With the ongoing U.S. economic recovery and implementation of the Affordable Care Act, health insurance coverage rates among Americans have increased significantly. Americans may expect health outcomes to improve as well. Despite the general positive trend in health care, there is still great variation in the health of residents among states and even within states.

24/7 Wall St. reviewed county-level health rankings from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. Rankings are based on overall health outcomes, a weighted composite of length of life, quality of life, and overall health factors. The health factors component is a weighted composite of healthy behaviors, clinical care, social and economic factors, and physical environment measures. These are the least healthy counties in each state.

Click here to see the least healthy county in each state.

The years of potential life lost per 100,000 people accounted for the length of life component of the model, while the percent of adults reporting poor or fair health and the numbers of physical and mentally unhealthy days accounted for the quality of life component. Together, the two components made up half the model.

The healthiest county in only three states reported an estimated number of years lost per 100,000 residents annually of more than 6,622 — the national estimate. When asked to rate their own health as excellent, very good, good, fair, or poor,16% of Americans replied fair or poor. The percentage replying fair or poor was lower in the healthiest county in every state.

Health factors made up the other half of the model. Socioeconomic measures were the most important components of the health factors portion of the model. Julie Willems Van Dijk, co-director of the County Health Rankings & Roadmaps program, explained how the lack of a good education — as one example — can increase the likelihood of negative health outcomes. Not only can a good education offer the knowledge necessary to lead a healthy lifestyle, but also it can pave the way to higher-paying jobs, which also tend to offer benefits such as health insurance. Residents without higher income are more likely to live in neighborhoods that lack healthier food options and places to conveniently and safely exercise.

While income is perhaps the most important factor in the health of a community, it is not merely the size of the residents’ paychecks that matter. According to Willems Van Dijk, income inequality can have a direct impact on health outcomes. “People who are very separate from each other and don’t have the kind of social cohesion and interaction that you have in a community with a more flat income distribution” report higher rates of chronic diseases, higher levels of stress, and on the whole worse health outcomes.

Nationwide, incomes in the 80th percentile were 4.6 times greater than those among the bottom 20th percentile of earners. Incomes in the healthiest counties in all but seven of the 50 states were better distributed than the national inequality ratio. The opposite tended to be true in unhealthy areas.

While strong economic conditions can lead to positive health outcomes, the impacts can also work the other way around. According to another Robert Wood Johnson Foundation study in 2013, annual obesity-related health care costs nationwide have been as high as $210 billion in recent years. That figure excludes productivity losses from poor physical health. The healthiest counties in all but 13 states had an obesity rate lower than the national obesity rate of 27%.

Willems Van Dijk noted that while there is a strong relationship between health and wealth, many other factors play a role. “The county health rankings show you a combination of these factors and how they interact with each other.” In fact, the disparities between areas within a state demonstrate how dependent the health status of an area is on local factors. “What [happens] in the local culture and the environment of local communities will affect all of those other health factors and then subsequently affect how well and how long you live,” said Willems Van Dijk.

To identify the least healthy county in each state, 24/7 Wall St. reviewed health rankings in most counties and county equivalents in each state from County Health Rankings & Roadmaps. The rankings are based on a model developed by the University of Wisconsin and include about 70 different health measures from a range of sources, predominantly U.S. government surveys.

These are the least healthy counties in each state.

Lowndes County, Ala.
> Pct. without health insurance: 15.5%
> Pct. food insecure: 25.8%
> Obesity rate: 43.7%
> 2013 unemployment rate: 11.9%

Although Lowndes County ranked second lowest in health outcomes and health behaviors among Alabama counties, other factors contributed to its rank as the least healthy county in Alabama. The county’s 43.7% obesity rate was about 10 percentage points higher than the state’s obesity rate. The county had just one primary care physician for its nearly 11,000 residents and no dentists or mental health providers. Nearly 36% of county residents said they were in poor or fair health, far more than the 20.5% of state residents who felt that way, which was itself the fourth highest percentage compared to states.

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Wade Hampton Borough, Alaska
> Pct. without health insurance: 30.1%
> Pct. food insecure: 24.6%
> Obesity rate: 34.6%
> 2013 unemployment rate: 22.1%

One out of every four Wade Hampton Borough residents said they were in poor or fair health, nearly double the share of Alaskans who felt that way, and supporting Wade Hampton Borough’s ranking as the least healthy area in Alaska. Just over 36% of adults in the county were smokers, much higher that 20.8% rate across the state. Wade Hampton residents had the worst health outcomes of any Alaska borough reviewed. Residents lacked access to any primary care physicians or dentists.

