The well-being of Americans hasn’t improved in the past six years, and it even declined slightly in 2013, according to a recent Gallup study. While national figures remained flat overall, the ranks of the states with the highest well-being scores changed considerably. North Dakota topped the well-being list in 2013 after failing to crack the top 10 in 2012. Hawaii, 2012’s top state, fell to number eight in 2013. West Virginia, on the other hand, remained at the bottom of the list for the fifth consecutive year.

The Gallup-Healthways Well-Being Index, which interviewed more than 176,000 people from all 50 states last year, measures the physical and emotional health of Americans across the country. 24/7 Wall St. reviewed the more than 50 metrics comprising the six broad categories Gallup used to identify well-being.

Click here to see America’s most content states

Click here to see America’s most miserable states

Well-being matters because it effectively reflects health, employment, education, and the local environment, Dan Witters, research director of the Gallup-Healthways Well-Being Index, told 24/7 Wall St. Witters suggested that this means that a strong economy and a healthy, educated workforce can improve well-being, just as high well-being may also influence further development.

Because these relationships appear to exist, “there’s a lot of things that employers or communities can do structurally, culturally, legislatively, that can positively affect change around well-being,” Witters added.

The Gallup-Healthways survey asked respondents a large range of questions. There were several indicators for which states with low well-being largely received low scores, and for which states with high well-being typically received high scores.

In states with high well-being scores, residents were less likely to smoke and more likely to exercise regularly and learn new things every day. These states also enjoyed the positive outcomes of such behaviors, including lower obesity rates and other common health problems.

The opposite was generally true for states with low well-being, where residents were more likely to have unhealthy lifestyles or limited access to basic necessities. As a result, they tended to feel physically and emotionally unhealthy. In those states, residents were among the most likely in the nation to suffer from health problems such as high cholesterol and blood pressure, as well as obesity. Broadly, residents in these states did not feel they were thriving.

Other factors considered by 24/7 Wall St., in addition to data from the Well-Being Index, may also influence a state’s score. The states with the lowest well-being typically had very low median household incomes. Having a stable income is important because it enables people to access basic needs such as healthy food, clean water, medicine, and health care. However, the opposite was not the case for the highest ranking states, a number of which were not especially well-off.

“For the most part, well-being goes up with income,” according to Witters. While a low income can definitely impair well-being, as incomes rise, factors such as emotional health tend to level out, Witters explained. For individuals, “emotional health scores kind of hit their peak at about $75,000 a year. And after that point, they really don’t get any better.”

However, while states with high well-being scores did not have necessarily high incomes, they often had other advantages, such as high educational attainment and low unemployment. In each of the top-rated states more than 90% of residents had a high school diploma, versus just 86.4% of Americans nationwide. Educational outcomes in low well-being states were generally poor. Also, many states with high scores had low unemployment.

Although a number of the states with the highest, and lowest, well-being scores have remained the same, the well-being of a number of states significantly improved in the most recent year. Perceived improvement in the work environment, especially in the supervisor’s treatment, was often behind these gains, according to Witters. He cited workplace evaluations as a major reason Hawaii fell in the rankings, as well as a major reason North and South Dakota, the two states with the highest well-being scores, entered the top 10 in 2013.

Regional patterns were also evident, as states in some parts of the country continued to do better than others in 2013. In particular, the Plains states were disproportionately well-represented among the states with the highest well-being. North Dakota, South Dakota, Minnesota, Nebraska, and Iowa were all among the top 10 states. States in the Southeast accounted for seven of the 10 states with the lowest well-being score in the nation. This has been the case in previous years as well.

24/7 Wall St. reviewed all 50 U.S. states based on their scores in the Gallup-Healthways 2013 Well-Being Index. Gallup-Healthways calculated a national well-being score as well as one for each state, assigning scores from 0 to 100, with 100 representing ideal well-being. In generating the rank, Gallup combined six separate indices, measuring access to basic needs, healthy behavior, work environment, physical health, life evaluation and optimism, and emotional health. In addition to the index, 24/7 Wall St. considered data from the U.S. Census Bureau’s 2012 American Community Survey, including median income, poverty levels, and the percentage of adults with a high school diploma or higher. From the Bureau of Labor Statistics, we reviewed state unemployment rates as of December 2013. We also reviewed 2010 statistics for life expectancy at birth and deaths from heart disease, as well as 2011 data on prescription drugs, published by The Henry J. Kaiser Family Foundation. We also considered state violent crime rates in 2012 from the FBI’s Uniform Crime Report Program.

