The Least Healthy County in Every State

Of the 67 counties in Alabama, Wilcox ranks as the least healthy. Nearly 43% of adults in the central Alabama county are obese, well above the 35% share of adults statewide and one of the highest obesity rates of any county in the country.

Low-income Americans tend to have less access to quality health care. Economic conditions partially explain the poor health outcomes in Wilcox County, where 31.9% of the population lives below the poverty line — more than double the 14.6% national poverty rate.

Unhealthy behaviors, particularly smoking, likely contribute to Kusilvak’s ranking as Alaska’s least healthy census area. Almost 43% of adults are regular smokers, the highest share of U.S. counties.

Kusilvak adult residents report on average about seven unhealthy physical days in a month, the most of all counties in the United States and higher than the national average of nearly four unhealthy days a month. Nearly 38% of adults in the county report being in poor or fair health, the fourth-largest share in the country and nearly triple the statewide share of over 13%. Nationwide, 16% of adults report being in poor or fair health.

More than one in every five residents in Apache County, Arizona, do not have health insurance, the largest uninsured rate of any county in the state. People with health insurance are more likely to make regular doctor visits and receive diagnosis and treatment for different ailments, from bacterial infection to chronic conditions and other serious diseases. The lower likelihood of regular doctor visits in Apache County may partially explain why the county’s premature death rate is nearly the highest in the state.

Unhealthy habits also are relatively common in Apache County. County adult residents are more likely to smoke and less likely to lead physically active lifestyles than the typical Arizona resident.

Phillips County is located along the banks of the Mississippi River in Southeast Arkansas. A relatively high share of adult county residents — higher than statewide — smoke regularly and lead a sedentary lifestyles, both leading causes of disease and disability. In addition, nearly 44% of the county’s adult population is obese, the 13th largest obesity rate of any U.S. county.

For different reasons, poverty is associated with unhealthy behaviors, which can result in an increased risk of disease or mortality. Nearly 31% of county adults say they are in fair or poor health, far more than the 16% share nationwide and the 25% share statewide.

Unhealthy behaviors are relatively common in Kern County, California. Of adults in the county, 23.6% report getting no exercise beyond getting up and going to work — a far larger share than the 17.9% of adults across the state who lead sedentary lifestyles. Adults in the county are also more likely to smoke, drink to excess, and be obese than adults across the state as a whole.

Low educational attainment may partially explain the prevalence of unhealthy behaviors. Higher educational attainment can lead to a better sense of control over one’s life and to healthier lifestyles, and just 15.8% of adults in Kern County have a bachelor’s degree, less than half the statewide bachelor’s degree attainment rate of 33.6%.

Costilla County is located on Colorado’s border with New Mexico. As the least healthy county in one of the healthiest states in the United States it ranks better in several measures of health than the nation as a whole, particularly in the adult obesity and inactivity rates. Relative to state rates, however, Costilla ranks worse.

Another factor contributing to Costilla County’s least healthy rank is the high share of uninsured residents. Of county residents, nearly 15% have no health insurance, compared with 10% nationwide and over 7% statewide. Research has shown that uninsured adults have worse access to care, receive poorer quality of care, and experience worse health outcomes than insured adults.

Due in large part to the prevalence of some unhealthy behaviors, Windham, a county situated in the northeast corner of Connecticut, ranks as the least healthy of the eight counties in the state. An estimated 22.3% of adults in Windham County drink excessively, the largest share of any county in the state and well above the 18.4% state excessive drinking rate. Adults in Windham are also less likely to exercise and more likely to smoke than in other countries in the state.

Unhealthy habits often lead to unhealthy outcomes, and 29.2% of adults in Windham County are obese, the largest share in the state.

Delaware only has three counties, but Kent has the highest share of adults reporting unhealthy habits. One in three adult residents do not exercise. Kent is also the county with the highest adult smoking rate.

These unhealthy behaviors are likely contributing to poor health outcomes in the county. People report on average more than 3.5 physically unhealthy days a month, more than in the other two counties. In addition, one in six residents report being in poor or fair health, also the highest share among the three counties.

In Putnam County, adults report an average of about five physically unhealthy days and five mentally unhealthy days per month. The statewide average is less than four days for each. Putnam County’s adult obesity rate of 37.9% is also well above the obesity rate across Florida as a whole of 25.9%.

Outcomes like these are largely attributable to some relatively common unhealthy habits in the county. For example, about one in every four adults in the county smoke, the highest smoking rate of any county in Florida.