Apache County, Ariz.
> Pct. without health insurance: 25.3%
> Pct. food insecure: 25.7%
> Obesity rate: 31.9%
> 2013 unemployment rate: 19.8%

Apache County residents ranked worst in Arizona for premature death, recording 14,350 years of potential life lost per 100,000 people annually, more than twice the statewide average of 6,714 years. The county’s 31.9% obesity rate was eight percentage points higher than the statewide rate. Two other factors may have contributed to the county’s poor health outcomes. One was the county’s high unemployment rate of 19.8%, which was more than twice the statewide rate of 8.0%. The other was the high child poverty rate of 49.3%, which was nearly double the state rate of 26.6%. About one in five county residents said they were in fair or poor health, more than the 15.6% of all Arizonans.

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Phillips County, Ark.
> Pct. without health insurance: 17.9%
> Pct. food insecure: 29.1%
> Obesity rate: 40.0%
> 2013 unemployment rate: 11.2%

Phillips County residents had access to just one primary care physician for every 2,969 people, compared with one for every 1,562 residents throughout the state. More than 29% of area households were food insecure, far higher than the 19.4% of households across the state, which was itself the second highest compared to all states. There were 1,424 cases of chlamydia per 100,000 residents in the county, more than two-and-a-half times the statewide rate. The teen birthrate in the county was 89.4 per 1,000 females aged 15-19, much higher than the statewide rate of 55.4 births per 1,000 female teens.

Lake County, Calif.
> Pct. without health insurance: 20.6%
> Pct. food insecure: 19.9%
> Obesity rate: 26.5%
> 2013 unemployment rate: 11.9%

About 25% of Lake County adults, nearly twice the statewide rate, were smokers, a major contributing factor to the county’s ranking as worst in the state for health behaviors. Nearly 22% of adults in Lake County were physically inactive in the past month, higher than the statewide share of 16.8%. Also, 26.5% of county residents were obese compared with 22.9% statewide. Lake’s ranking as the state’s least healthy county is relative. While it may have a low ranking compared to the rest of California counties, it compares well with the nation as a whole. For example, while the 86.9% of county residents who had access to exercise opportunities was less than the statewide share of 93.4%, it tops the national percentage of 85.0%.

Costilla County, Colo.
> Pct. without health insurance: 28.0%
> Pct. food insecure: 14.7%
> Obesity rate: 21.5%
> 2013 unemployment rate: 12.2%

Costilla County had some of the worst access to medical care in the country, with no primary care physicians or dentists and just one mental health provider,. At the same time, about 28% of county residents had no health insurance, much higher than the almost 17% of residents in the state without insurance. The county’s teen birth rate of 48.2 births per 1,000 female teen residents was higher than both the statewide rate and the national rate. About 22% of county residents rated their health to be fair or poor, far higher than the 12.8% statewide rate.

New Haven County, Conn.
> Pct. without health insurance: 11.2%
> Pct. food insecure: 14.4%
> Obesity rate: 26.9%
> 2013 unemployment rate: 8.6%

Although it is the home of Yale-New Haven Hospital, one of the nation’s top-rated medical facilities, New Haven County ranked lowest for overall health among Connecticut’s counties. But the county’s ranking within the state might simply reflect the fact that one of the state’s eight counties had to be last. While New Haven County’s factors were not as good as the state’s, they were, by and large, better than the nation’s. As an example, the county recorded more years of potential life lost per 100,000 residents annually than the state did, but less than the national figure. Similarly, 12.4% of county residents rated their health fair or poor. This was higher than the 10.8% of state residents, but lower than the 16.0% of national residents who said the same. Examining healthy behaviors yields similar results — the county’s smoking and obesity rates were higher than the state’s rates but lower than the national rates.

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Kent County, Del.
> Pct. without health insurance: 9.8%
> Pct. food insecure: 12.8%
> Obesity rate: 32.7%
> 2013 unemployment rate: 6.9%

Kent County ranked as the least healthy county in Delaware. The county’s obesity, smoking and physical inactivity rates were all higher than both the state and national rates. When asked to rate their lives excellent, very good, good, fair, or poor, nearly 15% of county residents replied fair or poor, higher than the 12.4% of Delaware residents or the 16.0% of Americans.