These are America’s most content (and miserable) states.

America’s Most Content States

10. Iowa
> Well-being index score: 68.2
> Life expectancy: 79.7 years (16th highest)
> Pct. obese: 28.1% (tied-20th highest)
> Median household income: $50,957 (23rd highest)
> Pct. with high school diploma: 91.6% (8th highest)

Iowa residents were among the most likely in the nation to report having access to basic necessities in 2013. This included among the best scores for access to healthy food, health care and safe neighborhoods. More than 82% of residents felt safe walking alone at night, and 87% felt they had enough money for health care and medicine, both among the highest proportions nationwide. Iowans were in relatively good physical health, with 77% of residents saying their health did not prevent them from going about their daily lives, more than those in any other state except for North Dakota and Nebraska. Working conditions were also quite good, with more than 90% of residents reporting they were satisfied with their jobs last year.

9. Washington
> Well-being index score: 68.3
> Life expectancy: 79.9 years (13th highest)
> Pct. obese: 25.0% (18th lowest)
> Median household income: $57,573 (12th highest)
> Pct. with high school diploma: 90.4% (tied-15th highest)

Washington residents had some of the nation’s best outlook for their future. They were also among the happiest Americans at work. Washington’s relatively strong economy likely helped to boost residents’ opinions about their future and their work. The state’s economy grew by 3.6% in 2012, outpacing the rest of the nation. Economic confidence, too, was among the highest in Washington when compared with the rest of the U.S. Respondents from the state were especially likely to indicate they practiced healthy behavior. Nearly 62% said their regular diet included fruits and vegetables, and nearly 83% said they did not smoke, both among the highest proportions of any state.

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8. Hawaii
> Well-being index score: 68.4
> Life expectancy: 81.3 years (the highest)
> Pct. obese: 23.7% (9th lowest)
> Median household income: $66,259 (5th highest)
> Pct. with high school diploma: 90.4% (tied-15th highest)

Hawaiians were more likely than most Americans to practice healthy behaviors. More than 62% of residents in the state exercised regularly last year, more than in any state except for Vermont. Also, 59.6% of residents regularly ate fruits and vegetables, higher than a majority of states. Residents were among the most emotionally healthy Americans, leading the nation in the percentage of respondents who smiled or laughed, or learned something new within the last day. While more than a dozen states ranked higher in physical health, life expectancy at birth in Hawaii was 81.3 years as of 2010, the highest in the nation. Incomes in Hawaii were largely higher than the rest of the U.S., and the state’s 4.5% unemployment rate in December was among the nation’s lowest. However, many Hawaiians were unhappy with their work environment. Just 47.8% of respondents felt treated like a partner at work, the second-worst rate in the U.S.

7. Colorado
> Well-being index score: 68.9
> Life expectancy: 80.0 years (11th highest)
> Pct. obese: 20.4% (2nd lowest)
> Median household income: $56,765 (14th highest)
> Pct. with high school diploma: 90.6% (12th highest)

Physical health was among the most important factors contributing to Colorado’s high well-being score. Colorado had the second lowest obesity rate in the nation in 2013. Additionally, just 7% of the state’s population had been diagnosed with diabetes as of last year, less than in any other state. State residents were also among the least likely to have had a heart attack. The high marks for good health may have something to do with the population’s healthy behaviors. Less than 18% of Colorado residents smoked last year, and almost 60% exercised regularly, both among the best marks in the nation. Respondents from the state were also generally upbeat about their future, giving strong evaluations of both their present lives and their expectations for the next five years.

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6. Vermont
> Well-being index score: 69.1
> Life expectancy: 80.5 years (5th highest)
> Pct. obese: 24.8% (12th lowest)
> Median household income: $52,977 (20th highest)
> Pct. with high school diploma: 91.7% (tied-5th highest)

Nowhere in the U.S. were residents more likely to practice healthy behaviors than in Vermont. Almost 72% of respondents in the state ate healthy all day within the past day, and more than 65% of residents stated they exercised regularly — both higher than any other state. Additionally, 67.8% of residents had eaten five servings of fruits and vegetables at least four times a week, also more than any other state. Unsurprisingly, Vermont residents surveyed were among the most likely to report being physically healthy. As for the state’s labor market, despite slow economic growth in 2012, the state’s unemployment rate was just 4.2% last December, among the lowest in the U.S. Residents were also more likely than most Americans to enjoy the environment in which they worked. Nearly 92% of adults aged 25 and up had a high school diploma in 2012, among the top figures nationwide.