Clay County’s rank as the least healthy of the 159 counties Georgia may be explained by the fact that no other county has a higher smoking rate. Almost 27% of adults light a cigarette on regular basis, compared with 17% nationwide. The county has half as many primary care physicians as the average for the state. Lack of doctors can restrict or severely hamper access to regular health care.

Clay County has a population of just over 3,000 people, and one in three adults report being in poor or fair health, the second highest share in the state.

There are only five counties in Hawaii. Though Hawaii County ranks as the least healthy of the five, unhealthy behaviors in the county are not much more common than they are across the state as a whole. For example, the county’s inactivity rate — 20% of county adults do not exercise — is the highest in the state by a slim margin and is better than the 23.0% share of adults nationwide with sedentary lifestyles.

Outcomes are also not especially poor in Hawaii County. Just 15.3% of adults in Hawaii County report being in fair or poor health, only slightly higher than the 14.0% share of adults across the state as a whole. For reference, 16.0% of adults nationwide report being in suboptimal health.

While several unhealthy behaviors are more common among residents of Benewah County than the average for the state, the shares are not significantly higher. In some cases, such as drinking excessively, the rate is lower than both the state and national average.

Still, one in seven do not have health coverage, higher than the state uninsured rate of 10%. People with no health insurance see doctors less frequently, even when feeling unwell.

Of the 102 counties in Illinois, Alexander County is the only one where more than one in every five adults smoke. Smokers die, on average, about 10 years before nonsmokers, and Alexander County residents are more likely to die before age 75 than residents of every other county in the state.

Adults with higher educational attainment typically lead healthier lifestyles, and in Alexander County, just 10.7% of adults have a bachelor’s degree, the smallest share of any county in the state.

With the exception of the average number of unhealthy days in a month, Crawford County ranks only marginally worse than other counties in the state. For example, nearly 22.5% of adults smoke, compared with the state smoking rate of 21%.

Still, almost a third of the adult population in Crawford County is obese and does not exercise. This may help explain why people report, on average, more than four physically unhealthy days in a month, the fourth highest average number out of all 92 counties in the state.

Appanoose County is the only county in Iowa where more than one in every three adults get no exercise beyond getting up and going to work. The prevalence of sedentary lifestyles may be partially attributable to lack of opportunities. Only 66.6% of area residents have access to areas for physical activity like parks and recreation centers, well below the 83.0% of Iowa residents.

Americans with health insurance are far more likely to make regular doctor visits and receive preventative medical care. In Appanoose County, 8.4% of residents are uninsured, compared with 4.7% of Iowa residents.

While a slightly smaller share of adults in Labette Country drinks excessively compared with the excessive drinking rate statewide, a significantly higher percentage does not engage in leisure-time physical activity. More than a third of adults do not exercise, compared with a state inactivity rate of 25%.

Adult residents of the county are also more likely to smoke on a regular basis, be obese, and

report being in poor or fair health compared with Kansas as a whole.

Leslie County, Kentucky, is the least healthy county in the state and one of the least healthy in the country. The county’s adult obesity rate of 43.3% is the highest of the 120 counties in the state and the 15th highest of the more than 3,000 counties nationwide.

Engaging in regular physical activity can help maintain a healthy weight, but in Leslie County, sedentary lifestyles are relatively common. An estimated 37.4% of adults in the county get no exercise beyond getting up and going to work, well above the 28.1% of inactive adults statewide and 23.0% nationwide.

East Carroll is not only the least healthy county in Louisiana, but also among the least healthy nationwide. Behaviors that may lead to unhealthy outcomes are very common among county residents. For example, one in three adult residents smoke regularly, the 13th highest smoking rate in the United States. Also, nearly 40% of adults are obese, compared with a 35% obesity rate statewide and 28% nationwide.

The average number of both mentally and physically unhealthy days a month people in East Carroll report having is among the highest in the country. More than 38% say they are in poor or fair health, the third highest share in the United States.

Washington County is a coastal county in the easternmost corner of Maine. Nearly 28% of adult county residents get no exercise beyond getting up and going to work, well above Maine’s 21.4% physical inactivity rate. Sedentary lifestyles may be attributable to limited opportunities. Just 46.7% of county residents have access to places for physical activity, such as parks and recreation centers, compared with 72.8% of state residents.

Regular exercise can promote better physical and mental health, and adults in Washington County report being in poor mental health more frequently than adults across Maine as a whole, and they are also slightly more likely to be obese.

Baltimore City is an independent city that is considered a county equivalent. Baltimore ranks slightly worse that the 24 counties in Maryland. Almost 34% of adults are obese compared with 29% statewide, and 18% drink excessively compared with 17% in the state as a whole. The differences are more significant in other measures such as not exercising and smoking. About 26% of adults do not exercise, and 20% smoke, compared with 22% and 14% statewide, respectively.

