tuckson added that the relationship between wealth and health could also be the result of lack of optimism poorer people may have. “When you do not have great hope for the future, when you’re living a life that is not as optimistic, people are generally not as inclined to take charge of their overall health. ‘What’s the point,’ people will say. ‘If my life is miserable anyway, why would I do something to make myself live longer?’”

Access to quality care is also crucial. In states where residents are most likely to be healthy, there are usually high numbers of physicians and doctors. The opposite is true in the nation’s least healthy states. In places with limited access to quality care, residents are more likely to have children with low birth weight, and preventable hospitalizations are also more common. Hawaii, America’s healthiest state, had the lowest rate of preventable hospitalizations among Medicare recipients.

The relationship between good health and good policy, however, is hardly straightforward. While some healthy states provide a considerable amount of health funding, others do not. Hawaii spent more than any other state on health care at $225 per person from 2011 through 2012. However, Minnesota, the third healthiest state, spent less than $47 per person. According to Tuckson, the lack of correlation between health spending and overall health is likely because it is difficult to measure consistently. “Funding for public health is a complicated statistic, and it can be captured differently from state to state, dependent on how their budgets are oriented.”

Based on data provided by United Health Foundation’s America’s Health Rankings, 24/7 Wall St. examined the 10 states with each the highest and lowest overall scores. These scores are based on a number of measures that fall into two separate categories: determinants and outcomes. Determinants are further divided into behaviors, such as smoking; community and environmental factors, such as children living in poverty; policy factors, such as public health funding and immunization rates; and clinical care factors, such as the availability of dentists and doctors. Additionally, we also reviewed supplementary data provided by America’s Health Rankings, including economic factors such as median household income. All data referenced are the most recent available data.

These are America’s most and least healthy states.

The Healthiest States

10. New Jersey
> Pct. obese: 24.6% (8th lowest)
> Cardiovascular deaths per 100,000: 248.0 (25th lowest)
> Physicians per 100,000: 140.4 (8th highest)
> Pct. visiting dentist in 2012: 71.2% (8th highest)

New Jersey, one of the wealthiest states in the nation, had the third highest median household income in 2012 at $66,692. It also had one of the lowest poverty rates last year at just under 11%. Overall, New Jersey residents have managed to maintain relatively good health. This could be partly due to the strong medical infrastructure in the state. Per 100,000 residents, New Jersey had among the most dentists and primary care physicians in the country.

9. North Dakota
> Pct. obese: 29.7% (15th highest)
> Cardiovascular deaths per 100,000: 231.3 (19th lowest)
> Physicians per 100,000: 115.9 (25th highest)
> Pct. visiting dentist in 2012: 67.2% (25th highest)

North Dakota struggles with obesity. Nearly 30% of the state’s adult population was obese in 2012, compared to 27.6% of adults nationwide. However, while obesity is usually a strong indicator of poor health outcomes, North Dakotans were among the healthiest in the country. State residents reported being sick only three days in a month and being in poor mental health just 2.8 days per month, on average. These were the second lowest and the lowest rates in the country, respectively. Between 2008 and 2010, the state had one of the lowest rates of cancer deaths per capita in the country. The state also had very low rates of high cholesterol and strokes in 2012.

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8. Colorado
> Pct. obese: 20.5% (the lowest)
> Cardiovascular deaths per 100,000: 202.6 (2nd lowest)
> Physicians per 100,000: 117.9 (24th highest)
> Pct. visiting dentist in 2012: 65.3% (20th lowest)

Colorado had the lowest obesity rate in the country last year at just over 20% of adults. As of 2011, the obesity rate among high school students was also the lowest in the nation. Exercise is likely paying off for Colorado residents. In 2011 and 2012, state residents were among the least vulnerable to heart attack and stroke. Much like many of the healthier states in the nation, Colorado’s poverty rate was low, a factor that has likely contributed to the health of its population. Less than 10% of households in the state relied on food stamps last year, one of the smallest shares in the country.

7. Connecticut
> Pct. obese: 25.6% (12th lowest)
> Cardiovascular deaths per 100,000: 219.8 (9th lowest)
> Physicians per 100,000: 162.3 (6th highest)
> Pct. visiting dentist in 2012: 76.1% (2nd highest)

Connecticut’s good health is clearly evident in the low rate of deaths due to preventable causes in the state as of 2009 — both third lowest in the nation. Factors such as low smoking and obesity rates likely play a role in promoting good health. Residents also benefit from ready access to medical professionals. Connecticut had 162.3 physicians and 79.1 dentists per 100,000 residents, both among the highest in the nation. Additionally, just 8.3% of people in the state lacked health insurance in 2011 and 2012. The availability of medical care may be due to high incomes in the state. A typical household in Connecticut earned more than $64,000 in 2012, versus a median household income of $51,017 nationwide.

