Most and Least Healthy States, Ranked From 1 to 50
According to the National Library of Medicine, Americans tend to live shorter lives and grapple with more health issues compared to people in high-income countries. On top of that, Americans in certain states have an even higher chance of being unhealthy.
Forbes set out to compile a complete ranking of states based on health criteria. Do you live in one of the healthiest states in America?
Measuring Health
Forbes used 21 metrics to determine the most and least healthy states in America, gathering data from the Kaiser Family Foundation and Centers for Disease Control and Prevention (CDC). They then assigned the metrics to the following three categories and weighed them accordingly:
- Lifestyle habits and health outlook (15 points)
- Substance abuse (25 points)
- Disease prevalence and mortality rate (60 points)
A Numbers Game
Each category received a score from 0 to 100; the lower the number, the healthier the state. All data collected was based on a rate per 100,000 residents. Forbes calculated the scores from each category, assigning a total healthiness score for every state, starting with the healthiest. They are as follows.
1: Hawaii
It’s official: Hawaiians are the healthiest people in America, according to Forbes’ study. The Aloha State received a coveted 0 out of 100 score. Their ranking was helped in great part by Hawaiians having the longest lifespan (80.87 years) and an obesity rate of only 24.83%, the second lowest in the nation.
Hawaii also ranks well in substance abuse. Its residents have the lowest alcohol-induced fatalities in America, and only 5.9% of Hawaiians 18 years and older report illicit drug dependence, the 7th lowest in the US.
2: Utah
Utahans put other fellow Americans to shame, for Utah residents reported the highest number of people who said they’ve exercised in the past month. That, coupled with Utahans having the lowest rates of disease mortality and chronic illness, gives them an excellent health score of 0.6 out of 100.
3: Minnesota
Minnesota is the top third healthiest country in America, with a health score of 1.11 out of 100. Only 2.5% of its residents report opioid misuse, the fifth lowest in the nation. Minnesotans also have the 7th lowest percentage of diabetes diagnoses.
4: California
Surf’s up, dude. But luckily for Californians, their health score isn’t. The Golden State snags the title of the fourth healthiest state in the US with a score of 3.2 thanks to excellent rankings for the healthiest lifestyle habits & health outlook category. Californians also have the second longest life expectancy of 80.23 years.
5: Massachusetts
Massachusetts has a low obesity rate of 25.67% compared to the national average, helping it land an impressive health score of 4.52. Only 11.27% of Bay Staters currently smoke, which is the fifth lowest in America.
6: Colorado
Colorado received a health score of 5.62 out of 100. It scored best in the lifestyle habits and health outlook category, with a low 1.12. However, Coloradans are struggling in the substance abuse area, with a gut-wrenching score of 88.27 out of 100.
7: Washington
Forbes gave Washington state a health score of 6.04. As with Colorado, its residents struggle with substance abuse, with a score of 81.48. On the positive side, the Evergreen State landed a lifestyle habits and health outlook score of 3.37.
8: Connecticut
Connecticut received a health score of 8.23. Like many states that share its top ten healthiest ranking in America, it scored well in the lifestyle habits & health outlook department. However, its moderate substance abuse and disease prevalence & mortality rate scores prevented it from claiming a higher position.
9: New York
New York scored an even 9.0 for healthiness. It had fewer swings between categories than many states, ranking in the low 20s for substance abuse and lifestyle habits & health outlook.
10: New Jersey
New Jerseyites should be proud to make the top ten healthiest states in America. However, it’s the first state on this list to surpass double digits, with a total healthiness score of 14.44. Disease prevalence and mortality rate having a high 60-point weight in this study is the main culprit for the Garden State not ranking higher.
11: Idaho
Idaho came close to New Jersey for healthiness, with a total score of 15.04. Substance abuse was the highest category for the Gem State, with a score of 44.44. On the bright side, Idahoans have an excellent 15.65 score for disease prevalence & mortality rate.
12: Oregon
Oregon jumps up over eight points from Idaho, with a total healthiness score of 23.05. It has a heartbreaking 100 out of 100 score for substance abuse. This perhaps comes as little surprise to Oregon residents, given that their state made the news for having the second-highest alcohol and drug addiction rate in the US.
13: Vermont
Vermont’s healthiness score is just a hair above Oregon’s, at 23.37. It also ranks terribly for substance abuse, with a score of 89.51. The Green Mountain State has a too-high for comfort prevalence & mortality rate score of 43.13. It’s low 11.8 habits & health outlook score is its saving grace.
14: Virginia
Virginia has a health score of less than 0.2 worse than Vermont. Its distribution looks significantly different, though, for it has a low 12.35 substance abuse score. Both the prevalence & mortality rate and habits & health outlook categories rank in the low 30s.
15: New Hampshire
New Hampshire has a total healthiness score of 24.91. Like several states we’ve covered, its residents struggle with substance abuse; Forbes gave it a painstakingly high score of 85.19. The Granite State performed best for lifestyle habits & health outlook, with a 20.79 score.
