UNHEALTHY LIFESTYLES

Health behaviors also contribute quite strongly to the development of chronic diseases.

People living in many areas in the South are twice as likely to be smokers and be sedentary than people living in Utah. Every Southern state except Florida has an adult obesity rate higher than 30 percent. This lack of fitness has led to the highest rates of injury in Army basic training across the region.

Poor lifestyle behaviors don’t explain everything, though. For example, West Virginia and Kentucky have very high rates of drug overdose deaths related to the opioid epidemic. However, rates in many Southern states — including Mississippi, Georgia and Arkansas — are lower than the rest of the country.

What is causing these poor health outcomes? As a public health researcher, I look to the physical and social conditions in which people live, including education levels, access to health care, air and water quality, housing, culture and many other factors. These can be the root causes of health and illness.

All of these states are relatively poor, with Kentucky, Alabama, West Virginia, Arkansas and Mississippi having the lowest household median incomes in the county. However, this doesn’t tell the whole story. Idaho, for example, is ranked 40th in household income and 14th in health.

Education is often viewed as an important indicator of health — but Alabama, Kentucky, Tennessee and Missouri are all in the Top 10 for high school graduation rates.

Air pollution — which is linked to heart attacks, bronchitis and asthma — falls somewhere in the middle for most Southern states. Violent crime tends to be higher, with the exception of Mississippi.

Of the 26 states that have comprehensive statewide indoor air smoking bans, none are in the South.

According to Walkscore, a site that calculates the walkability of cities, nine of the least walkable cities in the U.S. are in the South. Only one, Miami, is in the Top 10.