The Roman poet Virgil said “The greatest wealth is health” more than 2,000 years ago and that still holds true. America is a wealthy country but that doesn’t necessarily mean it’s a healthy one. In fact, affluence may result in a less healthy population, as people use more labor-saving devices, exercise less, and have ready access to calorie-laden food. That said, some parts of the country are healthier than others overall.
To identify the healthiest county in every state, 24/7 Tempo reviewed data tracking rates of smoking, obesity, and physical activity from County Health Rankings & Roadmaps, a joint program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Counties were ranked within their state for health outcomes and health factors, which were then averaged to find the healthiest county in the state. County median household income comes from the American Community Survey 2020 five-year estimates.
The results are startling. For example, Douglas County, the healthiest county in Colorado, has an obesity rate of 21.4%. That’s the lowest rate on our list, but it still means that more than one in five people in the state is obese. (These are America’s most obese counties.)
Click here to see the healthiest county in every state
Smoking has been described as the single most preventable cause of death, yet people across the country still smoke. Ironically, Virginia, a state strongly associated with tobacco, has a relatively low statewide smoking rate of 14.2% and has the county with the lowest rate on our list: Falls Church City (an independent city with county-level governance status), where only 8.8% of the population light up. However, neighboring West Virginia has a statewide smoking rate of 26.1% and its healthiest county, Monongalia, has a smoking rate of 20.3%. (For a number of reasons, these are the worst counties to live in.)
Physical activity is another factor strongly linked to health outcomes, and exercise rates also vary dramatically from state to state and within states. Colorado also scores well by this metric. Only a relatively low 18.7% of adults do not exercise regularly in the state and in Douglas County the figure is only 12.9%.
1. Alabama: Shelby
> Smoking rate: 15.3% (state: 21.1%)
> Obesity rate: 30.2% (state: 36.3%)
> Adults who do not exercise regularly: 23.6% (state: 30.8%)
> Median household income: $78,889
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2. Alaska: Juneau
> Smoking rate: 15.1% (state: 17.3%)
> Obesity rate: 27.5% (state: 30.7%)
> Adults who do not exercise regularly: 16.7% (state: 21.6%)
> Median household income: $88,077
3. Arizona: Maricopa
> Smoking rate: 14.3% (state: 15.6%)
> Obesity rate: 31.0% (state: 31.9%)
> Adults who do not exercise regularly: 24.8% (state: 23.6%)
> Median household income: $67,799
4. Arkansas: Benton
> Smoking rate: 16.4% (state: 21.1%)
> Obesity rate: 29.8% (state: 38.0%)
> Adults who do not exercise regularly: 26.5% (state: 30.4%)
> Median household income: $71,556
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5. California: Marin
> Smoking rate: 9.5% (state: 10.1%)
> Obesity rate: 22.5% (state: 26.2%)
> Adults who do not exercise regularly: 17.3% (state: 22.3%)
> Median household income: $121,671
6. Colorado: Douglas
> Smoking rate: 9.8% (state: 13.6%)
> Obesity rate: 21.4% (state: 23.6%)
> Adults who do not exercise regularly: 12.9% (state: 18.7%)
> Median household income: $121,393
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7. Connecticut: Middlesex
> Smoking rate: 13.2% (state: 12.6%)
> Obesity rate: 27.9% (state: 29.1%)
> Adults who do not exercise regularly: 21.3% (state: 23.3%)
> Median household income: $84,907
8. Delaware: New Castle
> Smoking rate: 15.4% (state: 16.4%)
> Obesity rate: 33.0% (state: 34.2%)
> Adults who do not exercise regularly: 26.8% (state: 25.3%)
> Median household income: $75,275
9. Florida: St. Johns
> Smoking rate: 16.4% (state: 15.3%)
> Obesity rate: 26.7% (state: 26.3%)
> Adults who do not exercise regularly: 22.2% (state: 25.9%)
> Median household income: $83,803
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10. Georgia: Oconee
> Smoking rate: 13.6% (state: 16.5%)
> Obesity rate: 28.0% (state: 33.4%)
> Adults who do not exercise regularly: 21.8% (state: 27.4%)
> Median household income: $95,064
11. Hawaii: Honolulu
> Smoking rate: 13.6% (state: 12.9%)
> Obesity rate: 25.4% (state: 25.5%)
