The Regional Geography of Unhealthy Living Characteristics

Researchers from Nationhood Lab, the University of Illinois-Chicago, and the University of Minnesota found stark differences in obesity, diabetes, and exercise across the American Nations in a new paper in Progress in Cardiovascular Diseases.

Credit: John Liberty/Motivf for Nationhood Lab

By Colin Woodard

Researchers have found substantial regional differences in four key indices of healthy behavior and health outcomes, with the Deep South and Greater Appalachia performing markedly worse across the board.

The new findings, published in the academic journal Progress in Cardiovascular Diseases, used my American Nations model and county-level data for 2020-2022 to examine rates of obesity and diabetes and also the self-reported prevalence of exercise and the availability of exercise opportunities. A lack of exercise is one of the key factors leading to obesity, diabetes, and ultimately heart disease.

The data revealed substantial differences in health across U.S. regional cultures and they fall into the same geographic patterns we saw with Covid-19 vaccinations and deaths, deadly gun violence, and Nationhood Lab’s forthcoming work on life expectancy.

The researchers – health scientists Ross Arena and Deepika Laddu of the University of Illinois – Chicago, the University of Minnesota’s Nicolaas Pronk, and myself (director of Salve Regina University’s Nationhood Lab) – found 27% of Deep Southerners and a quarter of Greater Appalachian residents reported a lack of physical activity, about a third more than among Left Coasters (18%) and a quarter greater than reported by residents of Yankeedom, the Far West, and Tidewater (all 21%). (The data is depicted in the map above.) Four smaller enclaves of regional cultures that largely lie outside the U.S. occupied the extremes, with First Nation (in northern and western Alaska) the worst at 30% inactive and New France (in southern Louisiana) just behind at 29%.

The same pattern was seen in the prevalence of Obesity, with New Netherlands (Greater New York City) and Left Coast seeing the lowest rates of the large regions (at 25 and 27% of residents respectively) and Greater Appalachia and the Deep South with the worst (at 36% for both.) First Nation and New France were the worst overall at 38 and 37% and Hawaii (Greater Polynesia) was the least obese at 24% of residents.

Credit: John Liberty/Motivf for Nationhood Lab

Diabetes rates followed in kind.  Deep South, Greater Appalachia and El Norte were the worse large regions, with 12, 11 and 11 percent of residents diagnosed with the disease, while the rates in Left Coast, Yankeedom, and New Netherland were just 9%. Among the “enclaves,” First Nation (13%), New France (12%), and Spanish Caribbean (11%) faring worse than the rest of the country, and Hawaii (Greater Polynesia) tying for healthiest at 9%. All of the underlying data came from the U.S. Centers for Disease Control as reported to the University of Wisconsin’s County Health Rankings and Roadmaps program (CHRR.)

Credit: John Liberty/Motivf for Nationhood Lab

 “Whenever I looked at state- and county-level data it was clear that southern states have higher prevalence of physical inactivity, obesity and diabetes, but the American Nations piece made it a lot clearer from a regional cultural level,” Arena, a physiologist who studies the effects of exercise, told me. “The difference between 18 percent of people being inactive and 27 percent makes a really big difference, and on a population level small improvements in those numbers can equate to big changes in health outcomes.”

Our team also parsed county-level data on access to adequate exercise opportunities as tabulated by the CHRR and defined as living in a census block less than half a mile from a park and either one or three miles from a recreational facility, depending on whether the area is urban or rural. The same patterns held, with more than 90 percent of residents of New Netherland, the Left Coast, and El Norte living near such exercise resources compared to only 75% in Greater Appalachia and the Deep South and just 46% in First Nation.

The study is available online and is currently in press at Progress in Cardiovascular Diseases, a bimonthly peer-reviewed medical journal established in 1958 and published by academic behemoth Elsevier. It had an impact score of 8.0 in 2022

The American Nations model, lead author Arena wrote in the published study, could start “helping us understand how stakeholders should uniquely craft the [healthy lifestyle] message in the context of the regional cultural differences.”

“There is enormous room for improvement in all the American Nations,” he added.

Thanks to Nationhood Lab’s partners at Motivf, where John Liberty produced the maps you see here..

— Colin Woodard is director of Nationhood Lab at Salve Regina University’s Pell Center for International Relations and Public Policy.