Well-Being Prevention & Cures

Here are the most and least healthy states in America

A new analysis underscores sharp geographical disparities in health outcomes.
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The Associated Press/ Jacquelyn Martin

Story at a glance


  • A new analysis finds Washington, Massachusetts, Utah and Vermont are the healthiest states in the nation.

  • In contrast, states concentrated in the southeastern region of the U.S. largely have the worst health outcomes.

  • Findings highlight the strong association between social determinants of health and health outcomes.

A new report from NiceRx ranked the most and least healthy states in America, based on rates of adult smokers, obesity, binge drinking, life expectancy and other lifestyle factors. 

After compiling composite health scores for each state based in part on Center for Disease Control and Prevention (CDC) data, researchers found Washington and Massachusetts were the top two healthiest states in the country, earning scores of 8.4 and 8.36, respectively, out of 10. Utah and Vermont each came in third with a score of 7.94.

Over 23 percent of those surveyed in Washington state reported being in “excellent health” and the state has an average life expectancy of 80 years. In 2021, average U.S. life expectancy was measured at 76.6 years, thanks in part to dramatic drops seen during the COVID-19 pandemic. 

Obesity rates were based on self-reported metrics, while additional factors included the number of residents searching for fitness classes, percentage of adults who exercise regularly, and prevalence of fruit and vegetable intake.

Following the top four states were Connecticut, Colorado, New York, New Hampshire, California, and Oregon, respectively.


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Washington, Connecticut, California,  Massachusetts, Colorado, and New Hampshire also all happen to be among the top 10 wealthiest states in the country as of 2021, based on median household income.

Notably, no states in the southeastern portion of the United States were found to be the healthiest, while Louisiana, Mississippi, Alabama, Kentucky and West Virginia made up the bottom five slots. A lack of data on several factors meant New Jersey was not included in final results.

Rates of chronic disease have historically been concentrated in the southeast region and disproportionately affect racial and ethnic minority populations in these states. Alabama, West Virginia, Kentucky, Louisiana and Mississippi are among the top states with the highest poverty rates, underscoring the relationship between low socioeconomic status and poor health.

Obesity is a key risk factor contributing to chronic diseases including cardiovascular disease and type 2 diabetes. As of 2020, CDC data show 35 percent or more of adults are obese in 16, including Alabama, Louisiana, Mississippi and West Virginia. 

NiceRx data show Colorado is home to the least obese adult population at 24.2 percent, followed by Massachusetts and Hawaii. Utah, California and Massachusetts are home to the fewest smokers.

Average life expectancy was highest in California, at 80.9 years on average — a stark contrast to the lowest life expectancy recorded in Mississippi at 74.4 years. Mississippi also had the highest proportion of self-reported obese citizens at 39.7 percent. 

Several factors contribute to individuals’ personal health including access to affordable health insurance and social determinants of health (pollution exposure, socioeconomic status, etc). 

Some states in the southeast U.S. remain holdouts in adopting Medicaid expansion under the 2010 Affordable Care Act, which has been shown to improve health outcomes for the nation’s underserved communities. 

Binge drinking prevalence was highest in Wisconsin at nearly 26 percent, followed by Iowa, North Dakota, Nebraska, South Dakota and surprisingly, Massachusetts and Hawaii.