Putnam County, Fla.
> Pct. without health insurance: 23.7%
> Pct. food insecure: 19.3%
> Obesity rate: 33.1%
> 2013 unemployment rate: 9.4%

About 27% of residents of Putnam County considered their health to be fair or poor. Just over half that share of the state population rated their health the same way. The county’s obesity, smoking, and physical inactivity rates all exceeded the state’s rates. The county had one primary care physician for every 2,818 residents, almost half the state ratio of one primary care physician for every 1,423 residents. The poor health habits and dearth of medical care were not without consequences. The 11,232 years of life lost per 100,000 Putnam residents due to premature death far exceeded the years of life lost in Florida at 6,893, which was roughly inline with the national estimate.

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Taliaferro County, Ga.
> Pct. without health insurance: 24.5%
> Pct. food insecure: 23.2%
> Obesity rate: 35.0%
> 2013 unemployment rate: 9.0%

Taliaferro County had no doctors, dentists, or mental health providers, a factor that contributed to its standing as the least healthy county in Georgia. In addition to a relatively high obesity rate, Taliaferro County had about 72 teen births per 1,000 females aged 15 to 19. Almost a quarter of the county’s residents had no health insurance compared with 17% nationwide. More than 23% of county households had limited access to food, higher than the 18.9% households across the state identified as food insecure, which was third highest compared to all states.

Hawaii County, Hawaii
> Pct. without health insurance: 9.9%
> Pct. food insecure: 15.0%
> Obesity rate: 24.5%
> 2013 unemployment rate: 6.8%

Relatively low income in Hawaii County, and relatively poor income distribution compared to the state contributed to its ranking as the least healthy county in Hawaii. About 11% of county residents could not afford to see a doctor compared with 7.4% statewide. Nearly 10% of county residents had no medical insurance. While the share of residents without insurance was far below the national rate of 17.0%, it was the highest of the state’s counties. Just over a quarter of the children in the county lived in poverty compared with 14.4% statewide.

Benewah County, Idaho
> Pct. without health insurance: 21.7%
> Pct. food insecure: 17.7%
> Obesity rate: 27.3%
> 2013 unemployment rate: 10.5%

Poor health habits and the lack of affordable health care contributed to Benewah County’s ranking as the least healthy county in Idaho. In addition to an obesity rate slightly higher than the national rate, about 26.3% of Benewah residents smoked compared with 16.5% of all Idaho residents and 20.0% of all Americans. At the same time, 23.7% of Benewah residents were physically inactive in the past month, a higher proportion than both the state and the nation. More than 21% of Benewah residents could not afford to see a doctor compared with 15.7% statewide.

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Hardin County, Ill.
> Pct. without health insurance: 13.4%
> Pct. food insecure: 14.6%
> Obesity rate: 33.5%
> 2013 unemployment rate: 12.3%

With only two primary care physicians and two dentists for its roughly 4,200 residents, Hardin County was Illinois’ least healthy county. Hardin’s health outcomes were among the worst. Though nearly all of Hardin County residents had access to exercise opportunities, 29.3% did not take advantage, compared with roughly 23% in the entire state. An estimated 9,692 years of life per 100,000 residents are lost annually due to premature death on average, more than 50% greater than the 6,349 years lost in Illinois.

Scott County, Ind.
> Pct. without health insurance: 15.6%
> Pct. food insecure: 15.8%
> Obesity rate: 29.5%
> 2013 unemployment rate: 8.0%

Scarcity of medical professionals and the cost of health care contributed to Scott County’s ranking as the the least healthy county in Indiana. About one in six county residents could not afford to see a doctor. Throughout the state there was one doctor for every 1,518 residents. An estimated 13,579 years of life were lost annually per 100,000 residents due to premature death, well above the state estimate and more than double the number of years lost due to premature death nationally.

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Appanoose County, Iowa
> Pct. without health insurance: 11.8%
> Pct. food insecure: 14.1%
> Obesity rate: 29.5%
> 2013 unemployment rate: 6.4%

About 23% of Appanoose residents rated their health as fair or poor, more than twice the 11.2% of all Iowans and 16.0% of all Americans who gave their health such low grades. County residents also had unhealthy habits with unhealthy consequences. In addition to an obesity rate of 29.5%, higher than the nation’s rate, about 27.6% of county residents smoked — roughly 10 percentage points higher than the state’s rate. About 31.4% of Appanoose County residents were physically inactive compared with 24.3% of the entire state and 23.0% of the nation.

Cherokee County, Kan.
> Pct. without health insurance: 15.7%
> Pct. food insecure: 14.9%
> Obesity rate: 39.1%
> 2013 unemployment rate: 6.1%

An estimated 11,651 years of life were lost annually per 100,000 Cherokee residents, far higher than the state estimate of 6,812. The county’s obesity rate of 39.1% was much higher than the state’s rate of 30.3% and national rate of 27.0%. The state’s smoking rate of 21.4% was also higher than both the state and country rates. More than one-third of county residents were physically inactive compared with 24.1% of all Kansans.

