America’s Health Crisis: Which States Are the Unhealthiest?

The health of a nation is a reflection of its people’s well-being and quality of life. Health disparities in the nation vary significantly based on location, influenced by various factors such as air quality and access to quality healthcare. Key indicators of poor health can provide insights into the broader health trends affecting different regions.

The Role of Location in Health Disparities

Geographical location significantly influences health outcomes. Urban areas often have better access to healthcare facilities but may suffer from poor air quality, contributing to respiratory issues. In contrast, rural regions frequently face shortages of well-trained and experienced medical professionals and underfunded facilities, leading to delayed diagnoses and treatments.

Environmental factors also play a crucial role. States with high pollution levels see increased rates of asthma and other respiratory illnesses. On the other hand, areas with cleaner air report fewer such cases. 

Access to nutritious food varies widely. Food deserts, often found in underserved urban and rural areas, limit healthy food options, increasing the prevalence of obesity and diabetes.

Key Indicators of Poor Health

Several key indicators reveal the state of health across different regions. Obesity rates are alarmingly high in states like Mississippi and Alabama, correlating with increased rates of cardiovascular diseases and diabetes. Smoking prevalence stands out in West Virginia and Arkansas, leading to higher instances of lung cancer and other chronic diseases. Diabetes rates are often considered an indicator of poor health in an area, so it is not surprising that Mississippi, West Virginia, and Alabama top this list in addition to several others.

Lifestyle Choices and Their Consequences

Lifestyle habits such as diet, smoking, alcohol consumption, and physical activity significantly impact health outcomes. Several states exhibit concerning trends in these areas, leading to increased rates of chronic diseases and heightened healthcare costs.

Diet and Obesity

Unhealthy dietary choices are a driving factor behind rising obesity rates. Processed foods high in sugars and fats are readily available and often more affordable, leading many to prioritize convenience over nutrition. In states with limited access to fresh produce and whole foods, or with a population less likely to be able to afford these foods which are often more expensive, obesity rates are soaring.

Children in these regions are particularly at risk, developing poor eating habits that persist into adulthood. Obesity is linked to numerous health issues including heart disease, diabetes, and hypertension. The prevalence of fast-food outlets over grocery stores exacerbates this problem, creating food deserts where nutritious options are scarce.

Smoking Patterns

The smoking rates in several states continue to contribute significantly to poor health outcomes. Nicotine addiction remains high, with substantial numbers of adults and teenagers smoking cigarettes regularly. This habit is directly associated with lung cancer, respiratory conditions, and cardiovascular diseases.

Physical Activity Levels

Physical inactivity is another leading cause of health issues. Many states report low levels of physical exercise among their populations. Sedentary lifestyles contribute to obesity, cardiovascular diseases, and mental health problems.

Economic factors, lack of recreational facilities, and unsafe neighborhoods hinder physical activity. Promoting active lifestyles through community programs and safe, accessible parks can mitigate these health risks. States with higher activity levels often showcase better overall health statistics and lower disease prevalence.

Key Findings from Our Data

These key findings underscore the urgent need for targeted interventions and policy changes to address the health disparities across different states, ultimately promoting a healthier and more equitable society.

Air Quality Index

The Air Quality Index (AQI) is a standardized indicator used to communicate how polluted the air currently is or how polluted it is forecast to become. The AQI is calculated based on the levels of five major air pollutants regulated by the Clean Air Act: ground-level ozone, particulate matter (PM2.5 and PM10), carbon monoxide, sulfur dioxide, and nitrogen dioxide.

States with the poorest air quality show significantly higher rates of respiratory illnesses, including asthma and chronic obstructive pulmonary disease (COPD). A direct correlation was found between high pollution levels and increased hospital admissions for respiratory issues.

Top 5 Worst States for Air Quality

For the Air Quality Index (AQI), a higher number indicates worse air quality, reflecting increased levels of pollution and greater potential health risks. 

