States With The Least Healthy Populations, Ranked (2024)

Most American adults aren’t exactly the picture of health, with six in 10 Americans reporting at least one chronic disease, according to the CDC. Four in 10 adults have two or more chronic diseases.

Some parts of the country have even worse numbers, partly because of unhealthy lifestyles and substance abuse.

To find the most and least healthy states, Forbes Advisor gathered data for 21 metrics from the Kaiser Family Foundation and Centers for Disease Control and Prevention (CDC). More specifically, we considered metrics spanning three key categories: disease prevalence and mortality rate, substance abuse, and lifestyle habits and health outlook.

Key Takeaways

• West Virginia tops the list of states with the least healthy populations, while Hawaii ranks as the state with the healthiest residents.
• Nine of the top 10 least healthy states are located in the South, including West Virginia, Mississippi, Kentucky, Alabama, Arkansas, Tennessee, Louisiana, Oklahoma and South Carolina.
• Five of the 10 healthiest states are in the Pacific and West, including Hawaii, Utah, California, Colorado and Washington.
• Although the western part of the country is home to many of the healthiest states overall, five of the worst states for substance abuse are located in the West, including Oregon, Alaska, Colorado, Nevada, and Washington.

Top 5 Least Healthy States

1. West Virginia

West Virginia’s score: 100 out of 100

West Virginia tops our list as the least healthy state. It has the highest prevalence of illness and death from chronic diseases.

West Virginians have the second lowest life expectancy nationwide (73.9) and the state ranks worst in the nation for several disease-related metrics, including:

• Cancer incidence rate (709.10 diagnoses per 100,000 state residents).
• Percentage of adults with diagnosed diabetes (13.2%).
• Cancer mortality rate (261.94 deaths per 100,000 state residents).
• Diabetes mortality rate (55.23 deaths per 100,000 state residents).
• Heart disease mortality rate (284.49 deaths per 100,000 state residents).
• Kidney disease mortality rate (27.46 deaths per 100,000 state residents).
• Chronic lower respiratory disease (CLRD) mortality rate (93.55 CLRD deaths per 100,000 state residents on average between 2018 and 2020). CLRD encompasses COPD, emphysema, chronic bronchitis and asthma.

West Virginia also ranked second worst for healthy lifestyle habits and health outlook.

Other sobering statistics are that West Virginia has the highest rate of drug overdose deaths in the nation (57.13 per 100,000 state residents), the highest percentage of adults who smoke (22.80%) and the second highest percentage of obese adults (39.8%), slightly behind Mississippi.

2. Mississippi

Mississippi’s score: 96.55 out of 100

Mississippi ranked second overall for unhealthy states. The state is second worst for disease prevalence and death due to chronic disease and topped the list of states for the least healthy lifestyle habits.

The state has the highest percentage of obese adults in the nation (39.87%), the lowest life expectancy at birth (73.63) and the highest percentage of adults who did not exercise in the past month (32.87%). Compare Mississippi’s exercise percentage to Utah and Colorado, where only 17% of adults say they didn’t exercise in the past month.

The Magnolia State also ranked worst for several disease-related metrics, including:

• Hypertension mortality rate (18.99 deaths per 100,000 residents).
• Influenza and pneumonia mortality rate (29.41 deaths per 100,000 residents).
• Alzheimer's disease mortality rate (59.06 deaths per 100,000 residents).

Mississippi is also second worst for the following:

• Percentage of adults with diagnosed diabetes (13.03%).
• Diabetes mortality rate (41.73 deaths per 100,000 residents).
• Kidney disease mortality rate (26.61 deaths per 100,000 residents).
• Reported opioid misuse in the past year (5.2%).

3. Kentucky

Kentucky’s score: 86.96 out of 100

The Bluegrass State ranked as the third unhealthiest state and also placed third on the list of states with the least healthy lifestyle habits.

Kentucky’s sobering statistics include:

• Second place for highest percentage of smokers (21.53%).
• Fourth most likely to report obesity (37.8%).
• Second highest percentage of adults who did not exercise in the past month (31.3%) and the fourth lowest life expectancy at birth (74.77).
• Sixth highest rate of drug overdose deaths (35.32 per 100,000 state residents).