16: Rhode Island
Forbes gave Rhode Island a health score of 26.19. At the risk of sounding like a broken record, a high 83.33 substance abuse score was the state’s worst category ranking. The disease prevalence & mortality rate category also wasn’t in Rhode Islanders’ favor, with a score of 41.98.
17: Wisconsin
Despite Wisconsin’s 27.04 score, it looks better than many of its fellow states in the top 20. The Badger State “only” has a substance abuse score of 53.7 out of 100. That said, it ranks just above 40.0 for the disease prevalence & mortality rate category.
18: Nebraska
Nebraska is the last state on this list to have a healthiness score in the 20s, at 28.82. That’ll seem like peanuts compared to the scores that will soon follow. The Cornhusker State ranked in the 40s for all categories except for substance abuse, which had a score of 39.51.
19: Texas
Everything is bigger in Texas, including a large percentage of its population, given its 35.8% obesity rate. That’s one of the factors contributing to its poor 51.69 score for lifestyle habits & health outlook. Forbes gave Texas an overall health score of 33.11.
20: Maryland
Maryland is doing almost 50% better than Texas in the lifestyle habits & health outlook category. But it still ranks worse for overall health due to having more than 33 points higher in the substance abuse category and a 6.3 higher score for disease prevalence & mortality rate.
21: North Dakota
It’s all downhill from here as we leave behind the top 20 healthiest states in the US. North Dakota has a health score of 25.72. It ranks moderately to poorly in all categories, with a 56.18 score for lifestyle habits & health outlook being the worst.
22: Illinois
Illinois has a health score of 37.17. The Prairie State struggles the most with the disease prevalence & mortality rate category, scoring 45.23 out of 100. Its 38.89 substance abuse score looks relatively low compared to many states covered up to this point.
23: Iowa
Forbes slapped a health score of 38.52 on Iowa. The Hawkeye State showed steady results, scoring in the 50s for all three categories. Unfortunately, those aren’t promising numbers for the health of its residents.
24: Alaska
Alaska is arguably the biggest mix bag in all of the US health-wise. With a disease prevalence & mortality rate score of 4.58, one would assume it would have a total health score lower than the 40.87 it received. However, Alaskans have a 45.51 score for lifestyle habits & health outlook and a cringe-worthy 95.06 substance abuse score.
25: Montana
Montana’s total health score clocked in at 41.11, putting it in the middle for state healthiness. The Treasure State had a relatively respectable 29.21 score for lifestyle habits & health outlook. A 79.63 score prevented it from ranking healthier, though.
26: Florida
Florida’s health score came in at 42.85. Some might argue its low ranking for healthiness in the US isn’t entirely fair, given the slew of seniors that move there during retirement. This could, in part, contribute to Florida’s high 63.55 disease prevalence & mortality rate score.
27: South Dakota
With a health score of 43.96, South Dakota residents have work to do to improve their health. The Mount Rushmore State ranked worst in the lifestyle habits & health outlook category, with a 58.43 score. But even a relatively low substance abuse score of 40.74 compared to the states it ranks near wasn’t enough to move it higher in the rankings.
28: Arizona
Arizona has a health score of 46.42. Its residents struggle with substance abuse, scoring 87.04 out of 100. That makes its 35.39 score for lifestyle habits & health outlook look small, though it’s far from a healthy number compared to the first ten states in Forbes’ ranking.
29: Georgia
Georgia’s 49.27 health ranking will make any research-oriented thinker do a double take. It has a zero substance abuse score. That doesn’t mean the Peach State doesn’t have residents using illicit drugs and with alcohol addictions. However, it ranked low enough in these categories for the number to be zero.
Unfortunately, Georgia scores medium to high for disease prevalence & mortality rate (35.5) and lifestyle habits & health outlook (59.55).
30: Maine
All the cholesterol in Maine’s lobster may be taking a toll on its residents, for the state received a health score of 49.65. It ranked among the highest states so far in the disease prevalence & mortality rate category, with a score of 68.89. The heavy weight Forbes gave to this category, coupled with a high substance abuse score, plummeted the Pine Tree State towards the bottom of the rankings.
31: Kansas
Kansas breaks into both the top 20 unhealthiest states in America and the first state to surpass a health score of 50, at 51.97. The Sunflower State scored quite evenly across all three categories, ranging in the 50s out of 100.
32: Wyoming
Forbes gave Wyoming a total health score of 52.4. Wyomingites suffer the most from health issues relating to the substance abuse category. As a silver lining, they have a lower-than-average prevalence & mortality rate score of 35.5.
33: Nevada
Nevada’s health score clocked in at 53.29. It had an exceedingly high substance abuse score of 88.27. Things aren’t looking promising for Nevadans in the lifestyle & health outlook category, either, with a score of 46.63.
