Americans do not share one health outcome. They share fifty. Adult obesity runs 42.7% in Mississippi and 24.9% in the District of Columbia, a 17.8-point gap inside the same country. This page turns federal data into something you can act on. Click any state for county detail, or read the findings below for patterns the raw rankings miss.
The State Health Divide
Healthiest vs unhealthiest state by premature death rate.
Same country, different outcomes. In Mississippi, 42.7% of adults are obese and 45.4% have high blood pressure. In Colorado, the hypertension rate is 29.2%. In DC, obesity sits at 24.9%. The A-versus-F comparison below is not metaphor. It is how two states thirty hours apart by car now differ on the measures that decide who lives to 75.
Healthiest State
Rhode IslandDeath rate 5,769 per 100K · Obesity 29.5% · Smoking 11.0% · Median income $93,337
Unhealthiest State
MississippiDeath rate 14,764 per 100K · Obesity 42.7% · Smoking 19.1% · Median income $49,487
The drivers are not mysterious. Medicaid expansion status, tobacco tax levels, grocery access, Appalachian and Mississippi Delta geography, and the income distribution of each state each move the needle. No single factor explains a 17-point obesity gap; all of them together do.
The County Health Divide
Top 5 healthiest counties and bottom 5 unhealthiest nationally.
County gaps dwarf state gaps. San Juan County, Washington records a premature death rate of 3,315 per 100,000. Buffalo County, South Dakota records 46,418. That is the same metric, the same year, the same federal dataset, fourteen times apart.
Healthiest Counties
Washington
South Dakota
Virginia
Colorado
Virginia
Unhealthiest Counties
South Dakota
South Dakota
South Dakota
South Dakota
North Dakota
The healthiest and unhealthiest counties often share a state capital. South Dakota holds both Douglas County at 3,318 and Buffalo County at 46,418, a 14x internal gap. A single state grade hides that reality. Click through to any state page to see where the county extremes actually sit.
What the Data Reveals
Six patterns the raw rankings miss. Every number here is verifiable from the data.
Two South Dakota counties, fourteen times apart
Douglas County, South Dakota records a premature death rate of 3,318 per 100,000 population. Buffalo County, same state, records 46,418. That is a 14x gap inside one state capital, one governor, one set of laws. The difference is not policy. It is reservation geography, median income of $32,803 in Buffalo versus $68,324 in Douglas, and generations of disinvestment.
Rich and dying in Alpine County
Alpine County, California has a median income of $83,265 and an uninsured rate of just 10%. It also has a premature death rate of 27,650 per 100,000, nearly seven times worse than nearby San Mateo County. The county sits in the Sierra Nevada with a population under 2,000 and no hospital. Money cannot buy a doctor who is not there.
Holmes County is 40% uninsured and healthier than average
Holmes County, Ohio carries a 40% uninsured rate, nearly four times the national figure of 11.4%. Its premature death rate is 6,124 per 100,000, well under the national average. The county has one of the largest Amish populations in the country. Low smoking in parts of the community, physical work, intact family networks, and strong social capital outperform the insurance card on the measures that kill Americans early.
40% obesity, top-tier longevity in rural Iowa
Lyon County, Iowa reports 40% adult obesity and a premature death rate of 4,025 per 100,000, inside the healthiest 10% of US counties. Dickinson, Story, and Winneshiek counties repeat the pattern: 40% obesity, death rates under 5,000. Smoking under 20%, median incomes above $70,000, and stable communities offset the BMI number. Obesity is a risk factor, not a sentence.
Mississippi vs DC: a 17.8-point obesity gap
Adult obesity hits 42.7% in Mississippi and 24.9% in the District of Columbia, a 17.8 percentage-point gap. Mississippi also leads on hypertension at 45.4%, diabetes at 16.0%, and physical inactivity at 36.4%. DC leads on seven of the eleven measures in this report. The country's best and worst state health profiles sit one Delta and one Amtrak away from each other.
West Virginia still smokes
21.1% of West Virginia adults smoke, against 9.5% in DC, an 11.6-point gap. Smoking remains the single largest preventable driver of early death in the United States. West Virginia also leads the nation on serious mental distress at 22.3%. The coal-era workforce, the opioid legacy, and persistent rural poverty show up together in the same state, in the same data.
The Income-Health Connection
Counties grouped by median household income. Each row averages the counties in that bracket.
Median income tracks health more tightly than any other single variable. In the 171 counties below $45,000 median income, the average premature death rate is 16,209 per 100,000. In the 258 counties above $90,000, it is 6,211. That is a 2.6x gap across the income ladder.