Kentucky also ranks fifth worst in the category looking at disease prevalence and mortality rates. The state reported the third highest mortality rate for both cancer (223.91 deaths per 100,000 state residents) and chronic lower respiratory disease (75.21 deaths per 100,000 state residents).

Kentucky residents additionally had the:

• Fourth highest cancer incidence rate (643.13 diagnoses per 100,000 state residents).
• Sixth highest diabetes mortality rate (34.49 deaths per 100,000 state residents).
• Seventh highest kidney disease mortality rate (21.53 deaths per 100,000 state residents).

4. Alabama

Alabama’s score: 85.69 out of 100

Alabama ranked fourth worst overall and also fourth in two categories: disease prevalence and mortality rate, as well as lifestyle habits and health outlook.

One problem with Alabama is that residents aren’t getting enough exercise: 38.33% of Alabama adults report being obese, and 30.6% don’t exercise within a month, both the third highest rates in the country. Alabamians have the third lowest life expectancy in the nation (74.5). Only Mississippi and West Virginia have a lower life expectancy.

On average, 63.63 Alabamians die from a stroke per 100,000 state residents, and 55.35 residents pass away due to Alzheimer’s disease per 100,000 (both the second highest amounts in the nation).

Alabama is also:

• Third highest percentage of adults with diagnosed diabetes (12.83%)
• Fifth highest rate of heart disease deaths nationwide (275.54 per 100,000 state residents).
• Most likely in the nation to report opioid misuse (5.3%).

5. Arkansas

Arkansas’ score: 85.35 out of 100

Arkansas ranked No. 5 among the most unhealthy states. The state is third highest for disease prevalence and death due to chronic disease.

Statistics that contribute to Arkansas’ poor results include:

• Second highest number of heart disease deaths (280.48 per 100,000 state residents) and chronic lower respiratory disease deaths (78.92 per 100,000 state residents).
• Third highest diabetes mortality rate (40.14 deaths per 100,000 state residents) and the fourth highest Alzheimer’s disease mortality rate (52.28 deaths per 100,000 state residents).
• Sixth highest rate of both influenza and pneumonia deaths (21.86 per 100,000 state residents) and kidney disease deaths (22.65 per 100,000 state residents).
• Fifth among the states with the least healthy lifestyle habits and worst health outlook.

The state is home to the third highest percentage of smokers nationwide (20.6%) and the seventh highest percentage of obese adults (37.5%). Arkansas adults were fourth most likely to report that they did not exercise in the past month (30.5%) and had the seventh lowest life expectancy nationwide (75.03).

Top 5 Healthiest States

1. Hawaii

Hawaii’s score: 0 out of 100

Hawaii tops the list of states with the healthiest population, thanks in part to residents having the longest lifespan (80.87 years), the second lowest percentage of obese adults (24.83%) and the sixth lowest percentage of adults who smoke (11.33%).

Hawaii residents enjoy the:

• Lowest chronic lower respiratory disease mortality rate in the nation (26.24 deaths per 100,000 state residents.
• Third lowest chronic liver disease mortality rate (9.09 deaths per 100,000 state residents).
• Sixth lowest diabetes mortality rate (22.34 deaths per 100,000 state residents).

Hawaii also fared well in a low percentage of substance abuse. The Aloha State had the seventh lowest score in the substance abuse category. Hawaii also reported the lowest number of alcohol-induced deaths (7.4 deaths per 100,000 state residents), and Hawaii adults were seventh least likely to report dependence on illicit drugs (5.9%).

2. Utah

Utah’s score: 0.60 out of 100

Utah is the second healthiest state. Residents have the lowest rates of chronic illness and disease mortality.

Utah is best in the nation for several disease-related metrics, including:

• Cancer incidence rate (356.61 diagnoses per 100,000 state residents) and cancer mortality rate (99.99 deaths per 100,000 state residents).
• Hypertension mortality rate (5.57 deaths per 100,000 state residents).
• Stroke mortality rate (27.44 deaths per 100,000 state residents).
• Chronic liver disease mortality rate (8.54 deaths per 100,000 state residents).

The state also ranks second lowest for both heart disease deaths (118.65 deaths per 100,000 state residents) and chronic lower respiratory disease deaths (26.48 deaths per 100,000 state residents).