What sets Baltimore apart from most other counties is the poverty rate. At 22.4%, it is the second highest poverty rate in the state after Somerset’s rate of 22.5%. In comparison, the third highest poverty rate is 16.8%. Poverty and chronic diseases are interconnected. The premature mortality rate in Baltimore is 610 deaths before age 75 per 100,000 residents annually, nearly twice the rate for Maryland as a whole.

Hampden County is the least healthy county in Massachusetts, a state with a relatively healthy population. The county’s 27.6% adult obesity rate — while well above the 24.3% statewide rate — is lower than the 28.0% national rate. County residents are also more likely to make regular doctor visits than the typical American as just 3.3% of the population are uninsured, less than a third of the 10.5% national uninsured rate.

Some unhealthy habits are relatively common in the county, however. For example, adults in Hampden are less likely to exercise and more likely to smoke than adults across the state and nation as a whole.

Almost one in 10 residents of Wayne County, which contains Detroit, do not have health insurance, twice the state uninsured rate. Lack of insurance may prevent people from seeing a doctor when they should. About one in five adult residents report being in poor or fair health, the seventh highest share of the 83 counties in Michigan.

In addition, the adult obesity, smoking, and inactivity rates are higher in Wayne than the state as a whole.

An estimated 21.4% of adults in Mahnomen County are in fair or poor health, by far the largest share of any of Minnesota’s 87 counties. Additionally, county adults report an average of 4.3 mentally unhealthy days and 4.6 physically unhealthy days per month, well above the averages across the state of 3.2 days and 3.0 days, respectively.

Poor outcomes are largely attributable to bad habits. For example, Mahnomen is the only county in the state where more than one in every five adults smoke. Further, 28.4% of county adults report completely sedentary lifestyles, compared with less than 20% of adults across the state.

With a poverty rate of almost 47%, more than double the state poverty rate, Holmes is the second poorest county in Mississippi. Living in poverty can have a negative effect on health because people may not be able to afford medical treatment if they need it and have enough means to buy healthy foods. The average number of both mentally and physically unhealthy days a month adults in Holmes report is the highest of all 82 counties in the state.

Two unhealthy behaviors that are significantly more common among residents in Holmes than in other counties are sedentary lifestyles and smoking. More than 40% of adults do not exercise, Holmes has the ninth highest smoking rate of U.S. countries and significantly higher than the national inactivity rate of 23% and state rate of 34%.

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

The relatively poor health among county residents is likely connected to the county’s economic conditions. Low-income Americans can afford less health care and fewer healthy options related to diet and lifestyle, and the stress associated with poverty can have negative effects on overall health. In Pemiscot County, 28.5% of the population lives below the poverty line, more than double the 13.4% state poverty rate.

One in four people in Big Horn County report being in poor or fair health, the highest share of all counties in Montana. The county also has the highest percentage of adults who are obese, at almost 38%, compared with 25% statewide.

Unhealthy habits that are significantly more common among residents of Big Horn than people in the state as a whole. Nearly 26% of adults smoke compared with 19% in the state as a whole, and 25% report no exercise compared with 21% statewide.

The stress associated with poverty can be detrimental to personal health, and in Thurston County, Nebraska, 30.5% of the population lives below the poverty line, nearly triple the 10.8% state poverty rate. Likely due in part to widespread financial insecurity, 22.6% of county adults report being in fair or poor health compared with just 14.2% of adults across the state.

Additionally, low-income Americans can afford less health care and fewer healthy options related to diet and lifestyle — and poor diets likely contribute to the county’s 43.3% obesity rate, by far the highest in the state.

Adults in Mineral County report the second highest average number of physically unhealthy days a month and the highest number of mentally unhealthy days of counties in Nevada. Smoking and not engaging in physical activities are unhealthy behaviors that are slightly more common among adult residents in the county than in the state as a whole.

Statewide, the county has the fourth highest share of uninsured residents and the second highest share of adults who report being in poor or fair health.

Coos County, New Hampshire, has the least physically active adult population of any county in the state. An estimated 26.2% of adults in the county get no exercise beyond getting up and going to work, well above the 20.6% of inactive adults in the state. Coos County adults are also more likely to be obese and in less than optimal health than the typical adult in New Hampshire.

Cumberland County ranks as the least healthy in New Jersey, in part because of its 35% state-leading adult obesity rate. To compare, the adult obesity rate in New Jersey is 26%. Also, Cumberland is the county with the highest percentage of adults who report spending no time exercising — almost 30% compared with a state average of 23%.