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6. Utah
> Pct. obese: 24.3% (6th lowest)
> Cardiovascular deaths per 100,000: 209.9 (4th lowest)
> Physicians per 100,000: 88.5 (6th lowest)
> Pct. visiting dentist in 2012: 68.4% (16th highest)

More than 83% of Utah’s adult population reported they exercised regularly last year, the second most among all states. Utah’s children were among the least likely to live in poverty last year. In addition, the state’s infant mortality rate of 4.4 deaths per 1,000 live births was the lowest in the nation in 2008 and 2009. Utah’s adults have been in good health the past few years. Between 2008 and 2010, the state had the lowest rate of deaths from cancer in the country. Also, just 2.6% of adults in Utah suffered from heart disease, a smaller percentage than every other state.

5. New Hampshire
> Pct. obese: 27.3% (22nd lowest)
> Cardiovascular deaths per 100,000: 218.9 (8th lowest)
> Physicians per 100,000: 133.6 (10th lowest)
> Pct. visiting dentist in 2012: 73.1% (5th highest)

An impoverished population often suffers from poorer health because poor residents are less likely to be able to afford care or to be well informed of good health practices. New Hampshire’s extremely low poverty rate may be a key reason the state is one of the healthiest in the country. Just 10% of the population lived below the poverty line in 2012, the lowest rate of any state. The state had one of the lowest rates of deaths from cardiovascular disease in the country. The state also had one of the lowest rates of premature death in the country. One factor affecting the health of New Hampshire residents may be the healthy choices they make. The state had one of the highest rates of healthy eating habits and visits to the dentist, both of which are tied to good health.

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4. Massachusetts
> Pct. obese: 22.9% (2nd lowest)
> Cardiovascular deaths per 100,000: 217.7 (5th lowest)
> Physicians per 100,000: 196.1 (the highest)
> Pct. visiting dentist in 2012: 76.2% (the highest)

Massachusetts had the second lowest obesity rate in the country last year at just 22.9%, compared with more than 27% nationwide. The state’s health care system has provided a model for the federal health care reforms. More than 96% of the state’s population had health insurance, considerably better than any other state in the nation. And Massachusetts residents used their coverage. A higher rate of the population had their cholesterol checked and went to the dentist than in any other state. The state also benefits from the availability of primary care physicians. In 2011, there were nearly 200 physicians per 100,000 residents. Additionally, a greater percentage of adolescents in Massachusetts were immunized than in all but one other state.

3. Minnesota
> Pct. obese: 25.7% (13th lowest)
> Cardiovascular deaths per 100,000: 186.9 (the lowest)
> Physicians per 100,000: 143.5 (7th highest)
> Pct. visiting dentist in 2012: 74.8% (3rd highest)

Last year, less than 12% of Minnesotans described their health as poor or fair, the lowest percentage of any state. Minnesota had the fewest deaths per 100,000 people from cardiovascular diseases in the nation from 2008 through 2010, and was tied for the nation’s fourth lowest rate for diabetes last year. Just 6.4% of infants born in 2011 had low birth weight, lower than all but five states. Also, Minnesota’s infant mortality rate was lower than any other state except for New Hampshire. Infant mortality may be tied to health care access, as in Minnesota less than 9% of the population lacked health coverage from 2011 through 2012, versus 15.6% nationally.

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2. Vermont
> Pct. obese: 23.7% (5th lowest)
> Cardiovascular deaths per 100,000: 220.8 (10th lowest)
> Physicians per 100,000: 170.9 (4th highest)
> Pct. visiting dentist in 2012: 70.8% (11th highest)

Drug use in Vermont has escalated in recent years. The state had one of the highest rates of illicit drug use in 2010 and 2011. In particular, heroin has been flowing into the state at an alarming pace. Despite this problem, the state’s population was very healthy. A greater proportion of Vermonters reported they were in good health than in any state except Minnesota. Residents also have access to better care. The state had a near-universal health plan, with more than 93% of the population covered by health insurance, tied for the second highest rate in the country. There are also more primary care physicians per capita in Vermont than all but a few states.

1. Hawaii
> Pct. obese: 23.6% (3rd lowest)
> Cardiovascular deaths per 100,000: 209.0 (3rd lowest)
> Physicians per 100,000: 139.4 (9th highest)
> Pct. visiting dentist in 2012: 70.4% (12th highest)

Hawaii is the healthiest state in the nation. Like many of the country’s healthiest states, obesity was extremely low in the state, as were the rates of many of the serious diseases that tend to accompany obesity, such as diabetes. Just 2.8% of adults had heart disease in 2012, the second-smallest proportion in the country. Hawaiians also had among the lowest rates of death in the country from cardiovascular diseases and cancer. One reason state residents are in good health may be the high level of access to care. The state had a high concentration of dentists and physicians per capita. Also, just 7.8% of the population did not have health insurance, compared to 15.6% of the population nationally.