Utah tied with Hawaii for having the seventh lowest rate of substance abuse overall but is 12th in the nation for reporting opioid misuse (4.1%)

Still, Utah ranked fifth among the states with the healthiest lifestyle habits. Only 4.2% of Utah adults meet the criteria for heavy drinking, the lowest percentage. “Heavy drinking” means adult men who report having more than 14 drinks per week and adult women who report having more than seven drinks per week, according to the CDC.

Utah is home to the lowest percentage of smokers in the country (7.77%) and Utah adults are least likely to report that they did not exercise in the past month (17.23%).

3. Minnesota

Minnesota’s score: 1.11 out of 100

Minnesota is the third healthiest state, ranking ninth best in two of the categories: chronic disease prevalence and mortality rate, as well as substance abuse.

Minnesota has the fourth lowest heart disease mortality rate (148.18 deaths per 100,000 state residents) and the fifth lowest influenza and pneumonia mortality rate (10.49 deaths per 100,000 state residents).

Other Minnesota highlights include:

• Eighth lowest rates of both kidney disease deaths (9.65 deaths per 100,000 state residents) and seventh lowest percentage of diabetes diagnosis (7.83%).
• Fifth least likely to report opioid misuse (2.5%).
• Tenth lowest rates of both drug overdose deaths (14.47 deaths per 100,000 state residents) and percentage of adults who report illicit drug abuse (6%).

Minnesotans have the third longest life expectancy nationwide (80), and Minnesota adults are fifth least likely to report that they did not exercise in the past month (19.73%)

4. California

California’s score: 3.02 out of 100

California ranks as the fourth healthiest state, including third for healthiest lifestyle habits and health outlook. California residents have the second longest life expectancy (80.23) and the Golden State is home to the second lowest percentage of smokers (9.23%).

California had the fifth lowest rates of the following disease-related metrics:

• Cancer incidence rate (464.32 diagnoses per 100,000 state residents).
• Cancer mortality rate (152.28 deaths per 100,000 state residents).
• Chronic lower respiratory disease mortality rate (33.67 deaths per 100,000 state residents).

California also reported the seventh lowest rate of heart disease deaths (162.67 deaths per 100,000 state residents).

5. Massachusetts

Massachusetts’ score: 4.52 out of 100

The Bay State is No. 5 overall for healthiest states, including sixth among the states with the healthiest lifestyle habits and health outlook.

Massachusetts residents have the fourth longest lifespan (79.83 years), behind only Hawaii, California and Minnesota. Only 25.67% of Massachusetts adults report being obese, better than every state except Colorado and Hawaii.

Massachusetts is also home to the fifth lowest percentage of adults who are current smokers (11.27%) and ranked seventh among the states with the lowest disease prevalence and mortality rates.

The state also fared due to:

• The third lowest number of diabetes deaths (20.67 deaths per 100,000 state residents) and the fourth lowest number of stroke deaths (34.35 deaths per 100,000 state residents).
• The fifth lowest Alzheimer’s disease mortality rate (24.99 deaths per 100,000 state residents) and sixth lowest percentage of adults with diagnosed diabetes (7.7%).

How Health Impacts Life Insurance Rates

When setting life insurance rates, companies typically use factors including:

• Age
• Gender
• Height/weight
• Past and current health
• Family medical history
• Driving record (such as speeding tickets and DUI convictions)
• Nicotine and/or marijuana use
• Substance use history
• Credit
• Criminal record

If you apply for life insurance, your past and current health will play a vital role in your life insurance quotes. Pre-existing conditions will lead to higher rates and may even cause life insurance companies to deny you coverage.

Smoking and drugs or alcohol abuse can also result in higher quotes because these activities can lower your life expectancy.

You could be considered a high-risk life insurance applicant if you have a severe health condition or multiple conditions.
Many life insurance companies still require life insurance medical exams. These exams include a paramedical professional collecting information like your weight, height and blood pressure, as well as blood and urine specimens. There may also be health-related questions and additional testing like an electrocardiogram (EKG).

That doesn’t mean you should skip life insurance or delay buying a policy if your health isn’t tip-top. For instance, waiting five or 10 years to apply for a term life insurance policy in hopes of losing weight or kicking a smoking habit may cost you more when you eventually apply for a policy. Age is a key factor when life insurance companies set rates, so waiting to buy a life insurance policy until you’re older will result in higher life insurance quotes.

