America’s Unhealthiest Counties

America’s Unhealthiest Counties

Where you live has a significant impact on how you live. But have you ever wondered just how much your county’s health metrics stack up against others?

Understanding your local community’s health factors can be both enlightening and alarming. Using a distinctive meta-rank system, we analyzed various health indicators in 99 of America’s major counties to determine which are the most unhealthy. Through this exploration, we aim to offer a deeper understanding of the health differences existing across various communities.

Key takeaways

  • Hidalgo County and El Paso County in Texas are the unhealthiest counties among those we analyzed.
  • Hidalgo County, TX, had the highest percentage of adults with obesity (43%). San Francisco County, CA, and New York County, NY, had the lowest (19%).
  • New York County residents searched for “gym near me” the most in 2023, with 10,149 searches per capita.

How major U.S. counties measure up in health

For this study, we used, Yelp, and Google Trends to collect and analyze data related to the following factors:

  • Poor health
  • Obesity
  • Physical inactivity
  • Smoking cigarettes
  • Heavy alcohol use
  • Accessibility of nutritious vs. fast food
  • Searches for local fitness centers

Explore the interactive table below to see how 99 of the most populated counties across the U.S. ranked in terms of health based on several variables. The lower rank numbers indicate unhealthier conditions, with one being the “worst,” while higher rank numbers mean a “healthier” score.


Hidalgo County, TX, is the unhealthiest county among those we analyzed, scoring 90.69 out of 100. Its population had the highest occurrence of obesity and ranked the second-worst for physical inactivity. Hidalgo also came in second for unhealthy food — a ranking for which we considered both the accessibility of healthy food and the number of fast food restaurants on Yelp per capita.

Some of America’s top obesity rates are in Texas, echoed by our finding that El Paso County, TX, ranked No. 2 on our list of unhealthiest counties overall. El Paso residents also reported a higher prevalence of inactivity than most counties we studied, indicating a significant number of adults not participating in physical activity outside of work.

Bronx County, New York, took third place for unhealthiness, ranking poorly for inactivity, poor health, and unhealthy food. Nutrition education and easy access to healthy food options is critical for good health, especially in counties with a high prevalence of unhealthy food scores. Collaborations between local farms and communities, along with urban gardens, could help improve the food environment.

We also saw a seasonal rhythm to fitness pursuits nationwide: as summer peaked, so did the desire to hit the gym. According to Google Trends data, online searches for “gym near me” soared in July and August, when many don their swimsuits and hit the beach. Search volumes then dipped in October, November, and December, when the busy, stressful holidays can challenge fitness goals. Finally, these searches surged again in January — just in time for New Year’s resolutions.

Among all the counties we studied, Kern County, CA, had the lowest search volume for “gym near me” per capita, pointing to a disparity in health-seeking behaviors. Local and economic factors may impact these residents’ fitness interests. For instance, half of Kern County residents can’t afford basic living expenses, placing gym membership fees out of reach. 

What specific factors might affect other counties’ rankings? Let’s dig deeper to find out.

The healthiest and unhealthiest counties in each category

For a closer look at the most and least healthy counties, we broke down the top and bottom three by each health and lifestyle metric. 

healthiness by US country infographic

Comparing counties across various health-related factors revealed some significant disparities. Hidalgo County, TX, stood out with the highest percentage of adults self-reporting obesity (43%), while both San Francisco County, CA, and New York County, NY, were on the more favorable end of the spectrum with the lowest percentages (19% for each). Over 1 in 4 Hidalgo residents also reported that their health was fair to poor.

New York County residents also displayed the most interest in using gyms in 2023, with a remarkable “gym near me” search volume of 10,149 per capita. In contrast, Kern County, CA, showed the least interest, with its residents’ per-capita search volume considerably lower at just 1,605. It’s essential for communities to foster environments that encourage walking, cycling, and other forms of exercise. Places struggling with health issues are where infrastructure for cycling, such as safe bike lanes and community biking events, can make a significant difference.

Wayne County, MI, had the highest percentage of adults who smoke cigarettes at 22%. Michigan is one of 12 states dubbed members of “Tobacco Nation,” where smoking is 50% more prevalent than the rest of the country. On a healthier note, Montgomery County, MD, had the lowest smoking rate at 8%. Our county data source also ranked it as one of the healthiest counties in Maryland.

Health dynamics across the U.S.

In different parts of the U.S., we saw trends suggesting that where and how you live may connect to your health. Our findings emphasize the urgency for localized health solutions, whether it’s socioeconomic factors or other variables at play. Organizations can help Americans pursue better health by creating more accessible health and fitness opportunities, such as public urban gardens, wellness programs, and bike lanes. No matter where you live, there are lots of ways to foster a culture of wellness and stay healthy in a way that works for you.


We collected health data on 99 of the most populous U.S. counties from to explore which are the most unhealthy. We also used data from the Yelp Fusion API. If there was no data available for the county, the API used the next closest option. Variables in the overall meta-rank are:

  • Percentage of adults in poor or fair health (20%)
  • Percentage of adults with obesity (BMI ≥ 30) (20%)
  • Percentage of adults doing no physical activity in their free time (10%)
  • Smoking/drinking score (20%)
    • Percentage of adults who smoke cigarettes 
    • Percentage of adults who report heavy alcohol use
  • Unhealthy food score (20%)
    • Food environment index (access to healthy food; 0 is worst, 10 is best.)
    • Number of fast food restaurants on Yelp per 100,000 residents
  • 2023 Google Trends search volume data for “gym near me” per 100,000 residents (10%)

County populations were obtained from the U.S. Census Bureau’s County Population Totals and Components of Change.

About Velotric

At Velotric, we believe in the power of cycling to contribute to a healthier lifestyle. Our e-bikes offer an accessible and enjoyable way to incorporate more physical activity into daily life.

Fair use statement

For those eager to share these insights, you’re welcome to do so for non-commercial purposes. However, always ensure to provide a link back to this page for proper attribution.

Leave a comment

Please note, comments must be approved before they are published

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.