The Healthiest States in America

Iowa makes the list of healthiest states in the country based on a wide range of factors. Only 9.6% of the population reported 14 or more days of poor physical health in a month — the second smallest share of all states — compared to a national average of 12.0%.

The low uninsured rate in the state — just 4.7% of Iowans do not have health insurance, the sixth smallest share in the country — may also be a major factor. People without health insurance are more likely than those with insurance to delay going to the doctor or forgo taking care of their health altogether.

Wyoming has one of the lowest rates of cancer-related deaths, the second leading cause of death in the United States after heart disease. There are 169.5 cancer deaths per 100,000 people in Wyoming, the sixth lowest rate in the country and way below the U.S. average of 189.3 per 100,000 people.

Diabetes, a disease that affects about a tenth of the U.S. population, is also relatively uncommon in Wyoming. An estimated 8.7% of adults in Wyoming have been diagnosed, the fifth lowest percentage in the country.

One factor contributing to Maryland’s better-than-average health outcomes and behaviors may be income. The higher the income, the lower the likelihood of disease and premature death, as wealthier people can afford healthier diets and have more access to high-quality health care. Maryland has the highest median household income and the fourth lowest poverty rate in the country.

It also has a relatively small share of adults who drink excessively — 14.6%, compared to a U.S. average of 18.2%. Over time, excessive drinking can lead to serious problems, such as hypertension, heart disease, stroke, liver disease, and digestive problems.

Compared to the rest of the country, relatively few people in Nebraska report frequent mental or physical distress. Only 11.2% of the state’s adult population reported 14 or more days of poor mental health in one month, the 10th smallest share in the country. There is a strong correlation between frequent mental distress and diagnosed mental disorders, such as depression and anxiety, according to the United Health Foundation. About 10.2% reported 14 or more days of poor physical health in one month, the sixth smallest share in the United States.

Nebraskans also have relatively healthy behaviors. For example, from 2015 to 2017 there were just 7.2 drug-related deaths per 100,000 residents a year, less than half the national rate and the lowest rate in the country.

Idaho has a low rate of preventable hospitalizations, a measure that reflects how efficiently people use outpatient services as well as the overall quality of health care in a state. There are 32.3 preventable hospitalizations per 1,000 Medicare enrollees — the fourth lowest rate — compared to the national rate of 49.4 per 1,000. Public health funding may also play a role in Idaho’s ranking among the healthiest states. The state spends an average of $150 per person on public health annually, the fourth largest amount, compared to a national average of $87 per person. The money is used to pay for programs promoting physical activity, healthy nutrition, and smoking prevention.

Virginia residents report some of the healthiest behaviors of any state. While nationwide 23.8% of U.S. adults do not exercise regularly, in Virginia just 22.0% of adults are inactive — one of the smaller shares of any state. Similarly, just 14.9% of Virginia adults smoke, less than the 16.1% national smoking rate.

One factor contributing to Virginia’s above-average health outcomes and behaviors may be income. It has the tenth highest median household income, at $72,577, compared to the U.S. median of $61,937. Also, 10.7% of households in Virginia earn more than $200,000 a year, the sixth largest share among all states.

Even though North Dakota has the 12th highest adult smoking rate and the eighth highest obesity rate in the United States, fewer residents die from cancer and heart disease — the two leading causes of death in the United States– than in a majority of the country. The state has the 10th lowest rate of both cancer and cardiovascular deaths at 176.8 and 227.5 deaths per 100,000 people, respectively. By comparison, the national average is 189.3 cancer deaths and 260.4 heart disease deaths per 100,000 people.

The state also has a relatively small share of adults reporting frequent physical distress, a measure associated with chronic health conditions like diabetes and hypertension. Just 9.8% of adults in North Dakota report feeling in poor physical health for more than 14 days a month, the fifth smallest share of any state and far below the national rate of 12.0%.