> Adults who do not exercise regularly: 25.1% (state: 23.9%)
> Median household income: $87,722
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12. Idaho: Ada
> Smoking rate: 13.2% (state: 15.9%)
> Obesity rate: 28.4% (state: 29.5%)
> Adults who do not exercise regularly: 21.1% (state: 23.3%)
> Median household income: $69,952
13. Illinois: DuPage
> Smoking rate: 11.2% (state: 14.8%)
> Obesity rate: 26.8% (state: 31.5%)
> Adults who do not exercise regularly: 22.7% (state: 25.1%)
> Median household income: $94,930
14. Indiana: Hamilton
> Smoking rate: 12.5% (state: 19.9%)
> Obesity rate: 26.3% (state: 35.4%)
> Adults who do not exercise regularly: 20.8% (state: 30.6%)
> Median household income: $98,880
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15. Iowa: Dallas
> Smoking rate: 12.8% (state: 17.4%)
> Obesity rate: 29.9% (state: 34.3%)
> Adults who do not exercise regularly: 21.7% (state: 26.1%)
> Median household income: $88,368
16. Kansas: Johnson
> Smoking rate: 11.9% (state: 16.8%)
> Obesity rate: 31.1% (state: 35.6%)
> Adults who do not exercise regularly: 19.3% (state: 26.7%)
> Median household income: $91,650
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17. Kentucky: Oldham
> Smoking rate: 17.0% (state: 24.5%)
> Obesity rate: 33.1% (state: 36.4%)
> Adults who do not exercise regularly: 25.3% (state: 31.6%)
> Median household income: $103,761
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18. Louisiana: St. Tammany Parish
> Smoking rate: 19.1% (state: 22.6%)
> Obesity rate: 30.7% (state: 36.2%)
> Adults who do not exercise regularly: 25.7% (state: 31.5%)
> Median household income: $70,730
19. Maine: Cumberland
> Smoking rate: 14.1% (state: 19.1%)
> Obesity rate: 25.3% (state: 31.4%)
> Adults who do not exercise regularly: 24.0% (state: 29.5%)
> Median household income: $76,014
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20. Maryland: Howard
> Smoking rate: 9.6% (state: 12.8%)
> Obesity rate: 25.5% (state: 32.0%)
> Adults who do not exercise regularly: 19.4% (state: 23.0%)
> Median household income: $124,042
21. Massachusetts: Middlesex
> Smoking rate: 11.6% (state: 12.2%)
> Obesity rate: 22.6% (state: 25.4%)
> Adults who do not exercise regularly: 22.4% (state: 26.0%)
> Median household income: $106,202
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22. Michigan: Ottawa
> Smoking rate: 16.2% (state: 19.6%)
> Obesity rate: 31.9% (state: 35.8%)
> Adults who do not exercise regularly: 22.0% (state: 24.6%)
> Median household income: $72,418
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23. Minnesota: Carver
> Smoking rate: 12.9% (state: 15.0%)
> Obesity rate: 28.7% (state: 30.0%)
> Adults who do not exercise regularly: 17.9% (state: 19.7%)
> Median household income: $104,011
24. Mississippi: Madison
> Smoking rate: 13.6% (state: 21.1%)
> Obesity rate: 32.7% (state: 41.2%)
> Adults who do not exercise regularly: 28.3% (state: 36.9%)
> Median household income: $71,621
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25. Missouri: Platte
> Smoking rate: 15.4% (state: 20.4%)
> Obesity rate: 32.2% (state: 34.6%)
> Adults who do not exercise regularly: 26.1% (state: 29.6%)
> Median household income: $82,448
26. Montana: Gallatin
> Smoking rate: 12.4% (state: 17.7%)
> Obesity rate: 22.9% (state: 28.0%)
> Adults who do not exercise regularly: 15.7% (state: 18.6%)
> Median household income: $70,124
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27. Nebraska: Hamilton
> Smoking rate: 15.4% (state: 15.1%)
> Obesity rate: 36.1% (state: 34.3%)
> Adults who do not exercise regularly: 26.5% (state: 26.6%)
> Median household income: $68,649
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28. Nevada: Douglas
> Smoking rate: 16.2% (state: 15.3%)
> Obesity rate: 31.3% (state: 30.5%)
> Adults who do not exercise regularly: 22.5% (state: 25.6%)
> Median household income: $71,415
29. New Hampshire: Rockingham
> Smoking rate: 14.3% (state: 16.9%)
> Obesity rate: 27.4% (state: 32.1%)
> Adults who do not exercise regularly: 20.2% (state: 21.1%)
> Median household income: $93,962
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30. New Jersey: Morris
> Smoking rate: 12.2% (state: 13.2%)
> Obesity rate: 25.4% (state: 25.5%)
> Adults who do not exercise regularly: 20.8% (state: 27.9%)
> Median household income: $117,298
31. New Mexico: Los Alamos