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Clay County, Ky.
> Pct. without health insurance: 17.0%
> Pct. food insecure: 20.5%
> Obesity rate: 30.5%
> 2013 unemployment rate: 13.4%

About 36.2% of Clay County residents rated their health as fair or poor, compared with 21.1% of state residents who rated their health the same. The percentage of the adult population who smoked — 36.3% — was higher than the state’s smoking rate of 25.6%, which was itself the second highest of all states. There were nine primary care physicians in Clay County, one for every 2,395 residents, compared with one for every 1,551 residents statewide. More than 30% of county residents could not afford to see a doctor, compared with 16.9% statewide.

East Carroll Parish, La.
> Pct. without health insurance: 21.6%
> Pct. food insecure: 29.8%
> Obesity rate: 42.6%
> 2013 unemployment rate: 14.2%

About 12,741 years of life were lost annually per 100,000 East Carroll Parish residents due to premature death, far higher than the estimated 9,131 years across the state, which was itself the fourth-highest such estimate compared to all states. The county had an HIV prevalence rate of 661.3 per 100,000 residents compared with a statewide rate of 451.7. The area’s teen birth rate of 78.9 births per 1,000 teen girls was far higher than the 50.2 teen birth rate for the state, which was the sixth highest rate compared with all states. A high teen birth rate and high prevalence of HIV both suggest relatively risky sexual behavior, which is strongly associated with unhealthy lifestyles.

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Somerset County, Maine
> Pct. without health insurance: 13.6%
> Pct. food insecure: 16.7%
> Obesity rate: 33.9%
> 2013 unemployment rate: 9.3%

The teen birth rate in Somerset County was 35.6 births per 1,000 females between the ages of 15 and 19, much higher that the statewide rate of 23.2, but just under the national rate of 36.6. About 25.6% of county residents smoked compared with 18.6% statewide, likely increasing the likelihood of premature death in the area. Residents were far more likely to die before age 75 than residents across both the state and the nation.

Baltimore City County, Md.
> Pct. without health insurance: 13.5%
> Pct. food insecure: 22.6%
> Obesity rate: 33.6%
> 2013 unemployment rate: 9.6%

Baltimore City County residents had poor health habits, contributing to the county’s rating as the least healthy county in Maryland. The county’s obesity rate of 33.6% relatively high — the statewide rate was 28.4%. Also, the percentage of those who smoked — 23.9% — was higher than the state rate of 15.4%. The percentage of those who were physically inactive was 29.0% compared with 22.9% statewide. As many as 14.3% of county residents could not afford to see a doctor compared with 10.9% statewide.

Hampden County, Mass.
> Pct. without health insurance: 4.9%
> Pct. food insecure: 12.6%
> Obesity rate: 28.9%
> 2013 unemployment rate: 8.9%

Hampden County’s HIV prevalence of 440.6 people per 100,000 residents was far higher than the state rate. County residents were more likely to engage in negative health outcomes relative to the rest of Massachusetts. Almost 19% of Hampden residents smoked compared with 15.2% statewide, and nearly 29% of county residents were obese compared with 23.9% statewide. Also, 26.7% of residents in Hampden were physically inactive, compared with 21.4% throughout the state.

Wayne County, Mich.
> Pct. without health insurance: 16.2%
> Pct. food insecure: 21.3%
> Obesity rate: 34.2%
> 2013 unemployment rate: 10.5%

With relatively high infant and child mortality rates, Wayne County ranked as the least healthy county in Michigan. The relatively high death rates were not the result of scarcity of medical care. With both the Detroit Medical Center and Henry Ford Health System, the county had 1,183 primary care physicians, or one for every 1,515 Wayne County residents. Wayne County’s HIV prevalence rate — the number of people diagnosed with HIV per 100,000 people — of 451 was more than two-and-a-half times the statewide rate of 169.

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Mahnomen County, Minn.
> Pct. without health insurance: 13.8%
> Pct. food insecure: 14.0%
> Obesity rate: 30.8%
> 2013 unemployment rate: 5.7%

Mahnomen county had five primary care physicians, or one for every 1,107 residents, slightly better than the state rate of one for every 1,113 residents. County residents had relatively unhealthy habits, which contributed to relatively poor health outcomes. Not only was the 30.8% obesity rate higher than the 25.9% statewide rate, but also 35.4% of residents smoked, more than twice the statewide rate of 16.2%. Nearly 29% of county residents were physically inactive, compared with 19.3% statewide.