Some 89.1% of adults in Rhode Island have at least a high school diploma, slightly above the 88.3% national high school attainment rate. Educational attainment is one of the strongest predictors of health outcomes. Nationwide, the share of adults with a diploma who say they are in optimal health is 27.6 percentage points higher than adults without a diploma. In Rhode Island, the difference is 31.5 percentage points.

The state has the highest immunization rates for various diseases, including human papillomavirus, the most common sexually transmitted infection; meningitis; and diphtheria, tetanus, and whooping cough (the Tdap vaccine). Most people in Rhode Island have health insurance, which may improve health outcomes as it allows for easier access to health care. Only 4.4% of the population lacks health insurance — the fifth lowest percentage in the country and half the national figure.

In California there are 5,665 premature deaths per 100,000 residents, the lowest rate in all of the United States. The cancer death rate in the Golden State is also among the lowest in the country — 168.9 per 100,000 people, compared to the national rate of 189.3 per 100,000 people annually.

Californians also tend to have healthy habits. For example, only 21.0% of adults report no physical activity, the 10th lowest figure nationwide, and only 11.2% of adults say they are regular smokers, the second lowest rate in the country.

New York has the third highest number of doctors per capita, which is one factor that helps it rank among the healthiest states. There are 230.7 primary care physicians per 100,000 people in the Empire State, compared to a rate of 159.6 doctors nationwide. According to the United Health Foundation, a large number of general practitioners in an area may lead to better health outcomes and reductions in health disparities across population subgroups.

New York ranks among the healthiest states also because of the amount of money it spends on public health. New York spends an average of $148 per person on public health annually, the fifth most of any state.

Like many of the healthiest states, Colorado residents are among the wealthiest in the nation. A typical household income is almost $72,000 a year, more than in all but 10 states. In addition to higher incomes, more than 83% of Colorado residents exercise on a regular basis, the highest percentage in the country. This high rate of physical activity likely contributes to the state’s low obesity rate. Just 22.9% of adult residents are obese, the lowest rate nationwide. The low obesity rate, in turn, likely helps keep down the prevalence of diabetes and cardiovascular disease in the state. There are an average of 207 cardiovascular deaths per 100,000 people in Colorado a year, the third lowest rate, and just 7.0% of the adult population has been diagnosed with diabetes, the smallest share nationwide.

People in Washington State tend to have healthy habits. Just 17.6% of adults say they do not exercise and only 12.0% report smoking on a regular basis, both of which are the third smallest such shares in the country.

Washington also has a relatively low preventable hospitalization rate, an indication of effective utilization of outpatient services and the overall quality of health care in the state. There are only 32.7 preventable hospitalizations per 1,000 Medicare enrollees, the fifth lowest rate in the country. Healthy lifestyle choices and access to quality health care may contribute to the state’s low rate of heart disease deaths. There are just 222.4 cardiovascular deaths per 100,000 people annually, the sixth lowest rate in the United States.

New Jersey ranks among the healthiest states because of several behavioral factors, including low rates of excessive drinking, adult obesity, and smoking. Wealth, which allows for access to higher quality health care and other components of a healthy lifestyle, may also help explain the state’s high ranking. Just 9.5% of New Jersey residents live below the poverty line, the fifth lowest poverty rate of any state and well below the 13.1% national figure. The Garden State also has the second highest median household income — close to $82,000 a year, or about $20,000 more than the U.S. median.

Minnesota has the lowest rate of cardiovascular deaths in the nation, at just 193.8 per 100,000 people. In all, 5,683 years of life were lost to premature death — before the age of 75 — for every 100,000 people in Minnesota in 2017, the second lowest rate in the United States. By contrast, almost 7,500 years of life were lost for every 100,000 Americans nationwide. The state’s high-quality clinical care likely contributes to favorable health outcomes. Only 10 states have fewer preventable hospitalizations relative to the number of Medicare beneficiaries, and only 4.4% of residents lack health insurance, half the national average. Drinking is one of the few metrics in which the state fared poorly — 21.8% of the state’s adult population drinks excessively, the seventh largest share in the nation.