Cumberland County is the poorest in New Jersey. Poverty can limit people’s access to health care as well as to healthy foods, which overtime may result in increased risk of diseases.

Personal health is often closely tied to income, and McKinley County is both the poorest and least healthy county in New Mexico. More than one in every three county residents live below the poverty line, compared with less than one in every five people across the state as a whole.

Stress associated with poverty can take a toll on personal health, and lower-income Americans can afford less health care and fewer healthy options related to diet and lifestyle. Partially as a result, more than a third of county adults are obese compared with less than a quarter of adults in the state. Additionally, 26.2% of adults in the county report being not in good health compared with 20.8% of adults across the state.

Bronx County has the highest share of adults who report being in poor or fair health, at almost 27%. The second highest share, in Sullivan County, is a much lower 19%, and the national and state shares are 16%.

Of all 62 counties in New York state, Bronx is also the county with adults reporting the highest average number of physically unhealthy days. One in three adults do not exercise, significantly higher than the state’s inactivity rate of one in four.

About one in every three adults in Robeson County, North Carolina get no exercise beyond getting up and going to work, the highest physical inactivity rate of any county in the state. Regular exercise can help maintain a healthy body weight, and the prevalence of sedentary lifestyles may explain Robeson County’s 38.6% obesity rate — nearly the highest in North Carolina.

Sioux County is located in the northernmost portion of the Standing Rock Reservation. The county’s population idenitifies primarily as Native American. Sioux County is not only the least healthy county in North Dakota, but also one of the least healthy nationwide. The county’s 38% adult smoking rate is the fourth highest in the United States, more than double the national smoking rate. Sioux’s annual premature mortality rate of 1,142 deaths before age 75 per 100,000 people is the worst in the country.

One in three county residents do not have health insurance, the highest uninsured rate of any county in North Dakota. The state’s uninsured rate is about 8%.

Adams is the only county in Ohio where more than one in every four adults smoke. The life expectancy of smokers is about 10 years below that of non-smokers, and of the 88 counties in Ohio, Adams County has the fifth highest premature mortality rate.

The increased likelihood of death before age 75 in Adams County is also likely attributable to the high uninsured rate. Americans with health insurance are more likely to receive preventative medical care, but 10.1% of county residents are uninsured, well above the 6.0% state uninsured rate.

Of all 77 counties in Oklahoma, Adair’s near 27% share of uninsured residents is the highest and is nearly double the state’s rate. Nationwide, the county ranks among the least healthy for the average number of mentally and physically unhealthy days every month, at fourth worst and 11th worst, respectively.

Adair County residents have some of the worst health behaviors and health outcomes in the country, too. Almost 27% of adult residents regularly smoke, compared with a nationwide smoking rate of 17%. In addition, almost 42% of adults are obese, far more than the corresponding state and national rates of 28% and 33%.

An estimated 35.2% of adults in Jefferson County, Oregon, are obese, well above the 27.2% statewide obesity rate. Low-income Americans tend to have less access to health care and cannot afford a wide range of healthy food options. The high obesity rate in Jefferson County may be attributable to poor diets among financially insecure county residents. Nearly 21% of Jefferson County residents live below the poverty line, the second highest poverty rate of any county in the state.

Philadelphia County, which contains the entire city of Philadelphia, has the highest poverty rate of all 67 counties in Pennsylvania. Nearly 26% of residents live below the poverty line, compared with the state’s poverty rate of 12.5%. (For reference, the second highest poverty rate is 19%, in Fayette.)

Although nearly all residents have access to places for physical activity (one of the highest rates in the country as a whole), 26% of local adults do not exercise, a larger share than the state inactivity rate of 24%.

Rhode Island’s population is relatively healthy compared to the nation as a whole. Even in Providence, the least healthy county in the state, the population is healthier than the broader U.S. population by several measures. For example, while Providence County’s 17.8% excessive drinking rate is higher than the 17.4% state rate, it is slightly below the 18.0% national rate. Similarly, the county’s 15.4% smoking rate is above the 14.4% state rate but below the 17.0% national rate.

Greater educational attainment is linked with healthier lifestyles, and though Providence County’s 27.8% bachelor’s degree attainment rate is by far the lowest of any county in the state, it is only slightly below the 30.9% national rate.

Prevalent unhealthy behavior may be partially responsible for poor health outcomes in Marlboro County. County adults are far more likely to not exercise and slightly more likely to smoke than adults in South Carolina as a whole. Such unhealthy habits can have harmful health consequences. The county’s annual premature mortality rate of 658 deaths before age 75 per 100,000 people is the highest of any county in the state and among the highest nationwide.