Income is a strong predictor, not a complete one. Alpine County, California posts an $83,265 median income and a 27,650 death rate, because remote geography removes the healthcare access that income usually buys. Holmes County, Ohio runs 40% uninsured and still beats the national average on early death. Access, behavior, and place matter alongside the paycheck.
Best and Worst States by Category
For each metric, the state with the best and worst value, plus the national average.
No state leads on everything. Mississippi is worst on obesity, hypertension, diabetes, inactivity, food insecurity, and housing insecurity, yet best on blood pressure medication adherence at 73.0%.
Obesity Rate
National avg: 35.6
District of Columbia
24.9
Mississippi
42.7
Smoking Rate
National avg: 15.1
District of Columbia
9.5
West Virginia
21.1
Uninsured Rate
National avg: 10.4
Massachusetts
5.2
Texas
20.7
Physical Inactivity
National avg: 26.0%
District of Columbia
15.1%
Mississippi
36.4%
Excessive Drinking
National avg: 16.8%
Utah
11.8%
District of Columbia
23.0%
Premature Death Rate
National avg: 9815.6
Rhode Island
5896.1
Mississippi
14746.6
Obesity Rate
National avg: 35.6
Best
District of Columbia 24.9
Worst
Mississippi 42.7
Smoking Rate
National avg: 15.1
Best
District of Columbia 9.5
Worst
West Virginia 21.1
Uninsured Rate
National avg: 10.4
Best
Massachusetts 5.2
Worst
Texas 20.7
Physical Inactivity
National avg: 26.0%
Best
District of Columbia 15.1%
Worst
Mississippi 36.4%
Excessive Drinking
National avg: 16.8%
Best
Utah 11.8%
Worst
District of Columbia 23.0%
Premature Death Rate
National avg: 9815.6
Best
Rhode Island 5896.1
Worst
Mississippi 14746.6
Click any state to see its full category report card and county-level breakdown.
All 50 States + DC Ranked
Ranked by premature death rate (healthiest first). Click any state for county detail.
Rhode Island
Obesity 29.5% · Smoking 11.0% · Uninsured 6.5%
Massachusetts
Obesity 28.0% · Smoking 11.7% · Uninsured 5.2%
Hawaii
Obesity 27.8% · Smoking 13.1% · Uninsured 7.3%
Connecticut
Obesity 30.5% · Smoking 11.0% · Uninsured 9.7%
Minnesota
Obesity 36.9% · Smoking 15.4% · Uninsured 8.4%
New Jersey
Obesity 29.7% · Smoking 11.4% · Uninsured 11.2%
Iowa
Obesity 39.3% · Smoking 15.9% · Uninsured 7.8%
New Hampshire
Obesity 31.7% · Smoking 11.7% · Uninsured 7.2%
New York
Obesity 32.9% · Smoking 13.4% · Uninsured 6.8%
Utah
Obesity 31.7% · Smoking 10.0% · Uninsured 10.2%
Vermont
Obesity 30.4% · Smoking 12.4% · Uninsured 6.5%
Wisconsin
Obesity 38.9% · Smoking 15.2% · Uninsured 8.2%
Nebraska
Obesity 39.6% · Smoking 14.6% · Uninsured 9.7%
Washington
Obesity 34.1% · Smoking 12.2% · Uninsured 9.9%
Idaho
Obesity 33.4% · Smoking 13.6% · Uninsured 12.1%
California
Obesity 29.9% · Smoking 12.4% · Uninsured 10.4%
Oregon
Obesity 35.4% · Smoking 13.8% · Uninsured 9.6%
Maryland
Obesity 36.4% · Smoking 12.7% · Uninsured 8.5%
Pennsylvania
Obesity 37.6% · Smoking 19.4% · Uninsured 9.6%
Wyoming
Obesity 34.1% · Smoking 14.5% · Uninsured 11.8%
Illinois
Obesity 38.6% · Smoking 15.2% · Uninsured 8.7%
Michigan
Obesity 37.9% · Smoking 16.2% · Uninsured 7.2%
Colorado
Obesity 27.1% · Smoking 12.7% · Uninsured 12.1%
Maine
Obesity 33.8% · Smoking 15.8% · Uninsured 8.5%
District of Columbia
Obesity 24.9% · Smoking 9.5% · Uninsured 6.4%
Delaware
Obesity 37.0% · Smoking 13.3% · Uninsured 9.5%
North Dakota
Obesity 38.8% · Smoking 15.3% · Uninsured 8.0%
Kansas
Obesity 38.7% · Smoking 15.9% · Uninsured 10.6%
Indiana
Obesity 39.7% · Smoking 17.4% · Uninsured 8.9%
Ohio
Obesity 39.0% · Smoking 17.3% · Uninsured 8.5%
Florida
Obesity 34.7% · Smoking 15.3% · Uninsured 15.8%
Montana
Obesity 33.4% · Smoking 15.6% · Uninsured 10.2%
Virginia
Obesity 37.8% · Smoking 15.0% · Uninsured 9.7%
Nevada
