The latest medical rankings suggest that counties in northern Minnesota are the unhealthiest in the state, while southern counties are the healthiest.
The sixth annual County Health Rankings from the Robert Wood Johnson Foundation and the University of Wisconsin paints a grim picture for the north of the state – where four out of the five lowest ranking counties for health outcomes can be found.
These rankings are judged based on life expectancy and how healthy people feel while they're alive. Here's a look at the map. The darker the color, the less healthy the county is.
The unhealthiest counties are:
Four out of five of the healthiest counties are in the south of the state, the exception being Wilkin County on the western border with North Dakota.
The healthiest counties are:
What's causing health issues in the northland?
The Duluth News Tribune reports adult obesity, high child poverty rates and physical inactivity are some of the contributing factors affecting low ranked counties in northern parts of Minnesota.
Another factor could be the larger American Indian populations.
More than two-fifths of the population in Mahnomen County is American Indian, while in Cass it is 11.9 percent and in Beltrami 20.8 percent, according to the County Health Rankings figures.
The Star Tribune reported on the health disparities that exist between the American Indian population and the state's white population, with a report by the Shakopee Mdwakanton Sioux Community finding that American Indians are twice as likely to become obese, and twice as likely to have Type II diabetes.
The Duluth News Tribune says the low ranking for many counties should be no surprise, given they have performed poorly in all six years of the report.
Mahnomen also ranked lowest for "health factors," – an estimate of the future health of counties based on health behaviors, clinical care, social and economic, and physical environment factors. Clearwater, Beltrami, Cass and Mille Lacs round out the bottom five.
Minnesotans much healthier than average Americans
While there are unhealthy pockets in the state, Minnesota as a whole is far healthier than the national average.
The study found that Minnesota has fewer premature deaths, fewer adults reporting poor physical or mental health, and fewer babies born underweight.
The state also has a lower rate of smoking (16 percent) compared to the national average (21 percent), while the state's great outdoors provides more access to physical activity.
One problem area for the state is alcohol, with 19 percent of adults admitting to binge or heavy drinking, compared to 16 percent nationally.