Best Life Insurance Options for Those With Pre-Existing Health Conditions

If you’re in very poor health and likely to be declined for a regular life insurance policy, your best bet may be a guaranteed issue life insurance policy. You can’t be turned down, but the coverage amount available may be small and you’ll likely pay a high cost for the amount you buy.

These can be a good fit for seniors who want to buy coverage for final expenses or for those with a medical condition that makes other types of life insurance cost prohibitive.

Guaranteed issue life insurance has a graded death benefit, which means the policy won’t pay out the full amount if you pass away in the first few years of owning the policy (unless you die in an accident).

Another way to avoid a life insurance medical exam is with simplified issue life insurance. These applications typically ask several questions and you can be denied if your answer is yes to any of them. Like guaranteed issue policies, simplified issue policies often cost more than if you went through a longer application process with a medical exam.

Related: Best Life Insurance Companies for Seniors

Best Life Insurance Options for Healthy Applicants

Younger and healthy people have a wide range of options for life insurance. There are many no-exam life insurance options these days targeted toward healthy applicants under age 50 or 60. Electronic data is quickly collected from several sources in the background, allowing insurers to offer good rates for term life insurance within a day or two, and sometimes instantly.

There’s also a bounty of life insurance options available for those willing to take a life insurance medical exam. Work with a life insurance agent or financial advisor who can help you pinpoint the companies most likely to offer you the best quotes.

Methodology

To determine which states have the least healthy (and healthiest) populations, Forbes Advisor examined data from the CDC and the Kaiser Family Foundation for all 50 states across three key categories: disease prevalence and mortality rate, substance abuse, and lifestyle habits and health outlook.

We considered 21 relevant metrics, which are listed below with their corresponding weights:

Disease Prevalence and Mortality Rate - Total Points: 60

• Cancer incidence rate per 100,000 state residents: 5% of score. Data comes from the CDC’s WONDER database. For this metric, we took a three-year average, using data from 2017 to 2019.
• Percentage of adults with diagnosed diabetes: 5% of score. Data comes from the Kaiser Family Foundation. For this metric, we took a three-year average, using data from 2018 to 2020.
• Cancer mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Diabetes mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Heart disease mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Hypertension mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Kidney disease mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Chronic Lower Respiratory Disease (CLRD) mortality rate per 100,000 state residents: 5% of score. CLRD includes chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, and asthma. Data for this scoring factor comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Stroke mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Influenza and Pneumonia mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Alzheimer’s disease mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Chronic liver disease/cirrhosis mortality rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.

Substance Abuse - Total Points: 25

• Percentage of Adults Who Are Heavy Drinkers: 5% of score. This metric includes adult men who report having more than 14 drinks per week and adult women who report having more than 7 drinks per week. Data comes from the CDC’s Behavioral Risk Factor Surveillance System. For this metric, we took a three-year average, using data from 2019 to 2021.
• Percentage of adults who report illicit drug dependence or abuse in the past year: 5% of score. Data for this metric comes from the Kaiser Family Foundation and is from 2019 to 2020.
• Percentage of state residents (age 12 or older) who report past year opioid misuse: 5% of score. This metric includes heroin and pain reliever misuse. Data comes from the Kaiser Family Foundation and is from 2019 to 2020.
• Alcohol-induced death rate per 100,000 state residents: 5% of score. Data comes from the Kaiser Family Foundation. For this metric, we took a three-year average, using data from 2018 to 2020.
• Drug overdose death rate per 100,000 state residents: 5% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.

Lifestyle Habits and Health Outlook - Total Points: 15

• Percentage of adults who did not exercise in the past month: 3.75% of score. Data comes from the CDC’s Behavioral Risk Factor Surveillance System. For this metric, we took a three-year average, using data from 2019 to 2021.
• Percentage of adults who report being obese: 3.75% of score. Data comes from the CDC. For this metric, we took a three-year average using data from 2019 to 2021.
• Life Expectancy at birth: 3.75% of score. Data comes from the CDC. For this metric, we took a three-year average, using data from 2018 to 2020.
• Percentage of adults who are current smokers: 3.75% of score. Data comes from the CDC’s Behavioral Risk Factor Surveillance System. For this metric, we took a three-year average, using data from 2019 to 2021.

State population data comes from the U.S. Census Bureau and is from 2021.