Click here to see the least healthy states

The Least Healthy States

10. Indiana
> Pct. obese: 31.4% (8th highest)
> Cardiovascular deaths per 100,000: 278.3 (12th highest)
> Physicians per 100,000: 101.6 (13th lowest)
> Pct. visiting dentist in 2012: 62.6% (17th lowest)

Like many of the nation’s least healthy states, Indiana residents tend to have bad habits that put them at higher risk of poor health. The state was among the 10 worst for smoking, physical activity and obesity. As the obesity rate has increased in recent years, so has the percentage of adults with diabetes. The state also had among the worst rates of cancer deaths per capita. Indiana’s median household income was nearly $5,000 lower than that of the nation in 2012. Public health funding per person was just $44.04, lower than all but two other states and less than half the national average funding of $92.32 per person.

9. Tennessee
> Pct. obese: 31.1% (10th highest)
> Cardiovascular deaths per 100,000: 309.3 (7th highest)
> Physicians per 100,000: 122.4 (18th highest)
> Pct. visiting dentist in 2012: 61.4% (14th lowest)

Unhealthy behavior is a problem in Tennessee. Nearly 25% of the adult population were smokers last year, the highest rate in the United States. Physical inactivity is also a problem in the state, where 28.6% of residents were inactive, among the worst rates in the nation. The state’s adult residents were among the most likely in the country to suffer from heart disease or to have had a heart attack. Like many other unhealthy states, Tennessee also had a high poverty rate, which America’s Health Rankings notes can increase the odds of chronic diseases, while also lowering life expectancy. Nearly 18% of Tennessee residents lived in poverty last year versus 15.9% nationwide. Also, more than 26% of children in Tennessee lived in poverty as of 2012, among the highest rates in the nation.

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8. South Carolina
> Pct. obese: 31.6% (7th highest)
> Cardiovascular deaths per 100,000: 277.6 (13th highest)
> Physicians per 100,000: 105.9 (18th lowest)
> Pct. visiting dentist in 2012: 59.6% (8th lowest)

Access to quality clinical care is a problem for many South Carolina residents. Almost 10% of infants in South Carolina suffered from low birth weight in 2011. This often occurs when expectant mothers do not receive adequate medical care. Additionally, South Carolina had fewer than 48 dentists per 100,000 residents in 2011, while less than 60% of residents visited the dentist last year. By contrast, there were 62 dentists per every 100,000 people nationwide, and 67.2% of adults visited the dentist in 2012. Many state residents are quite poor. South Carolina’s median household income was just $44,401 in 2012, versus $51,017 nationally. Also, the state’s 9.4% unemployment rate last year was one of the highest in the United States.

7. Oklahoma
> Pct. obese: 32.2% (6th highest)
> Cardiovascular deaths per 100,000: 330.5 (3rd highest)
> Physicians per 100,000: 82.7 (3rd lowest)
> Pct. visiting dentist in 2012: 58.9% (7th lowest)

In addition to high adult obesity and smoking rates, common factors in America’s least healthy states, Oklahoma also had among the worst rate of drug deaths between 2008 and 2010. While Oklahoma’s smoking rate remains high, it has improved significantly from 26.1% of adults in 2011 to 23.3% last year. In 2011, there were 76.9 preventable hospitalizations for every 1,000 Medicare recipients, eighth most in the nation. Such hospitalizations often arise when individuals do not address medical issues early on because they may lack appropriate access to care. As of 2011, there were fewer than 83 primary care physicians per 100,000 people, less than almost every other state.

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6. Kentucky
> Pct. obese: 31.3% (9th highest)
> Cardiovascular deaths per 100,000: 299.8 (8th highest)
> Physicians per 100,000: 102.5 (14th lowest)
> Pct. visiting dentist in 2012: 60.3% (10th lowest)

More than 28% of adults in Kentucky were smokers last year, the highest rate in the nation. Between 2008 and 2010, the state had the highest rate of cancer deaths, with about 227 deaths per 100,000 residents. Lung cancer deaths are particularly common in Kentucky, likely due to high smoking rates, according to the American Cancer Society. Kentucky’s poor state of health may be partly related to lack of exercise as nearly 30% of residents did no regular physical activity. In 2012, more than 31.3% of Kentucky residents were obese, among the highest rates in the country. The relatively high poverty rate, which last year was close to 20%, is likely another factor contributing to the state’s poor health. Kentucky may stand to benefit from the Affordable Care Act. The state’s new health insurance exchange has provided coverage for a greater percentage of its population than that of any other state.

