The annual list providing a county-by-county breakdown of American health has been released – and it's not good reading for northeast Minnesota.
The County Health Rankings and Roadmaps claim that the Northland is home to several of the most unhealthy counties in Minnesota – with St. Louis County, home of Duluth, 80th out of 87.
Other northeast counties ranking low include Cook (79th), Lake (70th), Itasca (83rd) and Carlton (72nd).
Mahnomen County in northeast Minnesota, which covers a large area of the White Earth Reservation, is the unhealthiest in the state, according to the study.
It is regularly found to be one of the lowest ranking counties for health, which speaks volumes for the health problems facing Minnesota's Native American population, which has a particularly high rate of diabetes.
According to the rankings, Mahnomen County has a premature death rate (ie. death before 75) more than twice that of the Minnesota average, while a third of residents are obese, a quarter smoke and just over a fifth are considered in poor or fair health.
By contrast, Carver County, covering a large area of the southwest Twin Cities metro, is the healthiest county in the state.
The study notes it has wide access to physical exercise, low STIs and teen pregnancies, and below average smoking and obesity levels (though obesity is still 23 percent).
In the Twin Cities, Hennepin County is 38th, while Ramsey County is 64th.
The top 5 healthiest counties
3. Red Lake
The top 5 unhealthiest counties