America’s healthiest state has clean air and water, good education, and safe cities—And says a lot about the country’s rural-urban divide

Homicides and deaths from drugs and firearms declined nationally in 2025, two of the key findings in a state-by-state summary of public health outcomes published Thursday by the United Health Foundation, the non-profit philanthropic arm of medical insurance giant UnitedHealth Group. 

New Hampshire emerged as the undisputed heavyweight in state-level health and wellness for the fourth consecutive year. Factors that contributed to New Hampshire’s appeal include low non-medical drug use, high secondary school completion rates, and a nearly 10% drop in homelessness. Granite Staters are also more likely to live close together, with nearly two-thirds of the population clustered in three metropolitan counties that include mid-sized cities such as Manchester and Dover.

While New Hampshirites gave in to some vices, such as heavy drinking, they were also less likely to engage in other unhealthy habits, such as smoking or staying physically inactive. The state also ranked highly in air and water quality, reading proficiency, and community safety.

The results nationally, however, are middling. While the U.S. as a whole has taken important steps in reducing premature deaths and addressing mental health issues, progress is uneven, and highlights some of the country’s most persistent divides.

Most Healthy States:

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

Least Healthy States:

1. Louisiana
2. Askansas
3. Mississippi
4. Alabama
5. West Virginia

The report lays out how each state performed on several public health metrics and ranks them in order of medical, behavioral, and social outcomes. Findings were based on 99 measures of health and well-being collected from 31 data sources. 

The result is a snapshot of where America is at its most and least healthy. And while many familiar names in wealthier metropolitan states fare well, the health picture is a reminder that the rural-urban split remains one of America’s most enduring partitions.

“We see progress across the nation, including improvements in mortality, stabilizing trends in measures of behavioral health and progress in several measures of clinical care,” Dr. Margaret-Mary Wilson, UnitedHealth Group’s chief medical officer, said in a statement. 

She also acknowledged where the country faces areas for improvement: “The data also show the distinct challenges faced by different communities, including rural America,” she said. 

Rural areas lagged metropolitan ones in several metrics. While physical inactivity fell across the board, rural residents were 1.2 times more likely to be inactive than their urban counterparts. And while cancer screening rates ticked upwards 14% in rural zones, in metropolitan areas they improved 18%. Unhealthy habits also tend to persist more outside of cities. Rural residents are 1.5 times more likely to smoke, for example.

The findings reinforce the dynamics underlying America’s long-standing rural-urban divide, which has come to intersect with health, education, economic growth, and politics. Rural residents are less likely to receive a bachelor’s degree and are more likely to die from a drug-related overdose. Depending on gender, 60-year-old rural residents can expect to live 6 months to 2 years less than city-dwellers, one 2025 study found. And recent elections have, in no small part, been swung by rural voters, highlighting the difference in needs and priorities based on where you live.

United Health’s findings fell along some familiar lines. Of the top five healthiest states, four were in the wealthy, metropolitan Northeast. Out of the top 10, only one was in the Midwest, and none were in the South. Meanwhile, the 10 least healthy states were almost entirely located in the South or the Southwest.

While some public health provisions, such as mental health services, became more widespread nationwide, the report highlighted some familiar pain points that affect all Americans. Notably, the high cost of healthcare remains a barrier for many, as the number of adults who forgo medical visits due to cost concerns rose by 8%. High healthcare costs might be a great unifier, as most Americans deem skyrocketing prices as the most urgent national health problem, regardless of where they live.