5. Montana
> Well-being index score: 69.3
> Life expectancy: 78.5 years (21st lowest)
> Pct. obese: 19.6% (the lowest)
> Median household income: $45,076 (12th lowest)
> Pct. with high school diploma: 92.8% (the highest)

Economic confidence in Montana was exceptionally bad in 2013, among the 10 worst states. Despite that, residents gave high ratings to their work environment. Nearly 94% of adults said they were satisfied with their job, the highest percentage nationally. This was likely due, in part, to feeling fully utilized at work — 89% of respondents said they used their strengths during the work day, more than all but one other state. Montana residents also practiced healthy behavior more than residents of most other states. A majority of the population reported healthy eating habits, weekly exercise routines, and lower than average smoking rate in 2013. Montana residents were also the least likely to be obese last year.

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4. Minnesota
> Well-being index score: 69.7
> Life expectancy: 81.1 years (2nd highest)
> Pct. obese: 22.0% (4th lowest)
> Median household income: $58,906 (9th highest)
> Pct. with high school diploma: 92.5% (2nd highest)

Minnesotans reported exceptional physical health in 2013. More than 81% of respondents were able to partake in age-appropriate activities, tied for the highest percentage in the U.S. Residents were also among the least likely Americans to report being obese. No state had fewer heart disease-related deaths per 100,000 residents than Minnesota in 2010. People surveyed in the state were also exceptionally likely to report having basic access to critical necessities, including medicine, and fruits and vegetable. Residents, were also among the most likely Americans to report they had adequate money for food, shelter, and health care. Minnesota’s median income of $58,906 in 2012 was one of the highest in the U.S. Also, 92.5% of adults 25 and over had a high school diploma — among the best in the nation. The state’s economy, too, grew at a rapid 3.5% clip in 2012, greatly outpacing the nation as a whole.

3. Nebraska
> Well-being index score: 69.7
> Life expectancy: 79.8 years (15th highest)
> Pct. obese: 27.1% (25th highest)
> Median household income: $50,723 (25th highest)
> Pct. with high school diploma: 90.5% (tied-13th highest)

Nebraska had some of the nation’s highest scores for both emotional and physical health. Residents were among the least likely to be depressed last year, trailing only North Dakota and New Jersey. More than 81% of residents did not have any health problems preventing them from age-appropriate activities, tied with Minnesota for the best nationwide in 2013. One factor improving Nebraskans’ well-being was likely their high quality living conditions. More residents were satisfied with their city than those in any other state, and most believed their city was improving overall. People in Nebraska were more confident about the future of the U.S. economy than residents of nearly all other states.

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2. South Dakota
> Well-being index score: 70.0
> Life expectancy: 79.5 years (tied-18th highest)
> Pct. obese: 28.3% (17th highest)
> Median household income: $48,362 (22nd lowest)
> Pct. with high school diploma: 90.5% (tied-13th highest)

Respondents from South Dakota were among the most likely people in the U.S. to report good emotional health. More than 86% of those surveyed reported smiling or laughing within the past 24 hours, second-highest in the U.S. Meanwhile, 90% reported enjoying a large portion of their day, and more than 93% felt happy during the previous 24 hours, both more than any other state. The state’s 3.6% unemployment rate in December tied for the second lowest in the U.S. Not only did much of the workforce have a job, but also people in the state were more likely to enjoy their work environment than residents of any other state except for neighboring North Dakota.

1. North Dakota
> Well-being index score: 70.0
> Life expectancy: 79.5 years (tied-18th highest)
> Pct. obese: 26.0% (24th lowest)
> Median household income: $53,585 (19th highest)
> Pct. with high school diploma: 91.7% (tied-5th highest)

Due in large part to profitable oil discoveries in the region, North Dakota’s economy grew by more than 13% in 2012, by far the fastest growth nationwide. The state’s unemployment rate has also been very low in recent years, clocking in at 2.6% in December compared with 6.7% nationally. With such low unemployment, it’s perhaps not surprising that economic confidence levels in the state were among the highest 10 in the country. More than nine in 10 adults were satisfied with their jobs in 2013, one of several reasons the state’s residents rated their work environment best in the nation. Supervisors in the state were more likely to treat their subordinates as partners than in any other state. With good wages and plenty of jobs, the vast majority of residents had enough money for adequate shelter, food, and medicine. The proportion of respondents that were satisfied with their city and believed it was improving, however, was less than the national average.