Quitman County, Miss.
> Pct. without health insurance: 21.6%
> Pct. food insecure: 29.1%
> Obesity rate: 41.0%
> 2013 unemployment rate: 13.3%

No state had a higher percentage of residents reporting fair or poor health than Mississippi, at 21.5%. In Quitman County, 35.1% of residents rated their health as fair or poor. The county had only one primary care physician, likely contributing to the negative health ranking. Premature death was also far more likely in Quitman than elsewhere. Approximately 14,300 years of life were lost annually per 100,000 county resident due to premature death, well above the 10,031 state estimate, which was itself the highest such figure compared to all states.

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Pemiscot County, Mo.
> Pct. without health insurance: 14.9%
> Pct. food insecure: 22.5%
> Obesity rate: 33.7%
> 2013 unemployment rate: 8.2%

About one in five Pemiscot County residents could not afford to see any of the five primary care physicians in the county. This was much higher than the statewide 13.9% of residents who could not afford to see a doctor. The difficulty in seeing a physician may have contributed to the relatively high infant mortality rates in the county. The infant mortality rate in the county — the number of infant deaths before the age of one per 1,000 live births — was 12.3 compared with 7.2 statewide.

Glacier County, Mont.
> Pct. without health insurance: 29.8%
> Pct. food insecure: 19.6%
> Obesity rate: 31.7%
> 2013 unemployment rate: 10.9%

Relatively high levels of risky behavior may have contributed to Glacier County’s rank as the least healthy county in Montana. The percentage of residents who smoked, 35.2%, was almost twice the statewide rate. The county’s obesity rate of 31.7% was higher than the state’s 24.5% rate. And the percentage of residents who were physically inactive — 30.5% — also outpaced the statewide rate. An estimated 14,667 years of life were lost per 100,000 Glacier County resident due to premature death, roughly double the state figure.

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Thurston County, Neb.
> Pct. without health insurance: 19.8%
> Pct. food insecure: 17.1%
> Obesity rate: 40.7%
> 2013 unemployment rate: 7.5%

Over 40% of Thurston County residents were obese, compared with 29.2% in all of Nebraska. In addition, 34.4% of county residents smoked, just under twice the rate in the entire state. Adding to the unhealthy behavior in the county, 31.4% of residents were physically inactive compared with 23.8% statewide. Unhealthy behaviors such as these are often associated with risky sexual behavior, which in turn can increase the likelihood of teen pregnancies. Thurston County’s alarming teen birth rate of 105.1 births per 1,000 females aged 15 to 19 was more than three times the state’s rate of 32.0 births.

Mineral County, Nev.
> Pct. without health insurance: 23.2%
> Pct. food insecure: 17.8%
> Obesity rate: 26.9%
> 2013 unemployment rate: 12.4%

To a large extent, Mineral County’s ranking as the least healthy county in Nevada is the result of relatively unhealthy behavior in the county. About 26.7% of county residents smoked compared with 20.8% statewide; 26.9% of county residents were obese compared with 24.7% statewide; and, a higher percentage of county residents were physically inactive than the statewide proportion. Unhealthy lifestyles among area residents helped lower life expectancy. The estimated 12,736 years of life lost annually per 100,000 people due to premature death was well above both the state and national figures.

Coos County, N.H.
> Pct. without health insurance: 16.3%
> Pct. food insecure: 12.5%
> Obesity rate: 31.3%
> 2013 unemployment rate: 6.4%

Just as strong socioeconomic factors accounted for strong health outcomes across New Hampshire, low incomes help explain Coos County’s worst-place health ranking. About 15.1% of Coos County residents could not afford to see any of the 37 primary care physicians in the county, well more than the percentage statewide. In addition, while 21.3% of children across the state qualified for free school lunch — nearly the lowest percentage — nearly 36% of children in Coos County were eligible.

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Cumberland County, N.J.
> Pct. without health insurance: 17.8%
> Pct. food insecure: 16.2%
> Obesity rate: 33.9%
> 2013 unemployment rate: 12.2%

About one in four Cumberland County residents considered their health either fair or poor, roughly 10 percentage points higher than the state as a whole. At least part of this may have come from residents’ relatively unhealthy habits. The county’s smoking rate of 24.1% was much higher than New Jersey’s 15.6% smoking rate. Similarly, the county’s obesity rate of 33.9% was significantly higher than the statewide rate of 24.4%. And the share of residents who were physically inactive — 29.1% countywide — was higher than the state rate of 24.3%.