34: Delaware
Delaware had a total health score of 53.54. The First State’s worst offender was the lifestyle habits & health outlook category, scoring 59.55. Delawareans aren’t doing much better in the disease prevalence & mortality category, scoring less than four points below that.
35: Pennsylvania
Pennsylvania scored just a hair higher than Delaware for the unhealthiest states in the US. Its poor disease prevalence & mortality rate score of 62.02 is the biggest contributor to the Keystone State’s bad ranking compared to most other states.
36: North Carolina
North Carolina’s total health score of 59.14 makes it the 15th most unhealthy country in America. Poor scores in the disease prevalence & mortality rate and lifestyle habits & health outlook categories were neck and neck, at 56.11 and 57.87, respectively.
37: New Mexico
New Mexico’s total health score takes an embarrassing leap from North Carolina’s, landing at 66.28. A high substance abuse score of 82.10 is one of the leading causes, though a 52.81 score in lifestyle habits & health outlook doesn’t help its situation.
38: Michigan
Michigan is less than 0.5 points above New Mexico for unhealthiness. It ranks high across the board for the categories, with disease prevalence & mortality rate and substance abuse being nearly identical, at 69.08 and 70.99 out of 100, respectively.
39: Indiana
The future doesn’t look bright for Indiana in the health department unless its residents take action to improve their health. Its 82.58 score in the lifestyle habits & health outlook category is one of the worst in the country.
40: Missouri
Missouri managed to stay out of the top ten unhealthiest states in the US, but its 71.98 total health score isn’t attractive. It scored moderate to high in all categories, with lifestyle habits & health outlook being the biggest offender, scoring 78.65.
41: Ohio
Ohio is the tenth most unhealthy state in the US. Forbes gave it a total health score of 73.38. While it ranks poorly across all categories, its 80.34 score for lifestyle habits & health outlook is the worst.
42: South Carolina
Southern cooking doesn’t appear to be boding well for South Carolinians’ health. The Palmetto State has a disease prevalence & mortality rate score of nearly 70, with its lifestyle habits & health outlook score nearing 80 out of 100.
43: Oklahoma
Oklahomans have some serious health issues to contend with, according to Forbes’ study. The Sooner State has a distasteful lifestyle habits & health outlook score of 87.64, making its substance abuse score of 50.62 appear relatively small.
44: Louisiana
Louisiana jumps into the 80s for total health, with a score of 82.47. As with the states before it, the Pelican State ranks poorly for habits & health outlook (91.57). It also has the second-highest substance abuse score in the top ten unhealthiest states, scoring 70.99.
45: Tennessee
Even though Tennessee managed to squeeze out of the top five most unhealthy states in America, its 82.81 total health score isn’t anything to boast about. Of the three categories, Tennesseans scored the worst for disease prevalence & mortality rate (76.15) and lifestyle habits & health outlook (86.52).
46: Arkansas
Arkansas is the fifth most unhealthy state in the US, with a total health score of 85.35 out of 100. Some contributing factors to this ranking include Arkansans having the second-highest heart disease fatalities and the third-highest diabetes mortalities. Furthermore, over 20% of its population currently smokes, making it the third-highest percentage of smokers in the US.
47: Alabama
Obesity is a major contributor to Alabama’s 85.69 total health score. Over 38% of Alabamians 18 years and older are obese, undoubtedly in part because they ranked the third-highest in America for residents reporting they haven’t exercised within the past month. The Cotton State also has the second-highest rate of people passing away from strokes and Alzheimer’s disease.
48: Kentucky
Kentucky is the third-most unhealthy state in the US, with a Forbes health score of 86.96 out of 100. The Bluegrass State has the fourth-highest cancer incidence rate, with over 643 diagnoses per 100,000 residents. Its 21.53% smoking percentage also makes it the second-highest state for residents who currently smoke.
49: Mississippi
Mississippi scraped by with taking the unhealthiest state title, but with a health score of 96.55, its residents are far from being in the clear. The Magnolia State has the highest obesity rate in America (39.87%) and the lowest life expectancy at birth. Mississippi residents also suffer from the worst mortality rate metrics for hypertension, Alzheimer’s disease, and influenza & pneumonia.
50: West Virginia
West Virginia’s health score of 100 out of 100 is tough to swallow. Factors making West Virginia the number one unhealthiest state in the US is it having the highest rate of drug overdose fatalities (57.13 per 100,000 residents) and the highest prevalence of illness and mortality from chronic diseases.
Some of the disease-related metrics that West Virginia ranked as the worst in America include diabetes mortality, heart disease mortality, kidney disease mortality, and cancer incidence rate.
Scoring Nuances
The 21 metrics Forbes used to rank America’s unhealthiest states weren’t divided equally among the three categories. Disease prevalence & mortality had 12 metrics, substance abuse had five metrics, and lifestyle habits & health outlook had four metrics.
A Grim Outlook
The National Library of Medicine states that the US fares worse in nine health categories than other high-income countries. Examples of these health categories include obesity and diabetes, heart disease, disability, and drug-related mortality.
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