> Smoking rate: 9.2% (state: 16.5%)
> Obesity rate: 24.4% (state: 32.2%)
> Adults who do not exercise regularly: 15.1% (state: 24.8%)
> Median household income: $119,266
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32. New York: Putnam
> Smoking rate: 13.5% (state: 12.9%)
> Obesity rate: 26.9% (state: 27.2%)
> Adults who do not exercise regularly: 22.8% (state: 27.0%)
> Median household income: $107,246
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33. North Carolina: Orange
> Smoking rate: 14.1% (state: 18.9%)
> Obesity rate: 29.8% (state: 34.0%)
> Adults who do not exercise regularly: 21.4% (state: 25.9%)
> Median household income: $74,803
34. North Dakota: Burleigh
> Smoking rate: 16.5% (state: 17.4%)
> Obesity rate: 32.3% (state: 35.8%)
> Adults who do not exercise regularly: 25.5% (state: 27.9%)
> Median household income: $72,974
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35. Ohio: Delaware
> Smoking rate: 15.0% (state: 21.8%)
> Obesity rate: 30.4% (state: 34.6%)
> Adults who do not exercise regularly: 20.9% (state: 27.6%)
> Median household income: $111,411
36. Oklahoma: Canadian
> Smoking rate: 17.4% (state: 19.2%)
> Obesity rate: 33.3% (state: 37.1%)
> Adults who do not exercise regularly: 29.7% (state: 33.4%)
> Median household income: $73,591
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37. Oregon: Benton
> Smoking rate: 13.8% (state: 14.9%)
> Obesity rate: 28.1% (state: 28.8%)
> Adults who do not exercise regularly: 22.2% (state: 23.5%)
> Median household income: $65,142
38. Pennsylvania: Chester
> Smoking rate: 13.7% (state: 17.8%)
> Obesity rate: 29.3% (state: 33.1%)
> Adults who do not exercise regularly: 20.2% (state: 24.6%)
> Median household income: $104,161
39. Rhode Island: Bristol
> Smoking rate: 14.5% (state: 13.8%)
> Obesity rate: 26.8% (state: 30.1%)
> Adults who do not exercise regularly: 20.1% (state: 26.0%)
> Median household income: $85,413
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40. South Carolina: Beaufort
> Smoking rate: 15.6% (state: 18.4%)
> Obesity rate: 27.8% (state: 35.5%)
> Adults who do not exercise regularly: 22.5% (state: 28.5%)
> Median household income: $71,430
41. South Dakota: Lincoln
> Smoking rate: 15.3% (state: 19.0%)
> Obesity rate: 30.0% (state: 33.1%)
> Adults who do not exercise regularly: 25.9% (state: 28.9%)
> Median household income: $84,260
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42. Tennessee: Williamson
> Smoking rate: 13.3% (state: 20.7%)
> Obesity rate: 28.5% (state: 36.6%)
> Adults who do not exercise regularly: 21.5% (state: 29.0%)
> Median household income: $111,196
43. Texas: Collin
> Smoking rate: 12.4% (state: 14.7%)
> Obesity rate: 30.2% (state: 34.1%)
> Adults who do not exercise regularly: 22.5% (state: 26.9%)
> Median household income: $100,541
44. Utah: Morgan
> Smoking rate: 8.9% (state: 7.9%)
> Obesity rate: 29.3% (state: 29.9%)
> Adults who do not exercise regularly: 18.0% (state: 18.7%)
> Median household income: $100,408
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45. Vermont: Chittenden
> Smoking rate: 12.9% (state: 16.2%)
> Obesity rate: 23.1% (state: 27.1%)
> Adults who do not exercise regularly: 17.4% (state: 19.3%)
> Median household income: $76,316
46. Virginia: Falls Church City
> Smoking rate: 8.8% (state: 14.2%)
> Obesity rate: 27.5% (state: 31.8%)
> Adults who do not exercise regularly: 17.4% (state: 24.8%)
> Median household income: $146,922
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47. Washington: King
> Smoking rate: 10.0% (state: 12.8%)
> Obesity rate: 22.3% (state: 28.2%)
> Adults who do not exercise regularly: 16.4% (state: 18.9%)
> Median household income: $99,158
48. West Virginia: Monongalia
> Smoking rate: 20.3% (state: 26.1%)
> Obesity rate: 39.9% (state: 39.7%)
> Adults who do not exercise regularly: 26.2% (state: 29.5%)
> Median household income: $54,198
49. Wisconsin: Ozaukee
> Smoking rate: 13.1% (state: 16.2%)
> Obesity rate: 31.6% (state: 34.3%)
> Adults who do not exercise regularly: 18.3% (state: 22.3%)
> Median household income: $84,394
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50. Wyoming: Teton
> Smoking rate: 11.3% (state: 18.4%)
> Obesity rate: 22.2% (state: 29.6%)
> Adults who do not exercise regularly: 18.5% (state: 24.0%)
> Median household income: $87,053
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