Obesity 34.6% · Smoking 16.4% · Uninsured 13.0%
Missouri
Obesity 38.9% · Smoking 19.1% · Uninsured 10.0%
Texas
Obesity 37.6% · Smoking 14.9% · Uninsured 20.7%
North Carolina
Obesity 37.4% · Smoking 15.7% · Uninsured 11.4%
South Dakota
Obesity 37.0% · Smoking 17.9% · Uninsured 9.8%
Georgia
Obesity 38.5% · Smoking 17.2% · Uninsured 15.0%
Oklahoma
Obesity 40.9% · Smoking 18.8% · Uninsured 12.1%
Alaska
Obesity 35.5% · Smoking 19.4% · Uninsured 11.4%
Tennessee
Obesity 39.9% · Smoking 20.5% · Uninsured 12.9%
Louisiana
Obesity 42.1% · Smoking 19.9% · Uninsured 10.0%
Kentucky
Obesity 40.3% · Smoking 21.9% · Uninsured 9.8%
Arkansas
Obesity 41.0% · Smoking 18.4% · Uninsured 12.3%
Alabama
Obesity 41.8% · Smoking 17.7% · Uninsured 11.5%
West Virginia
Obesity 41.3% · Smoking 21.1% · Uninsured 9.3%
New Mexico
Obesity 35.1% · Smoking 14.7% · Uninsured 17.0%
South Carolina
Obesity 39.1% · Smoking 15.8% · Uninsured 13.6%
Arizona
Obesity 33.3% · Smoking 14.3% · Uninsured 15.3%
Mississippi
Obesity 42.7% · Smoking 19.1% · Uninsured 13.0%
Frequently Asked Questions
How the grades are built, and what the numbers mean.
How is each state graded?
We take 11 CDC PLACES measures (obesity, hypertension, diabetes, smoking, mental distress, physical inactivity, uninsured rate, food insecurity, housing insecurity, routine checkup, blood pressure medication) and rank each state by percentile. We then combine the percentiles into an overall score and assign a letter grade from A to F. A state can hold a C overall and still lead the country on one measure, as Mississippi does on medication adherence at 73.0%.
Why does the healthiest and unhealthiest county often sit in the same state?
State averages smear over extreme local conditions. South Dakota has Douglas County at a 3,318 premature death rate and Buffalo County at 46,418, a 14x gap. New Mexico has Los Alamos at 3,583 and McKinley at 27,593. The gap is driven by tribal reservations, remote geography, and income inequality, not state policy alone.
Does high income always mean better health?
Usually, not always. Counties below $45,000 median income average a premature death rate of 16,209 per 100,000; counties above $90,000 average 6,211. But Alpine County, California has $83,265 income and a 27,650 death rate because no hospital exists nearby. Bristol Bay, Alaska has $99,790 income and a 16,588 death rate. Remoteness, behavior, and access can override the paycheck.
Which health measure matters most for life expectancy?
Smoking remains the single largest preventable driver of early death. West Virginia smokes at 21.1%, DC at 9.5%, and that 11.6-point gap tracks closely with the premature death gap between the two. Obesity, hypertension, and diabetes compound the risk, but lifetime tobacco exposure is the clearest single line between the healthiest and unhealthiest counties in the dataset.
Where does this data come from, and how current is it?
State-level rates come from CDC PLACES, the federal small-area estimation program. County rankings come from County Health Rankings & Roadmaps (University of Wisconsin), using the most recent release. Income and uninsured figures come from the American Community Survey. Both PLACES and CHR refresh annually, so the numbers represent roughly a 1 to 2 year lag against today.
Methodology & Sources
How the state and county grades were calculated.
Explore more
Prescription Drugs
1,779 drugs with Medicare Part D claim counts, costs, and prescriber data.
Procedure Costs
Medicare payments and commercial ranges for 128 common procedures.
Medical Conditions
1,185 conditions searchable by body system, with specialties and FDA drug matches.
Pharma Transparency
Manufacturers behind the top drugs and what they pay doctors.