Rio Arriba County, N.M.
> Pct. without health insurance: 24.1%
> Pct. food insecure: 14.1%
> Obesity rate: 24.6%
> 2013 unemployment rate: 8.3%

Only three states had a higher obesity rate than New Mexico’s 23.5% rate. But Rio Arriba County, the state’s least healthy county, had an even higher obesity rate at 24.6%. Rio Arriba’s other lifestyle measures too were only slightly worse than the state as a whole. The smoking rate of 21.7% in the county compared with the state’s 18.7%, and the physical inactivity rate of 21.6% compared with the state’s 19.8%.

Bronx County, N.Y.
> Pct. without health insurance: 15.8%
> Pct. food insecure: 21.8%
> Obesity rate: 28.0%
> 2013 unemployment rate: 11.8%

Incomes across New York are distributed more unevenly than in any other state, with household incomes in the 80th percentile equal to 5.5 times that of the bottom 20th percentile. In Bronx County, incomes in the 80th percentile were 6.4 times that of the bottom 20th percentile. About 22% of county residents lacked adequate access to food compared with 14% of residents statewide. Nearly 18% of residents could not afford to see a doctor, though there were 677 primary care physicians in the county. There was one doctor for every 2,080 residents in the county compared with one for every 1,210 residents statewide. The county’s HIV prevalence rate was a high 2,084 for every 100,000 residents. This was much higher than the 810 people living with HIV per 100,000 residents in all of New York State.

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Scotland County, N.C.
> Pct. without health insurance: 20.2%
> Pct. food insecure: 26.4%
> Obesity rate: 35.7%
> 2013 unemployment rate: 14.6%

Nearly 28% of Scotland County residents considered their health fair or poor compared with 17.5% of state residents. The high percentage of residents with a poor self-evaluation reflects the low quality of life in Scotland County compared with the state as a whole. In addition, county residents had relatively unhealthy habits. Nearly 25% smoked compared with 20.2% statewide, and 28.0% were physically inactive compared with just under 25% of all North Carolinians.

Rolette County, N.D.
> Pct. without health insurance: 21.5%
> Pct. food insecure: 16.2%
> Obesity rate: 40.0%
> 2013 unemployment rate: 12.9%

Nearly 23% of the residents in Rolette County, located on North Dakota’s border with Canada, considered their health fair or poor, nearly twice the 11.5% of state residents. The unhealthy habits of county residents may have contributed to that view. Nearly 36% smoked, almost twice the 18.1% statewide smoking rate. And slightly more than one-third of county residents, 33.4%, were physically inactive, which may have contributed to the county’s obesity rate of 40.0% — far higher than the state’s 29.5%.

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Pike County, Ohio
> Pct. without health insurance: 14.1%
> Pct. food insecure: 18.8%
> Obesity rate: 32.4%
> 2013 unemployment rate: 12.5%

More than one in five Pike County residents considered their health just fair or poor, a higher percentage than in the state or across the nation. A greater percentage of county residents demonstrated unhealthy habits than state residents as a whole, with higher smoking and obesity rates and a higher percentage of residents who were not physically active. In addition to relatively unhealthy habits and poor self evaluations, premature death was all too common in the county. An estimated 10,913 years were lost annually per 100,000 Pike residents due to premature death, far higher than the state and national estimates.

Pushmataha County, Okla.
> Pct. without health insurance: 25.6%
> Pct. food insecure: 18.3%
> Obesity rate: 31.7%
> 2013 unemployment rate: 7.6%

Pushmataha County’s obesity rate of nearly 32% was roughly in line with the state’s obesity rate. Both were higher than the national obesity rate. Residents were also far more likely than state residents to smoke, with 38.9% of Pushmataha residents reporting the habit. The county is also one of Oklahoma’s poorer counties, which likely contributed to the challenges of staying healthy. About 18.3% of county households were food insecure, higher than the state percentage, which itself was among the highest compared to states.

Jefferson County, Ore.
> Pct. without health insurance: 24.1%
> Pct. food insecure: 16.8%
> Obesity rate: 30.4%
> 2013 unemployment rate: 10.7%

As with some other least healthy counties, Jefferson County may rank low within the state, but it fares well compared with the nation as a whole. The percentage of smokers in Jefferson County of 16.7% was lower than the national rate of 20.0% and barely higher than the state’s rate of 16.2%. Similarly, the 17.9% of county residents who were physically inactive was lower than the nation’s rate of 23.0% and not much higher than the statewide rate of 16.1%. It might follow then that just 12.9% of Jefferson County residents considered their health fair or poor compared with 13.8% of the state’s residents and 16.0% of all Americans. Jefferson County, though, lost 9,124 years of potential life due to premature death per 100,000 people, much higher than the comparable state figure of 5,958 years lost.