It’s somewhat surprising to see Indiana on the list. Stephen Wagner, partner at Wagner Reese LLP, reminds Hoosiers that legal actions can be taken based on violations of the Clean Air Act or other environmental regulations designed to protect public health. Wagner said, “Indiana residents may file lawsuits against corporations, government entities, or other parties responsible for the pollution. These lawsuits often fall under environmental law and can include claims for health issues caused by poor air quality, such as respiratory problems, cardiovascular diseases, and other related illnesses. Plaintiffs may seek compensation for medical expenses, lost wages, and pain and suffering, as well as demand stricter regulations and remediation efforts to improve air quality.” 

Top 5 Best States for Air Quality

Alaska boasts the best air quality in the United States, largely due to its vast, unspoiled wilderness and low population density, which results in minimal industrial pollution. The state’s stringent environmental regulations and proactive measures to preserve its natural landscapes further contribute to its pristine air. Other states with commendable air quality include Hawaii, Georgia, South Dakota, and South Carolina, all benefiting from their geographic locations and lower levels of industrial activity.

AQI Numbers and Categories:

0-50 (Good): Air quality is considered satisfactory, and air pollution poses little or no risk.

51-100 (Moderate): Air quality is acceptable; however, there may be a moderate health concern for a very small number of people who are unusually sensitive to air pollution.

101-150 (Unhealthy for Sensitive Groups): Members of sensitive groups (e.g., children, elderly, and individuals with respiratory or heart conditions) may experience health effects. The general public is not likely to be affected.

151-200 (Unhealthy): Everyone may begin to experience health effects; members of sensitive groups may experience more serious health effects.

Diabetes Rates

Diabetes rates are a critical indicator of public health, reflecting the broader trends in lifestyle and environmental factors that influence well-being. Our data reveals alarming disparities in diabetes prevalence across different states, with certain regions experiencing significantly higher rates. The findings highlight the urgent need for targeted interventions to address the root causes, such as poor diet, lack of physical activity, and limited access to healthcare, which contribute to the rising diabetes epidemic.

Top 5 Worst States for Diabetes Rates

The above numbers represent the percentage of adults in the state diagnosed with Diabetes, rounded to the nearest whole number. It is worth noting that data from Florida was not available for this study.

Top 5 Best States for Diabetes Rates

States with the lowest levels of diabetes, such as Colorado, Vermonth, and New Hampshire, often benefit from a combination of factors including higher rates of physical activity, healthier diets, and better access to healthcare. These states typically promote active lifestyles and have strong public health initiatives that encourage regular exercise and balanced nutrition. Low diabetes rates are a key indicator of overall health because they reflect not only the prevalence of healthy living habits but also the effectiveness of preventive healthcare measures and education.

Smoking Rates

West Virginia and Arkansas exhibit the highest percentages of adult smokers, leading to elevated rates of lung cancer, COPD, and other related health conditions.

Top 5 Worst States for Smoking Rates

The above numbers represent the percentage of adults in the state who are current cigarette smokers, rounded to the nearest whole number. Current smokers reported having smoked 100 or more cigarettes ever and one or more cigarettes in the past 30 days. 

Top 5 Best States for Smoking Rates

States like Utah, California, and Maryland boast the lowest levels of adult smokers, thanks to comprehensive public health campaigns, stringent tobacco control policies, and widespread anti-smoking education. These states have implemented high tobacco taxes and smoking bans in public places, which significantly deter smoking habits. Low smoking rates are a crucial health indicator as they correlate with lower incidences of respiratory diseases, cardiovascular conditions, and various cancers, ultimately reflecting a healthier population and reduced healthcare costs.

Food Insecurity Percentile

Food insecurity remains a pressing issue, significantly impacting the health and well-being of individuals and communities. Our data reveals stark disparities in food access across different states, with certain regions experiencing alarmingly high levels of food insecurity. These findings underscore the urgent need for comprehensive strategies to ensure that all individuals have reliable access to nutritious food, which is essential for maintaining overall health and preventing chronic conditions such as malnutrition and obesity. Addressing food insecurity is crucial for fostering healthier, more resilient communities.

