Do you live in one of America’s healthiest communities?

What makes a healthy community? Sure, factors such as disease rates, smoking rates, and eating habits matter, but experts know that an accurate picture of population health accounts for much more.

Healthy communities produce great health outcomes—but they also offer the resources and opportunities that support good health, such as economic and social equity, high quality education, a clean environment, access to quality food and housing, strong infrastructure, community vitality, and the assurance of safety. US News and World Report factored all of these social determinants of health into its newly released list of Top 500 Healthiest Communities Nationwide. 

To build its population health overview, US News drew from CDC data on health outcomes, incidence of physical and mental health conditions, adult lifestyle behavior, access to healthcare, and more. Its model combined these scores with similarly designed scores for other determinants of health, such as housing, access to healthy food, infrastructure, and economy, to create a holistic ranking.

The list is a thought-provoking picture of population health trends in the United States. In the West, many counties offer new infrastructure and great access to open space—more than 60% of the counties in the top 50 are west of the Mississippi River. For example, among the 500 healthiest communities, 14 of North Dakota’s 53 counties made the list, while only three of North Carolina’s 100 counties are represented. Some suburban pockets of the midwest and mid-Atlantic, however, offer job opportunities and access to world-class care that vault them toward the top of the list. 

Read on to find out which communities are the healthiest in the United States—from least to most healthy. 

Sublette County and Teton County, Wyoming

More than half of Wyoming’s 23 counties ranked in the top 500, with Sublette and Teton County at 12th and 13th, respectively. These bordering communities have a combined land area larger than New Jersey, but fewer than 35,000 residents between them.

The more populous Teton County had a higher population health score, driven by life expectancy (nearly 90 years) and some of the best mental health outcomes in the rankings. It has a low reported depression rate and nearly half the national rate of combined suicide, alcohol, and drug deaths. 

Sublette County, on the other hand, had a more modest population health score than its neighbor. It has more smokers per capita, a less-active population, and a lower but still life expectancy. But obesity and diabetes prevalence are also significantly lower than national averages, and the rural county offers great access to local health food, earning a Food Environment Index Score nearly three times that of the median county.  

What did both counties have in common for these rankings? Some of the best environmental conditions and access to open space in the country.

Howard County, Maryland

Maryland’s lone entry into the top 50 is Howard County, a densely populated community of more than 300,000 tucked between Baltimore and Washington, DC. It was ranked eighth on the list for high overall population health, education, economic, and infrastructure scores. 

Nearly 96% of residents in Howard County have health insurance, and Howard County has more primary care doctors per thousand residents (1.3) than the average county (0.9).  And despite living in the heart of the I-95 corridor, only 9.5% of adults report frequent mental distress—compared with a national average over 15%—and heart disease prevalence is 2 percentage points lower than the national rate.

Living in a dense area can have some infrastructure advantages. High-speed internet, for example, is considered essential for receiving necessary health information and taking advantage of telehealth. Nearly 98% of people in Howard County have access to it. Maryland and the DC Metro Area also offer top-of-the-line medical institutions.

Falls Church, Loudoun County, and Fairfax County, Virginia

This contiguous region of the Washington, DC, suburbs is one of the country’s healthiest areas. Falls Church, an unincorporated town, landed third on the list, while nearby Loudoun County placed fourth. Fairfax County, which separates the two, is hardly a weak link at 14th on the list—and ranks second by population health score.

These three communities are home to about 1.6 million people, making them among the most densely populated and economically diverse healthy communities. Each one features uninsured rates below the 10.6% national average. 

Social determinants like education factored into their high rankings as well. Educational attainment correlates closely with how long people live. In Loudoun and Fairfax, at least 67% of the population holds at least an associate’s degree—more than double the median rate for US counties—and in Falls Church, that number rises to more than 80%. Strong economic opportunities contribute to high employment and health insurance rates that also help make these some of the healthiest to live in, and people typically do for a long time: The median life expectancy in all three counties is over 81 years.

Douglas County, Colorado (and many other Colorado counties)

Colorado produced five of the top 10 healthiest counties on the list, with Douglas County sitting highest at third. It’s a large county south of the Denver metropolitan area, with a suburban northern corridor and a rural southwest dominated by Roxborough State Park and the San Isabel National Forest. 

Douglas County residents can use all of that beautiful protected outdoor space for activities such as hiking, fishing, and kayaking, which contribute to the community’s high health ranking. On average, 26.5% of US adults report that they don’t engage in any leisure-time physical activity. In Douglas County, the number is only 10%. Of course, certain outdoor sports can be expensive. The average household income in Douglas County is about $120,000, more than twice the national average—which also makes it easier for residents to afford high-quality care. 

Combining an energized, high-income adult population with plenty of outdoor green space and proximity to Denver’s booming economy, Douglas County has a great recipe for population health, and that’s reflected in health outcomes. While more than 17% of the US adult population is considered to be in poor or fair health, that’s true for only 8.1% of Douglas County adults.

Broomfield County, a tiny slice of Denver’s northern suburbs, ranked fifth, while scattered across different parts of the state’s rural western half were Routt (tenth), Pitkin (seventh), and San Miguel (sixth) counties. Despite being spread around the state, these five Colorado counties all shared key health advantages that put them in the top 10, like their obesity rates—which are at least 10 percentage points lower than the national average across the board.

Los Alamos County, New Mexico

For history buffs, Los Alamos County may ring a bell—it was the clandestine location where the first atomic bomb was built during WW2.  

The small county of nearly 20,000 is tucked between the larger Sandoval and Santa Fe counties, the latter home of the state capitol. Mostly suburban, highly educated, and high-earning, Los Alamos checks all of the boxes for a healthy community, and this was its second year atop the list. Its smoking rate is less than half of the national average at just 9.6%, and 97.5% of county residents have health insurance. 

The size, wealth, and education of the community all contribute to great access to care, and residents have rates of depression and heart disease below national averages. It helps that Los Alamos is the wealthiest county in the state, which increases the population’s access to care—and attracts caregivers. Los Alamos County has twice as many primary care doctors as the median US county.

But despite the West’s overall high representation in the US News rankings, with states like Wyoming, Utah, Colorado, and Iowa all receiving multiple nods in the top 50, Los Alamos was the exception in its state: No other New Mexico county made the list.