Oglala Lakota is one of only two counties nationwide where the majority of residents live below the poverty line. Stress associated with poverty can take a toll on personal health, and about one in every three adults in Oglala Lakota County report being in suboptimal health, nearly triple the 11.8% share of adults across the state reporting suboptimal health.

Low-income Americans tend to have less access to health care and often cannot afford a wide range of healthy food options, and this appears to be taking a toll in Oglala Lakota County. An estimated 41.2% of adults in the county are obese, well above the obesity rates of 30.6% statewide and 28.0% nationwide.

About 30% of Lake County residents live below the poverty line, double the state’s poverty rate, and more than in any of the 95 Tennessee counties. Having limited means can tie people into a cycle not being able to afford health care, nutritious foods, and healthy lifestyles in general. This can, over time, undermine overall health. More than one in four adults in the county report being in poor or fair health, the second largest share in the state. Nationwide, 16.0% of adults report being in suboptimal health, and statewide 19.1% of adults do.

In addition, about 35% of adults in Lake County are obese, slightly more than the comparable shares statewide.

As is often the case among counties on this list, Brooks County, Texas, is poor. Nearly 42% of the population of the southern Texas county lives below the poverty line, by far the highest poverty rate in the state. Stress associated with poverty can be detrimental to overall health, and in Brooks County, 37.8% of adults report being not in good health, more than double the 18.2% share of adults statewide who report being in suboptimal health. Brooks County adults are also more likely to smoke and less likely to exercise than the typical adult in Texas.

Located in southeastern Utah, San Juan County is the least healthy county in the state. Only about half of county residents have access to recreation centers, parks, and other venues for physical exercise, significantly less than the 87.7% of Utah residents. Also, nearly 31% of adults in the county are obese, the fourth highest share of all 29 counties in the state.

In addition, the San Juan’s adult residents report the highest average number of both mentally and physically unhealthy days in a month, both significantly higher than the state’s average and the county with the second highest number.

Vermont is a relatively healthy state compared to the U.S. as a whole. Even in Essex County, the least healthy county in the state, residents are only slightly more likely to be unhealthy than the typical American. For example, 25.2% of county adults lead completely sedentary lives — well above the 19.5% state physical inactivity rate but only slightly higher than the 23.0% national rate. Similarly, 16.3% of county adults report being in fair or poor health, a far larger share than the 12.5% of adults across Vermont but closely aligned with the 16.0% national share.

In Petersburg City, an independent city categorized with counties by the Census Bureau, poor health outcomes are far more common than they are across the state as a whole. For example, the obesity rate is over 45%, the highest in Virginia and the fifth highest in the United States. Additionally, the premature death rate of 765 deaths before age 75 per 100,000 people is more than double the corresponding statewide rate of 316 deaths per 100,000 people.

Though Ferry County ranks as the least healthy county in Washington state, area residents are less likely to exhibit certain unhealthy habits than the typical American. For example, while the 20.6% share of county adults who never exercise is higher than the state physical inactivity rate of 17.1%, it is lower than the 23.0% national rate. Additionally, the county’s 28.3% obesity rate is slightly higher than the statewide rate of 27.0% but closely in line with the 28.0% U.S. obesity rate.

About 12% of McDowell County residents do not have health insurance, the second highest uninsured rate of counties in the state and nearly double the state uninsured rate and uninsured Americans are less likely to receive preventative medical care. McDowell County residents have an average of 6 mentally unhealthy days a month, the most of any U.S. county, and 6.4 physically unhealthy days, the third most.

Additionally, nearly one in three adults in the county report being in poor of fair health, among the highest shares in the country. This is also more than the state’s rate of 24.1% of adults who report suboptimal health and far more than the national share of 16.0%.

Adults in Menominee County, Wisconsin, report an average of 5.8 mentally unhealthy days and 6.3 physically unhealthy days per month, about two and three days more than the state average respectively, and by far the most of any of Wisconsin’s 72 counties. Being overweight can detract from overall personal health, and a staggering 45.1% of adults in the county are obese, the highest share of any county in Wisconsin and well above the 30.6% state obesity rate.

Certain widespread unhealthy habits also contribute to poor outcomes in Menominee County. For example, nearly one in every three adults in the county smoke, the largest share of any county in the state.

Nearly 19% of Fremont County residents lack health insurance, the highest share of the state’s counties and much higher than the state’s uninsured rate of 12.3%. Adults in Fremont are also slightly more likely than adults in the state as a whole to be obese and to not exercise. All of these factors combined may help explain why 16.8% of county adults report being in fair or poor health, the highest share of counties in the state and slightly higher than the national rate of 16.0% and the state rate of 15.1%.