Click here to see America’s most miserable states

America’s Most Miserable States

10. Louisiana
> Well-being index score: 64.9
> Life expectancy: 75.7 years (4th lowest)
> Pct. obese: 32.7% (4th highest)
> Median household income: $42,944 (8th lowest)
> Pct. with high school diploma: 83.0% (4th lowest)

Louisiana residents suffered from limited access to basic needs. Last year, nearly 9% of those surveyed in the state noted they did not have easy access to clean and safe drinking water, while nearly 12% of residents lacked easy access to medicine, both among the worst rates in the nation. Just 61.4% of respondents felt safe walking home alone at night, the lowest rate in the U.S., and significantly lower than the national rate of more than 70% who felt safe in the same circumstances. Louisiana also ranked among the lowest in healthy behaviors because of its residents’ high smoking rate and limited healthy eating. As of 2010, there were 229.4 deaths due to heart disease per 100,000 people in the state, fourth-highest nationally. That same year, life expectancy at birth in the state was just 75.7 years, one of the worst figures in the nation.

9. Oklahoma
> Well-being index score: 64.7
> Life expectancy: 75.9 years (5th lowest)
> Pct. obese: 30.5% (10th highest)
> Median household income: $44,312 (10th lowest)
> Pct. with high school diploma: 86.7% (19th lowest)

Oklahomans had among the most unhealthy behaviors in the U.S. during 2013. Only about half of the population said they ate fruits and vegetables on a regular basis last year, less than any other state. Oklahoma residents also reported poor access to basic necessities. More than 10% of residents said they did not have easy access to clean and safe drinking water, worse than any other state. Oklahomans also self-reported poor physical health. More than 6% of adults said they have had a heart attack as of last year, more than in any other state, and considerably higher than the national average of 3.8%. In 2010, there were 235.2 heart disease-related deaths per 100,000 residents, the third-highest rate nationwide.

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8. Missouri
> Well-being index score: 64.5
> Life expectancy: 77.5 years (11th lowest)
> Pct. obese: 29.0% (14th highest)
> Median household income: $45,321 (14th lowest)
> Pct. with high school diploma: 88.0% (23rd lowest)

The economic confidence of Missouri residents improved considerably between between 2012 and 2013. Despite this, respondents had some of the worst outlooks about their lives in 2013. Just one half of residents surveyed said they were thriving last year, among the lowest rates in the nation. With a high number of residents experiencing stress, as well as a relatively low number reporting having smiled or laughed within the last day, Missouri ranked among the worst states for emotional health.

7. Tennessee
> Well-being index score: 64.3
> Life expectancy: 76.3 years (8th lowest)
> Pct. obese: 31.3% (7th highest)
> Median household income: $42,764 (7th lowest)
> Pct. with high school diploma: 85.1% (13th lowest)

Tennessee residents were among the most likely to have a variety of physical health problems in 2013, including diabetes, high cholesterol, high blood pressure, and chronic pain. People living in Tennessee were also less likely to feel safe walking at night than residents of many other states. The state’s violent crime rate of 643.6 incidents per 100,000 residents was the highest in the nation in 2012 and may justify these fears. Economic confidence in the state was among the worst last year. This was despite the fact that the state’s economy grew by 3.3% in 2012, one of the largest growth rates that year.

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6. Arkansas
> Well-being index score: 64.3
> Life expectancy: 76.0 years (tied-6th lowest)
> Pct. obese: 32.3% (5th highest)
> Median household income: $40,112 (2nd lowest)
> Pct. with high school diploma: 84.8% (9th lowest)

Arkansas rated as one of the most physically unhealthy states as of 2013, ranking behind just two other states. Only 71.8% of residents were able to partake in age-appropriate activities, among the lowest rates in the nation, while 36.8% of respondents reported high blood pressure, one the highest figures of any state. More than 32% of respondents were obese last year, compared to 27% nationally.. Arkansas had 222.5 heart disease-related deaths per 100,000 residents in 2010, fifth highest in the nation. Healthy behaviors in the state, as well as access to basic needs, were also rated lower than most other states. Likely contributing to the state’s low rank in many of these measures is its large poor population. Nearly 20% of all people in the state lived below the poverty line in 2012, fourth highest in the nation.