New Hampshire has an infant mortality rate of just 3.9 deaths per 1,000 live births, the second lowest of any state. There are 226 cardiovascular deaths per 100,000 people in the state, the eighth lowest rate. Additionally, nearly all teenagers in the state — 97.5% — are vaccinated for tetanus, diphtheria, and whooping cough, the highest teenage Tdap immunization rate in the country. Infectious diseases such as chlamydia, whooping cough, and salmonella are less prevalent in New Hampshire than all but one state, West Virginia.

Residents also enjoy the state’s clean air. At 4.4 micrograms of harmful fine particulate matter per cubic meter, New Hampshire has the lowest air pollution rate in the country. Dirty air has been linked to stroke, lung cancer and heart disease.

While high levels of excessive drinking are a weakness in most of the nation’s healthiest states, just 11.3% of Utah adults report excessive drinking — the lowest rate. In addition, just 9.0% of Utah residents are smokers, also the lowest rate in the country. And only 17.5% of state residents do not exercise regularly, the second lowest figure nationwide.

With a median household income of $71,414, Utah residents are among the nation’s wealthiest. High incomes help Utah households afford healthier food, medicine, and medical care. As in the majority of healthy states, Utah residents were also in relatively good physical health. The state has the nation’s lowest concentration of deaths from cancer as well as the second lowest rate of adults with diabetes.

Connecticut has one of the nation’s lowest smoking rates, at just 12.2% of the adult population. The state also has one of the lowest obesity rates in the United States, at 27.4% of the adult population.

The state fares well in health determinants related to both policy and clinical care. The child immunization rate of 75.3% is the tenth highest in the country, and the adolescent immunization rate of 95.4% is the third highest in the nation. Further, Connecticut had the fourth highest concentrations of primary care doctors at 220 per 100,000 people.

A major reason for Hawaii’s high ranking among the healthiest states is its dedication to promoting good health through policy. The state provides $192 in public health funding per person, behind only Alaska and New Mexico. Just 4.0% of Hawaii’s population is not insured, the second-best rate nationwide. By comparison, 8.8% of Americans across the country are uninsured and, on average, states’ public health funding totals just $87 per person.

Beyond just policy, Hawaiians are among the least likely Americans to be obese or physically inactive. Preventable hospitalizations are the lowest in the nation at just 23.3 per 1,000 Medicare beneficiaries, compared to 49.4 per 1,000 beneficiaries nationwide. The state had just 209.8 cardiovascular deaths and 159.1 cancer deaths per 100,000 people, both among the lowest rates.

Massachusetts has the lowest rate of people without health care coverage in the nation, at just 2.8% of the population. By comparison, 8.8% of all Americans lack health insurance. In addition to having a largely insured population, Massachusetts also had the second highest concentration of primary care physicians in the U.S., at more than 247 for every 100,000 residents, as well as the highest concentration of dentists, at 82.7 per 100,000 people.

Low rates of smoking and obesity also help residents stay healthy. And high levels of immunization, too, help promote good health. About 82.1% of children between 19 months and 35 months have received the recommended doses of key vaccines. Immunization coverage among adolescents is the fifth highest, at 94.7%.

Vermont is the healthiest state in the country. Obesity, smoking, and physical inactivity are relatively uncommon behaviors among Vermonters. Just over 90% report exercising on a regular basis, the fourth highest share in the country and just 27.5% of adults are obese. In comparison, 23.8% of Americans across the country say they don’t exercise and 30.9% are obese. The adult smoking rate is also significantly lower than the U.S. average at 13.7%, the 10th lowest, compared to 16.1% nationwide.

Vermont’s public health funding is among the highest in the nation. The state spends $144 per person for programs promoting nutrition, exercise, no smoking, and other healthy habits. In addition, the rate of uninsured residents is among the lowest in the country — 4.3%, more than half the national rate.