- Health encompasses physical, mental and social factors.
- The United Health Foundation analyzed data in these areas and ranked states based on them.
- Their 2025 annual report lists NH as the healthiest state and Louisiana as the unhealthiest.
Many factors influence our health. What we eat, how active we are, how we manage stressors and our sleep quality and quantity are common lifestyle behaviors experts reference. But did you know that socioeconomic factors, physical environment, clinical care and health outcomes also play roles in how healthy we are?
The United Health Foundation’s 2025 annual report takes all of these areas into consideration when ranking which states are the healthiest and which are the least healthy. Specifically, it analyzes 99 measures of health and well-being drawn from 31 distinct data sources to provide a comprehensive portrait of health at both the national and state levels. The United Health Foundation derives its definition of health from the World Health Organization’s definition, which is not just the absence of disease, but encompasses physical, mental and social well-being.
The Healthiest States
According to this report, New England rocks the health arena, taking the first four spots:
- New Hampshire
- Massachusetts
- Vermont
- Connecticut
- Utah
New Hampshire residents might not be so surprised to see their state at the top of the list—it’s New Hampshire’s fourth consecutive year on top. The state ranked highest in socioeconomic factors, but also scored top spots for healthy behaviors, clinical care and health outcomes. In this study, socioeconomic factors included economic categories like unemployment, homeownership and food insecurity, plus social issues like volunteerism, education and homicide prevalence.
Its lowest ranking was at No. 9 for physical environment. Researchers did note that the state has a few weaknesses—namely a higher prevalence of excessive drinking, low levels of public health funding and higher levels of Black/white residential segregation.
The Least Healthy States
As with any list, there are also those ranking at the bottom:
46. West Virginia
47. Alabama
48. Mississippi
49. Arkansas
50. Louisiana
Though Louisiana ended up at the bottom of the list, the research team notes that the state ranked much higher in clinical care, coming in at No. 38. The state also scored well in reading proficiency among elementary school students and had a high prevalence of cancer screenings and of adults who have a primary care provider. Still, the state’s low rankings—either No. 50 or 49—in categories like socioeconomic status, health outcomes and healthy behaviors resulted in its low rank.
What Else Did This Study Find?
Here are some highlights of the top areas that came into play overall and how much they improved or worsened on a National level.
National Improvements
- Between 2022 and 2023, premature death decreased 8%, and the drug death rate decreased 3%. This is the first national improvement in drug deaths since 2018.
- Cancer screenings increased an average of 15% between 2022 and 2024. Cancer screenings in adults living in rural areas improved 14%; for those living in metropolitan areas, cancer screenings increased 18%.
- Between 2023 and 2024, physical inactivity decreased 10%, now meeting the Healthy People 2030 goal at the healthiest level since America’s Health Rankings began tracking it in 1996. Those living in rural areas have some catching up to do, though, as physical inactivity was 1.2 times higher among adults living in rural areas compared with metropolitan adults.
- Cigarette smoking decreased 4% between 2023 and 2024.
- Between 2021 and 2022, volunteerism increased 22%, which is great, because volunteering has been linked with slowing down cognitive decline.
National Downtrends
- The rate of multiple chronic conditions increased 6% between 2023 and 2024.
- While smoking decreased by 4%, e-cigarette use increased by the same amount, suggesting that people are swapping cigarettes for e-cigarettes.
- Homelessness and the share of individuals who avoided care due to cost increased 16% and 8%, respectively.
How Does This Apply to Real Life?
Regardless of which state you live in and where it ranks, the good news is that you can choose to change your behavior and make healthier choices. And when you influence others in your circle to do the same, it becomes contagious. This is one way to help improve the health of your community.
On a personal level, it’s helpful to get a baseline of your current habits and health status. Where do you feel you rank with diet, physical activity, sleep and stress? Are there improvements you can make in these areas? If so, what are they, and will you commit to making them happen?
What about medical tests and screenings? Here are the recommended screenings based on age, according to the American Cancer Society.
- Cervical cancer screening: starting at age 25
- Breast cancer screening: starting at age 45, with the option to start at 40
- Colorectal cancer screening: starting at age 45
- Prostate cancer screening: Black men should discuss being screened at age 45 with a medical professional, and all men age 50 and over should discuss
- Lung cancer screening: all former and current smokers aged 50+ should discuss with a medical professional
While you may feel it’s a waste of time to see a medical professional once a year for checkups, especially if you feel fine, potential problems can be caught at these appointments. For example, my primary care practitioner discovered a quarter-sized nodule on my thyroid when I was 37 (and otherwise healthy). It ended up being precancerous, and I had my thyroid removed.
Being consistent with wellness checkups will also help you establish a trusting relationship with your provider and give you someone as a home base who can refer you to specialists if needed. Based on this report, individuals are increasingly avoiding seeking medical care due to cost. It also reports that the number of uninsured people increased by 4% between 2023 and 2024. Medical costs can be intimidating when you’re without insurance, but sometimes there are strategies available to avoid high costs. Reach out to the financial aid office at the clinic or medical center. Some clinics offer a sliding fee scale based on your income, and many medical centers offer financial aid and payment plans. In fact, when I went through my thyroid situation, we had no insurance at the time. We applied for financial aid through the medical center, which covered most of the expenses.
Our Expert Take
This report suggests that some states rank higher than others in areas of individual and public health. While some things are out of our control, many factors regarding our health depend on our personal decisions. And whether you enlist friends and family members to join you on walks, hikes or bike rides, or get involved at your state policy level, there are many ways you can influence the health of others. And who knows? Maybe next year your state will rank higher, and you will have played a role in that.