5. Ohio
> Well-being index score: 64.2
> Life expectancy: 77.8 years (13th lowest)
> Pct. obese: 30.9% (8th highest)
> Median household income: $46,829 (17th lowest)
> Pct. with high school diploma: 88.8% (25th highest)

Despite its low well-being score, Ohio stands out from other low ranking states because it doesn’t exhibit many of the elements often present in those states. For one, Ohio’s median household income of $46,829 in 2012 was higher than most states with low well-being scores. Similarly, its residents had better access to basic needs than residents of other low well-being states. However, residents generally had low evaluations of their lives, trailing only West Virginia and Kentucky by that measure. Just 49.3% of respondents stated they were thriving in their lives last year, one of the lowest proportions in the nation. Relatively few respondents indicated they had a learning experience within the previous 24 hours, and residents were among the most likely in the U.S. to have felt angry that day. This contributed to Ohio’s low ranking for emotional health.

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4. Alabama
> Well-being index score: 64.1
> Life expectancy: 75.4 years (tied-2nd lowest)
> Pct. obese: 28.1% (tied-20th highest)
> Median household income: $41,574 (4th lowest)
> Pct. with high school diploma: 84.0% (6th lowest)

The median household income in Alabama of just $41,574 in 2012 was fourth lowest in the nation. The relatively low income of many state residents may have made it difficult for them to access basic necessities. Relatively few Alabama residents said they had enough money to afford medicine, food, or adequate shelter. Alabama residents also had among the worst physical health in the nation. High blood pressure and diabetes in particular were much more common in Alabama than in most other states. Also, there were 236 deaths per 100,000 people due to heart disease, the second-most nationwide.

3. Mississippi
> Well-being index score: 63.7
> Life expectancy: 75.0 years (the lowest)
> Pct. obese: 35.4% (the highest)
> Median household income: $37,095 (the lowest)
> Pct. with high school diploma: 82.3% (3rd lowest)

Nowhere else in the U.S. did people feel as negative about their work environment as in Mississippi. But this was just one of the problems facing state residents. Respondents were among the most likely in the nation to lack access to basic necessities. More than a quarter of people surveyed in the state indicated they did not have money for food at some point in the previous 12 months, while nearly as many lacked money for health care. By a number of measures, the state was one of the absolute poorest in the nation. The median income in Mississippi was just $37,095 in 2012, lowest in the U.S. Also, 24.2% of people lived below the poverty line, more than in any other state. With limited access to basic needs and poor healthy behaviors, the state was among the worst in the nation in physical health assessments. Last year, no state had a higher obesity rate than Mississippi. In 2010, no state had a higher rate of death from heart disease or a lower life expectancy at birth than Mississippi.

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2. Kentucky
> Well-being index score: 63.0
> Life expectancy: 76.0 years (tied-6th lowest)
> Pct. obese: 30.6% (9th highest)
> Median household income: $41,724 (5th lowest)
> Pct. with high school diploma: 83.8% (5th lowest)

Kentuckians had some of the most unhealthy behaviors last year. Less than 60% of those surveyed said they ate well all day, the worst among all states, while the smoking rate was the highest in the nation. Unhealthy habits in the state likely contributed to poor physical health. Respondents from Kentucky were among the most likely to complain about lack of energy and sleep, and nearly 30% said health issues prevented them from going about their normal lives. The state’s population was the nation’s most reliant on prescription drugs, with 19.3 prescriptions filled per capita in 2011, tied with West Virginia.

1. West Virginia
> Well-being index score: 61.4
> Life expectancy: 75.4 years (tied-2nd lowest)
> Pct. obese: 34.4% (2nd highest)
> Median household income: $40,196 (3rd lowest)
> Pct. with high school diploma: 84.5% (8th lowest)

No Americans had as negative an outlook about their future as West Virginians, who rated their projected life in five years the lowest. Additionally, just 44.8% of residents described themselves as thriving, the lowest in the nation. West Virginia also had the lowest score for overall emotional health, ranking either the lowest or second-lowest in nearly all of the indicators considered by the Gallup-Healthways Well-Being Index. Unsurprisingly, residents had less confidence about the future of the U.S. economy than those anywhere else in the nation. Outside of attitudes, West Virginians were also the least physically healthy respondents in the nation. The state had the highest rates of both high blood pressure and high cholesterol, and the second highest obesity rate. It also had the highest rate of respondents unable to partake in age-appropriate activities.

Click here to see America’s most content states

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