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
A report card for the country has a familiar winner, and underlines some enduring divides.
America’s public health report card is in, and New Hampshire has retained its crown as the country’s healthiest state.
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:
- New Hampshire
- Massachusetts
- Vermont
- Connecticut
- Utah
Least Healthy States:
- Louisiana
- Askansas
- Mississippi
- Alabama
- 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.