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Philadelphia County, Pa.
> Pct. without health insurance: 15.8%
> Pct. food insecure: 22.1%
> Obesity rate: 30.0%
> 2013 unemployment rate: 10.0%

With a premature death rate about 40% higher than the entire state of Pennsylvania, Philadelphia County — which includes the city of Philadelphia — ranked as the least healthy of the Keystone State’s 67 counties. Philadelphia county residents’ relatively unhealthy habits contributed to the poor ranking with higher smoking and obesity rates and a higher rate of physical inactivity than the state’s. The county’s 1,344 cases of Chlamydia per 100,000 residents was by far the highest rate in the state, ahead of second ranked Sullivan County’s 697 cases per 100,000 residents.

Providence County, R.I.
> Pct. without health insurance: 15.0%
> Pct. food insecure: 16.7%
> Obesity rate: 27.8%
> 2013 unemployment rate: 10.2%

Just as counties in other small states, Providence County’s health data compared relatively well to the nation. But because a county must be the worst in each state, Providence was still the worst in Rhode Island. About 15.4% of Providence residents considered their health fair or poor, less than the national rate of 16.0% but higher than the statewide rate of 13.1%. The county’s smoking rate was greater than the state as a whole but smaller than the nation. And the number of years lost annually to premature death per 100,000 county residents was higher than the state, but lower than the national estimate.

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Marlboro County, S.C.
> Pct. without health insurance: 20.4%
> Pct. food insecure: 25.8%
> Obesity rate: 39.8%
> 2013 unemployment rate: 12.9%

Almost a quarter of Marlboro County residents could not afford to see any of the county’s eight primary care physicians, far higher than the 16.1% of South Carolina residents who could not afford to see a doctor. About 28.3% of Marlboro County residents considered their health to be fair or poor compared with just 16.2% of state and 16.0% of residents across the nations who graded their health so low.

Shannon County, S.D.
> Pct. without health insurance: 17.4%
> Pct. food insecure: 25.6%
> Obesity rate: 42.5%
> 2013 unemployment rate: 12.9%

Nearly one in every five Shannon County residents considered their health to be fair or poor compared with 11.1% of all South Dakotans. The county’s smoking and obesity rates of 43.5% and 42.5%, respectively, were considerably higher than the state’s rates of 18.1% and 29.4%, respectively. The county’s low ranking within the state is a combination of unhealthy habits and poor health outcomes. Shannon County residents lost 25,394 years of potential life annually due to premature death per 100,000 people — almost four times the statewide rate of 6,738 years lost.

Hancock County, Tenn.
> Pct. without health insurance: 17.1%
> Pct. food insecure: 19.5%
> Obesity rate: 29.8%
> 2013 unemployment rate: 12.3%

Almost 40% of Hancock County residents smoked compared with 22.6% statewide, and nearly 40% were physically inactive compared with 30.3% in all of Tennessee. Also, 29.3% of Hancock residents considered their health to be fair or poor, well above both the state and national figures. County residents lost 13,805 years per 100,000 people annually due to premature death, compared with 8,696 in the entire state. The county had just one primary care physician for its 6,679 residents.

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San Augustine County, Texas
> Pct. without health insurance: 25.1%
> Pct. food insecure: 23.7%
> Obesity rate: 30.3%
> 2013 unemployment rate: 10.1%

San Augustine County had just two primary care physicians for its roughly 8,800 residents. An estimated 16,266 years of life were lost due to premature death annually per 100,000 residents, almost two-and-a-half times the state estimate of 6,650 years lost. Area residents also had much lower incomes than Texas residents as a whole, which may have made adopting healthy lifestyles more difficult. Nearly 24% of households were food insecure, far higher than the percentage of Texas households reporting limited access to adequate food.

Duchesne County, Utah
> Pct. without health insurance: 17.1%
> Pct. food insecure: 13.6%
> Obesity rate: 26.9%
> 2013 unemployment rate: 3.5%

Duchesne County lost an estimated 9,565 years of life per 100,000 people due to premature death annually, contributing to its standing as the least healthy county in Utah. The county’s smoking rate, while lower than the nation’s, was 19.2%, more than twice Utah’s smoking rate. And while the county’s obesity rate matched the nation’s, the 23.1% of Duchesne residents who were physically inactive was much higher than the state’s 16.6% of inactive residents.