5. West Virginia
> Pct. obese: 33.8% (4th highest)
> Cardiovascular deaths per 100,000: 311.0 (6th highest)
> Physicians per 100,000: 105.5 (17th lowest)
> Pct. visiting dentist in 2012: 56.4% (4th lowest)

West Virginians are among the most likely Americans to suffer from a range of serious diseases. Thirteen percent of the adult population had diabetes as of 2012, more than any other state in the country, while deaths due to cardiovascular diseases and cancer were more common than in most other states. More than a quarter of West Virginians surveyed in 2012 described their own health as being poor or fair, the most of any state. For many residents, unhealthy behaviors may contribute to overall poor health. The state’s smoking and obesity rates were among the highest in the nation. Prescription drug abuse is a major concern in West Virginia. Between 2008 and 2010 there were 22 drug-related deaths per 100,000 residents, trailing only one other state.

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4. Alabama
> Pct. obese: 33.0% (5th highest)
> Cardiovascular deaths per 100,000: 335.8 (2nd highest)
> Physicians per 100,000: 99.9 (tied for 11th lowest)
> Pct. visiting dentist in 2012: 58.6% (5th lowest)

Nearly 25% of Alabama residents described their general health as fair or poor, a higher percentage than any other state except for West Virginia. Heart diseases and high cholesterol levels were more common in Alabama than most other states. Also, 4.6% of the state’s adult population suffered from stroke last year, a larger share than any other state. Also, infant mortality was the second highest in the country at 8.5 per 1,000 live births, compared with just 6.3 deaths per 1,000 live births nationwide. In a recent press release, the Alabama Department of Health attributed the high infant mortality rate to low birth weights and high smoking rates among expectant mothers. Additionally, infant mortality occurred at higher rates among women without health insurance. Last year, 24% of adults were regular smokers, considerably higher than the national rate. About 10% of all live births were underweight in 2011.

3. Louisiana
> Pct. obese: 34.7% (the highest)
> Cardiovascular deaths per 100,000: 318.5 (5th highest)
> Physicians per 100,000: 120.3 (20th highest)
> Pct. visiting dentist in 2012: 56.1% (3rd lowest)

Children born in Louisiana face a number of serious health-related challenges. Last year, 31% of minors in the state lived in poverty, the highest rate in the nation. Nearly 11% of children born as of 2011 had low birth weight, a sign that the mother may have limited access to health care, possibly because of a lack of health coverage. In 2011 and 2012, nearly one-fifth of the state’s population lacked health coverage. Obesity has skyrocketed in Louisiana, nearly tripling from 12.3% of the adult population in 1990 to 34.7% last year, the highest rate of any state. Louisiana residents also were more likely than most Americans to die of cardiovascular disease or cancer.

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2. Arkansas
> Pct. obese: 34.5% (3rd highest)
> Cardiovascular deaths per 100,000: 319.4 (4th highest)
> Physicians per 100,000: 99.9 (tied for 11th lowest)
> Pct. visiting dentist in 2012: 54.9% (the lowest)

High rates of smoking and physical inactivity among Arkansas residents contributed to the general poor health in the state last year. One in four adults were smokers, and 31.4% of adults were physically inactive, the largest share of any state. Between 2008 and 2010, deaths from cancer in the state were among the highest nationally, at about 216 per 100,000 residents. High rates of smoking and obesity — more than 34% of Arkansas adults were obese last year — explain in part the populations’ vulnerability to cancer. CARTI, a nonprofit cancer care provider, announced this month it plans to build a new cancer center in Little Rock. The nonprofit clinic likely will benefit Arkansas residents, many of which are living in poverty. Last year, the poverty rate was nearly 20%, the fourth highest in the country.

1. Mississippi
> Pct. obese: 34.6% (2nd highest)
> Cardiovascular deaths per 100,000: 358.6 (the highest)
> Physicians per 100,000: 82.1 (2nd lowest)
> Pct. visiting dentist in 2012: 55.4% (2nd lowest)

For the second consecutive year, Mississippi ranked as the least healthy state in the nation. Like other unhealthy states, Mississippi had high smoking, obesity and physical inactivity rates. Aside from unhealthy habits, living conditions of many in the state are not conducive to good health, with nearly 30% of children living in poverty last year. Limited access to quality health care is also a problem, with just 82 primary care physicians and 42 dentists per 100,000 residents as of 2011, both lower than almost any other state. These conditions may have contributed to the state’s poor health. The state had some of the highest rates of cardiovascular and cancer deaths in the nation. The effects of Mississippi residents’ poor health and limited access to medical care are perhaps nowhere better seen than in the state’s infant mortality rate of 9.9 deaths per 1,000 live births in 2008 and 2009, the nation’s highest.

Click here to see the most healthy states

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