The Healthiest & Unhealthiest Communities in the U.S.

• Based on our analysis, Marin County, Calif., is the healthiest county in the U.S., while Harris County, Texas, ranks as the unhealthiest.
• Western states make up the majority of our best counties. Three of the 10 healthiest counties are located in California, while others are found in Colorado, Hawaii, and Montana.
• Conversely, most of the unhealthiest counties are located in the South and Southwest, including Texas, Arizona, and Louisiana.
• The healthiest counties are generally higher-income areas, with higher health insurance coverage rates, lower rates of food insecurity, and lower ratios of residents to primary care providers.
• Residents in the unhealthiest counties have less access to grocery stores, are more likely to experience food insecurity, and have more limited access to primary care providers.

We ranked 576 U.S. counties across multiple health measures to find the healthiest and unhealthiest areas. The map below shows the ranking of each county, with No. 1 being the healthiest and No. 576 being the least healthy. You can hover over each county to see its overall ranking and population.

Our rankings are based on 14 key metrics that capture the individual, environmental, and structural aspects of health for a given community. This includes measures such as life expectancy and health insurance coverage, water and air quality, and food insecurity and healthcare access.

The Western U.S. has the highest concentration of healthy counties. California, Montana, and Colorado were among the states that ranked the highest — 60% of counties in the top 10 are located in western states.

We found the unhealthiest counties generally located in the Southern portion of the U.S., where the distribution of healthcare providers is sparse, and health outcomes for adults are worse. Texas counties rank for six out of the 10 bottom spots, followed by Arizona and Louisiana.

Based on our analysis, the healthiest county in America is in the San Francisco Bay Area. Marin County, across the Golden Gate Bridge from San Francisco, ranks as the top county for health based on our metrics. California is comparatively a healthy state in general. As seen in the table below, it’s the only state to have multiple cities (three) appear in our top 10 list.

Many of the top healthiest counties have nature parks, backing up scientific studies that suggest the positive effects green space and exercise opportunities have on our health. The healthiest counties are also full of high-income earners. The median income in Marin County is $136,214, which is well above the U.S. median income of roughly $74,580. Runner-up Gallatin County, Mont., had the lowest median income of the top 10, which was still above average at $83,064. Median incomes in the top-10 healthiest counties are around twice as high as median incomes in the bottom-10 unhealthiest counties.

Harris County, Texas, is ranked as the unhealthiest county in America, likely because it's heavily polluted. Based on our analysis, the county has the most toxic chemical releases and the sixth-worst median air quality of any county in the U.S.

Unlike the healthiest counties, the top 10 unhealthiest counties had several repeated states. As seen in the table below, Texas and Arizona are home to the majority of the unhealthiest areas, with Louisiana being the only other state to make the list.

While all the counties in the top 10 have significantly higher median incomes compared to the national average, nearly all the bottom 10 counties have median incomes that fall below the national level. However, Pinal County, Ariz., is an exception.

Another metric we considered is having low access to grocery stores, which forces residents to rely on fast food and gas stations for food. Residents who live in so-called “food deserts” — a place that requires more than one mile of travel to a large grocery market — are more likely to experience shorter life expectancy.

Apache County, Ariz. (ranked second-to-last) has the worst access to grocery stores of any county we ranked, with 70% of residents having low access. There are only nine grocery stores to serve a population of over 64,000.

Pinal County, Ariz., ranked third unhealthiest, has the worst ratio of primary care physicians to residents, having only one provider for every 6,772 residents. Hidalgo County, Texas, has the highest percentage of residents without health insurance.

Yes, several studies indicate that where you live can have a major impact on your health. The Geospatial Research, Analysis, and Services Program (GRASP) has defined the five environments that affect the quality of health and well-being:

• Natural environment: The natural environment is where we live, including air, land, water, plants, and animals. This can be impacted by contamination, catastrophes, and naturally occurring compounds.

• Built environment: An area’s built environment includes buildings, parks, roads, and transportation systems we use, as well as water distribution systems, electrical grids, and mobile and broadband networks. This environment can impact our access to health care, healthy food, clean water, and safe places for physical exercise.

• Population connectivity: Our connections with people and animals in our communities.

• Social and behavioral environment: This includes cultural traditions such as diet, behavior, and language, which can impact an individual's health and health literacy.

• Health policy environment: State and local governments enact policies that can influence access to health programs and emergency services, regulate natural resources, and more. Social and economic policies also influence housing, safety, employment, public transportation, and education, which can affect human health.

An example of this in action is the difference in life expectancy between residents of Nevada and Utah. Despite being neighboring states with similar climates, income levels, and physicians per capita, a study revealed that mortality rates were “substantially higher” in Nevada, which was attributed to higher cigarette and alcohol consumption and “marital and geographical instability.”