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Essex County, Vt.
> Pct. without health insurance: 10.5%
> Pct. food insecure: 13.5%
> Obesity rate: 27.4%
> 2013 unemployment rate: 5.8%

While just 10.6% of Vermont residents rated their health to be just in fair or poor condition, that percentage jumped to 17.4% in Essex County, located in the state’s northeast corner. The county’s health choices and outcomes certainly reflect that self-evaluation. There was relatively high percentage of smokers in the county, 25.7% compared with 16.1% statewide. Also, the county’s 27.4% obesity rate topped the state’s 24.2% rate, and the percentage of county residents who were physically inactive of 24.8% was much higher than the 18.4% of physically inactive residents statewide. There were only two primary care physicians to serve the county’s 6,211 residents.

Buchanan County, Va.
> Pct. without health insurance: 16.0%
> Pct. food insecure: 13.4%
> Obesity rate: 28.8%
> 2013 unemployment rate: 9.8%

The state of Virginia suffers from poverty issues, which are related to poor health choices and poor health outcomes, and Buchanan County is certainly no exception. Close to a third of the county’s children lived in poverty, more than double the state rate. Buchanan ranks as the least healthy county in Virginia. It should be no surprise, then, that the county has a rate of years lost due to premature death per capita that is more than double the state rate. Just under 29% of Buchanan County residents rated their health to be only fair or poor. Statewide, the rate was 13.5%. Just over 30% of Buchanan adults smoked compared with a 17.5% rate for Virginia as a whole. The county also had higher rates of obesity and lower rates of exercise among adults compared to both the state and the nation.

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Grays Harbor County, Wash.
> Pct. without health insurance: 20.1%
> Pct. food insecure: 17.3%
> Obesity rate: 34.6%
> 2013 unemployment rate: 11.8%

Compared to the population of Washington overall, Grays Harbor County residents had poorer health habits. A greater percentage of county residents smoked, a higher percentage were obese, and a larger proportion of the population was physically inactive than the comparable state rates. A greater percentage of county residents than state residents also engaged in binge drinking. The county lost an estimated average of 8,514 years due to premature death per year per 100,000 people. The rate in Washington State was just 5,506 years.

McDowell County, W.Va.
> Pct. without health insurance: 20.8%
> Pct. food insecure: 19.4%
> Obesity rate: 37.5%
> 2013 unemployment rate: 10.0%

Nearly one third of McDowell County residents rated their health as fair or poor, compared with 21.5% of all West Virginians, and more than double the 16.0% national rate. Many in the county had unhealthy habits, which may have helped contribute to this. About 40% of county residents were physically inactive, higher than both the state and national percentages. The state’s 37.5% obesity rate was 4.2 percentage points higher than the state’s rate and 10.5 percentage points higher than the national rate. Just over 35% of county residents smoked compared with 26.0% of all West Virginians.

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Menominee County, Wis.
> Pct. without health insurance: 14.9%
> Pct. food insecure: 18.1%
> Obesity rate: 39.2%
> 2013 unemployment rate: 14.1%

Almost half, about 45.6%, of Menominee County residents smoked — significantly higher than the 18.3% of all Wisconsinites and 20% of all Americans. The high smoking rate combined with relatively high rates of obesity and physical inactivity, contributed to Menominee County rank as the least healthy county in Wisconsin. These unhealthy habits may have contributed to the state’s high rate of premature deaths. The county lost an estimated average of 13,323 years due to premature death per year per 100,000 people. The Wisconsin rate was just 7,360 years.

Fremont County, Wyo.
> Pct. without health insurance: 23.7%
> Pct. food insecure: 14.0%
> Obesity rate: 25.0%
> 2013 unemployment rate: 6.0%

Although only 13.9% of Fremont County residents considered their health to be fair or poor, the county ranked as the least healthy in Wyoming. The relatively low percentage of the poor health self assessment compared favorably with the national rate of 16.0%. Fremont County, though, struggled with a high infant mortality rate of just under 10 deaths per 1,000 live births before the age of one compared to a statewide rate of 7. Fremont’s smoking and physical inactivity rates both exceed the state’s rates.

Click here to see the healthiest county in each state.

Correction: In a previous version of this article Buchanan County was incorrectly described as part of West Virginia. While the data associated with the county was correct, Buchanan is in fact a county in Virginia. 

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