Top 5 Worst States for Food Insecurity Rates

The data above represent the percentage of the state’s population considered to be food insecure, rounded to the nearest whole number. For this research, food security is defined by a person having access at all times to enough food for an active, healthy life for all household members. The remaining households are considered food insecure and at least some time during the year experienced reduced food intake and disrupted eating patterns at times because of limited money and other resources for obtaining food. 

Top 5 Best States for Food Insecurity Rates

New Hampshire has the lowest levels of food insecurity, a reflection of their robust social safety nets, higher median incomes, and effective community support programs. States that score well in this category have strong economic stability and comprehensive assistance programs that ensure residents have consistent access to nutritious food. Low levels of food insecurity are a vital health indicator because they are directly linked to better overall health outcomes, including lower rates of chronic diseases and improved mental health, as well as enhanced children’s development and academic performance.

Obesity Rates

A total number of 16 states have over 35% of the population classified as obese, including the top five listed below. These states also report higher consumption of fast food and lower intake of fruits and vegetables, highlighting the impact of diet on obesity.

Top 5 Worst States for Obesity Rates

The above numbers represent the percentage of adults in the state who are currently obese, rounded to the nearest whole number. For the purpose of this research, people who are obese have a Body Mass Index (BMI) of 30 or above and almost always have a large amount of body fat in relation to their height.

“Indiana’s higher than average obesity rates are a significant public health concern, highlighting the urgent need for comprehensive strategies to promote healthier lifestyles across the state,” said Jason Reese, partner at Wagner Reese,LLP. “Addressing this issue should be public health initiative number one. We need to improve access to nutritious foods, make sure all Hoosier have opportunities for physical activity, and there are robust public health education initiatives in place.”

Top 5 Best States for Obesity Rates

States like Colorado, Hawaii, and Massachusetts report the lowest levels of obesity, attributed to their strong emphasis on outdoor activities, active lifestyles, and access to fresh, healthy foods. Colorado, Hawaii, and Vermont benefit from favorable climates that encourage physical activity and have robust public health initiatives promoting exercise and balanced diets. Low obesity rates are a key health indicator as they are closely associated with reduced risks of chronic conditions such as heart disease, diabetes, and certain cancers, ultimately reflecting a healthier, more vibrant population.

Overall Unhealthiest States

Based on comprehensive data analysis and extensive research, these states have emerged as the most unhealthy in the nation. Various metrics, including high rates of chronic diseases, poor air quality, elevated obesity levels, and significant food insecurity, contribute to their ranking. These findings underscore the pressing need for targeted public health initiatives and policy interventions to address the underlying issues and improve overall health outcomes in these regions.

Top 5 unhealthiest states

Mississippi tops the list as it is the state with the highest obesity rate, food insecurity rate, and Diabetes rate as well as one of the top states for adult smokers per 100,000 residents. Louisiana ranks in the top five for the highest obesity rate, food insecurity rate, and Diabetes rate as well as one of the top states for the worst air quality. Arkansas’s poor air quality, plus high rates of adult smokers and food insecurity earn it a top spot on the list. West Virginia also sees an alarmingly high rate of obesity, food insecurity, smoking, and Diabetes. Kentucky’s poor air quality and high rate of adult smokers earn it the last spot on the list of most unhealthy states in the U.S.

Overall Healthiest States

Based on comprehensive data analysis and extensive research, these states have been identified as the healthiest in the nation. Factors such as low rates of chronic diseases, excellent air quality, high levels of physical activity, and strong access to nutritious food contribute to their top rankings. These findings highlight the successful public health initiatives and policies in place, serving as models to other states for improving health outcomes across the country.

