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America's Healthiest & Unhealthiest States

States in New England perform best, while the South still falls behind.

For the second year in a row, residents of Vermont are the healthiest people in the nation, according to a new state-by-state survey by the nonprofit United Health Foundation, which is funded by insurer UnitedHealth Group.

Vermonters may already be celebrating their first place-finish with an invigorating mountain hike. Mississippians, on the other hand, are unlikely to toast their ninth consecutive last-place finish.

The ranking, which has been published by United Health for 21 years, measures residents of each state on 22 activities that can predict future health, such as smoking and exercising, as well as events that have already occurred, like deaths or violent crime.

What is Vermont doing right? Among its many virtues, according to the survey, the state boasts a high percentage of residents with health insurance, high per-capita public health funding and ready availability of primary care physicians. The state has steadily risen in the rankings since placing 17th in 1997 and 1998.

The Top 5 include:

1. Vermont
2. Massachusetts
3. New Hampshire
4. Connecticut
5. Hawaii

Meanwhile, Mississippi scored at or near the bottom on 11 of the 22 survey measures, showing a high prevalence of obesity, high rate of childhood poverty, low high school graduation rates, limited availability of primary care physicians and many preventable hospitalizations. Mississippi has ranked in the bottom three since 1990.

The Bottom 5 include:

46. Oklahoma
47. Nevada
48. Arkansas
49. Louisiana
50. Mississippi

Go to Forbes.com to see the full rankings of America's Healthiest and Unhealthiest States

Overall the survey shows American health improving in meaningful ways, but still held back by three serious challenges: Childhood poverty, increasing obesity and inadequate insurance coverage.


Reed Tuckson, M.D., executive vice president and chief of medical affairs at UnitedHealth Group, calls obesity, lack of insurance and poverty trends "alarming." They conspire to shorten the average number of years Americans are healthy and productive, he says. Two of the factors, lack of health insurance and childhood poverty, have been exacerbated by the deep recession.

Yet several encouraging trend lines continued to rise through 2009, the most recent year surveyed. Perhaps most notably: The percentage of people who smoke has fallen to 17.9 percent,from about 30% in 1990.

Other significant national trends:

Infant mortality rates have fallen 34%, to 6.7 deaths per 1,000 live births, from 10.2 in 1990.
The incidence of infection disease has dropped 57 percent since 1990, to 17.5 cases per 100,000 people, from 40.7 cases in 1990.
Violent crime rates have decreased 29 percent, to 429 offenses per 100,000 people, from 609 in 1990.
Across the country state government officials and public health experts are looking for new ways to improve the health and well being of their citizenry--and improve their rankings in the process.

Across the country state government officials and public health experts are looking for new ways to improve the health and well being of their citizenry--and improve their rankings in the process.

Tennessee has bobbed near the bottom of United Health's rankings since 1990, but is on an upswing, climbing two spots this year to 42nd place. "We've turned the corner," says Susan Cooper, Tennessee's health commissioner.

Cooper says that several years ago, the state's political leaders looked at ways to improve Tennessee's rank by improving access to health insurance. Eventually they decided insurance wasn't the primary cause of or solution to health problems; instead, they set their cross-hairs on nutrition, physical inactivity and tobacco use. Any improvement in these areas, says Cooper, improves many other health issues, including diabetes, cardiovascular disease, cancer and infant mortality.

Programs were set up to address the three factors, the most successful of which dealt with smoking. At virtually every turn of the bureaucracy residents are asked if they smoke and, if so, whether they would like to attend a free cessation program. Legislators also tripled the tax on tobacco--this in one of the three top tobacco-producing states in the nation. As a result the prevalence of smoking in Tennessee has fallen to 22 percent in 2009, from 26.2 percent five years ago.

Cooper recognizes that the state has growing problems with child poverty and obesity, but she's encouraged by Tennessee's progress. "I could be [ranked] 42nd for the rest of my life, as long as we're improving and the nation is improving," she says.

Go to Forbes.com to see the full rankings of America's Healthiest and Unhealthiest States