Worst States to Live In

10. Indiana
Based on health outcomes and various health determinants, Indiana was identified as the 10th least healthy state in America. Like all of the unhealthy states, Indiana residents struggled with obesity. 

The state’s obesity rate of nearly 32% was the ninth highest rate in the country. While 75% of Americans nationwide reported exercising regularly, less than 70% of Indiana residents did, one of the lower figures reviewed. 

Environmental factors also contributed to the state’s poor health ranking. Residents were exposed to nearly 12 microns of particulate matter found in smoke or haze on average, more than in all but one other state. 

While the state’s public health services were among the most underfunded nationwide, nearly 73% of adolescents in the state had received vaccinations as of last year, one of the higher immunization rates in the nation.

9. South Carolina
There were nearly 560 violent crimes reported per 100,000 South Carolina residents last year, more than in all but four other states. 

A high violent crime rate can not only increase the risk of bodily injury and death, but it can also cause mental health issues and long-term stress for families, neighborhoods, and children. Infectious diseases were also more common in South Carolina than in many other states. 

For example, there were 580 cases of chlamydia and 31.1 cases of salmonella per 100,000 residents, both the fifth highest rates nationwide. Likely brought on by the state’s high obesity rate, 12.5% of residents had diabetes last year, nearly the highest rate in the nation.

8. Alabama
Alabama residents had the second highest rate of cardiovascular deaths, at nearly 330 per 100,000 people. High cholesterol and high blood pressure were common more in Alabama than in almost any other state. 

The prevalence of these risk factors contributed to high rates of heart disease and stroke. In all, more than 10,000 years of life were lost for every 100,000 people due to premature deaths — defined as deaths that occur before age 75. Alabama’s infant mortality rate of 8.6 deaths per 1,000 live births was also worse than all but one state. 

As in a majority of unhealthy states, low incomes may partly contribute to poor health outcomes. A typical household in Alabama made $41,381 in 2013, among the lowest median household incomes nationwide.

7. West Virginia
More than 27% of West Virginians reported a smoking habit last year, the highest smoking rate in the nation. 

Tobacco habits normally start fairly early in life, and youth smoking was quite common in West Virginia. Nearly one in five high school-age state residents had smoked at least once in the previous 30 days, also the highest rate in the country. It’s not just tobacco that West Virginians abuse. 

There were an alarming 31.3 drug-related deaths per 100,000 state residents last year, by far the worst rate nationwide. In addition, there were 220 cancer deaths per 100,000 state residents, the third highest rate among all states reviewed.

6. Tennessee
More than one-third of Tennessee adults and nearly 17% of adolescents were considered obese last year, both the fourth highest rates nationwide. 

As in most states, the obesity problem in Tennessee has worsened considerably. 

Physical inactivity was likely a major contributor. Less than 63% reported routine exercise, less than in all but one other state. Residents also had among the highest rates of heart attacks, and there were more than 300 cardiovascular deaths per 100,000 people, one of the highest rates. 

Determinants such as a struggling economy and safety concerns also played a role in the state’s poor ranking. More than 8% of Tennessee’s workforce was unemployed in 2013, one of the highest rates nationwide. 

The state also had the nation’s worst crime rate, at 643.6 violent crimes per 100,000 people in 2013.

5. Oklahoma
Less than 63% of children in Oklahoma had been vaccinated, one of the worst rates of any states. Also, 18% of residents did not have health insurance last year, one of the higher rates reviewed. The state’s public health system received about $79 per capita in public funding, one of the nation’s lower rates. 

Even more scarce than funding was access to a primary care doctors. There were less than 85 primary care physicians per 100,000 residents in Oklahoma, a lower rate than in all but two other states. Policies and clinical care measures like these tend to result in worse health outcomes for residents. 

Chronic conditions such as high blood pressure and high cholesterol were more common in Oklahoma than in the vast majority of states. There were also 322 cardiovascular deaths per 100,000 Oklahoma residents, the third worst rate in the nation.

4. Kentucky
While nationally cancer deaths have fallen 4% since 1990 to a rate of 189 per 100,000 Americans, the prevalence of cancer in Kentucky remain stubbornly high. Kentucky led the nation with 228 cancer deaths per 100,000 people. 

The popularity of tobacco in the state likely contributed to the cancer death rate. More than 26% of residents reported a smoking habit, a higher rate than in every state except for West Virginia. 

Residents also struggled with obesity. Nearly a third of residents were considered obese, one of the highest rates nationwide. Kentucky also led the nation for youth obesity, with 18% of teenagers considered obese. Economic factors likely play a role in the state’s poor health outcomes.

For example, nearly 32% of children in Kentucky lived in poverty last year, the worst rate nationwide.

3. Louisiana
Like all of the least healthy states, Louisiana’s obesity rate was relatively high last year. More than 33% of adults were considered obese, the sixth highest rate. While the national obesity rate rose from a year ago, it actually fell slightly in Louisiana from the year before. 

Poor diets among state residents also contributed to Louisiana’s low health ranking. On average, residents in only one other state consumed less vegetables daily than people in Louisiana. Smoking was also more common in Louisiana than in all but a handful of states. 

Unhealthy habits tend to be more common in poorly educated populations. The four-year graduation rate for Louisiana ninth graders was 72%, worse than in all but four other states. 

Louisiana households were also the poorest in the nation with a median household income of less than $40,000 in 2013.

2. Arkansas
While more than 70% of children had been immunized nationwide in 2013, just 57% of children in Arkansas were vaccinated, the worst rate in the country. 

Arkansas residents were also the least likely to make an annual visit to the dentist, with less than 55% doing so last year. And like all unhealthy states, Arkansas residents struggled with obesity. 

Nearly 35% of state residents were considered obese last year, the third highest rate nationwide. Nearly 18% of high school-aged residents were also considered obese, the second-highest rate.

Low incomes likely contributed in part to poor health outcomes. A typical household made $39,919 in 2013, less than every state except for Louisiana.

1. Mississippi
Mississippi is once again the least healthy state in the nation. More than 35% of residents were obese last year, the highest rate in the U.S. This was likely due in part to just 61.9% of residents reporting exercising routinely, the lowest rate nationwide. 

Based on daily vegetable consumption, Mississippians also had the worst diets in the country. In terms of clinical care, the state is in need of improvement. There were 41.9 dentists and 81.8 primary care physicians per 100,000 people, both the second-lowest rates in the country. 

Premature death was estimated to have cost roughly 10,354 years of life for every 100,000 residents, the highest figure reviewed. Specifically, there were 346 cardiovascular deaths per 100,000 people, the highest in the nation. 

Yet another example of the residents’ poor health and of Mississippi’s poor quality health care system is the infant mortality rate, which, at 9.1 deaths per 1,000 live births, was the worst rate in the country.