Top 5 healthiest states

Perhaps in a surprising victory, Hawaii has earned the honored distinction of being known as the healthiest place to live in the U.S. This is because its residents have remarkably amazing air quality, above only Alaska. Only 10% of adults in the Hawaii smoke cigarettes, nearly half the rate of West Virginia, 9% of residents experience food insecurity, and only 8% have been diagnosed with Diabetes. When comparing these numbers to those of Mississippi and other states in the South, a clear distinction is made.

Massachusetts, Vermont, and others on the healthy state list earn their spot thanks to crisp, clean air, low chronic disease rates, and few adult smokers. In fact, all five of these states are listed in the lowest states for obesity rates.

Summary of the Key Findings

Our comprehensive analysis highlights significant health disparities across different states, underscoring the urgent need for targeted interventions and policy changes to promote a healthier and more equitable society. The Air Quality Index (AQI), a standardized measure of air pollution, reveals that states with poorer air quality experience higher rates of respiratory illnesses like asthma and COPD. This correlation between high pollution levels and increased hospital admissions for respiratory issues emphasizes the need for improved air quality management.

Additionally, our data on diabetes rates indicates alarming disparities, with states like Mississippi and Alabama showing significantly higher prevalence. These findings point to the necessity of addressing root causes such as poor diet, lack of physical activity, and limited healthcare access. Furthermore, smoking rates in states like West Virginia and Arkansas are contributing to elevated incidences of lung cancer and COPD, while food insecurity remains a pressing issue in states like Mississippi and Louisiana, impacting overall health and well-being. 

The obesity epidemic is also prevalent, with states like Mississippi and West Virginia reporting the highest rates. These unhealthy states, including Mississippi, Louisiana, and Arkansas, require urgent public health initiatives to address these multifaceted health challenges. On the other hand, states like the Hawaii and Massachusetts, identified as the healthiest, showcase successful public health policies that can serve as models for improving health outcomes nationwide.

We have created a table that includes all the index parameters, allowing you to see the percentage of each state’s population affected by these health issues, such as diabetes rate, smoking rate, food insecurity rate, obesity rate, as well as the Air Quality Index (AQI).
Due to some states received identical index scores, they share the same ranking, which has reduced the total number of distinct ranks to 42, even though there are 50 states.
A rank of 1 indicates the most unhealthy state, with the least healthy states listed at the top, while the healthiest states appear at the bottom.

Unhealthiest and Healthiest States in the U.S.

Methodology

We developed a comprehensive ranking system for the 50 U.S. states, evaluating each state across various statistical categories. States with the poorest performance in a given category were ranked highest. For example, Mississippi, with an obesity rate of 39.70%, was rounded to 40% and ranked first in the obesity category, whereas Colorado, with the lowest rate at 24.20%, was ranked last.

For the table above, each state received an index score based on its rankings across all five categories. In cases where states had identical statistics in a category, they were assigned the same index score. The total points for each state were then calculated and divided by the number of categories, which was five in most cases. For states lacking data in a category, such as Florida for diabetes rates, the total score was divided by four instead of five to ensure standardization.

Ultimately, the states with the fewest points were identified as the worst for healthy living, ranking highest in our index due to their poor performance across all categories. Conversely, the healthiest states accumulated the highest number of points and were positioned at the bottom of the index. This methodology allowed us to effectively rank the unhealthiest states using a strategy where fewer points indicated a higher rank for being the least healthy.

Data Sources for Index

Air Quality Index (AQI) / 2024 (real time data) – https://www.aqi.in/dashboard/united-states

Diabetes rate (%) 2021 data – https://www.kff.org/other/state-indicator/adults-with-diabetes-by-age/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Smoking Rates by State (%) 2022 data (current smokers) – https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/data-tables/ad-cig-smoking-state

Food Insecurity by State (%) 2021 data (25th page on file) – https://www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=2912.8

Obesity Rate (%) 2023 data – https://wisevoter.com/state-rankings/obesity-rate-by-state/