S TAT E O F

AMERICAN WELL-BEING
2013 STATE, COMMUNITY, AND CONGRESSIONAL DISTRICT ANALYSIS

WA MT
OR NV ID
WY

ME

ND SD NE

MN
WI
MI PA NY
OH WV KY TN AR MS LA AL

VTNH
NJ

CT RI

MA

IA
IL
IN

UT CA AZ

MD DE
VA
NC SC

CO
NM

KS
OK

MO

GA

TX FL

AK

HI

A Note of Thanks to Our Team: Sangeeta Agrawal Carl Black Patrick Bogart Chris Cigarran Sandy Cummings Kurt Deneen Daryle Dowell Chuck Eberl Susan Frankle Christopher Gregory Molly Hardin Jim Harter Lauren Kannry Ann Kent Ben Klima Diana Liu Marc Malloy Ryan McWaters Bruce Middlebrooks Ed Muller Jim Pope Bob Porter Joy Powell Tom Rath Deacon Rohrer Judy Schultz Lindsey Sharpe Vicki Shepard Melanie Standish Doug Stover John Turner Dan Witters

Cover image: Map of the United States showing each states relative well-being rank, colored by quintile. Each states outer ring (if any) represents the highest rank the state has ever achieved in the six-year history of the Gallup-Healthways Well-Being Index. A states inner ring (if any) represents its lowest rank.

For press inquiries, please contact: Healthways Bruce Middlebrooks bruce.middlebrooks@healthways.com 615-614-4463 Gallup Leticia McCadden Leticia_McCadden@gallup.com 202-715-3156

Copyrights 2014 Gallup, Inc. and Healthways, Inc. All rights reserved. Gallup-Healthways Well-Being Index is a registered trademark of Gallup, Inc. All rights reserved. www.well-beingindex.com

LETTER FROM THE CEOs

Leaders, Many of you are looking at incomplete metrics, and youre missing out on a huge opportunityone that will improve your populations health, increase productivity, better the community, and lower costs. Were proposing that you measure well-being. Simply put, well-being is a metric that you can no longer aord to ignore in your population. Its predictive, its actionable, and it correlates with the metrics that matter most to your businessproductivity, performance, and cost. For an individual, high well-being means a life well-livedall the things that are important to each of us, what we think about, and how we experience our lives. In the aggregate, high well-being means healthier populations, more productive and protable businesses, and more economically vibrant communities. It means that wherever you may leada business, a healthcare organization, a community, a state, or a nationhaving this metric on your dashboard will give you the information you need to make the right decisions with condence. Well-being is your business. Chronic disease and obesity are on the rise, healthcare costs continue to be the No. 1 expense item for many businesses, and workers tell us that relationships in the workplace have declined signicantly over the past six years. Its time for leaders at all levels in all sectors to take notice. It is our responsibility to create a new normalone with well-being at its core. Measuring well-being provides the dual benets of educating individuals on what well-being is and giving leaders insights into what interventions to take at the population level. These micro- and macro-level actions result in more sustainable lifestyles, stronger communities, and signicant cost savings. Where a culture of well-being takes hold, positive health, cost, and productivity outcomes follow. Well-being is our business. For more than 50 years, Gallup and Healthways, in partnership with leading economists, psychologists, and other scientists have been exploring the dimensions of a life well-lived. We understand what dierentiates a thriving life from one spent sueringand the impact of well-being on measurable business value. Whats more, Gallup and Healthways have pioneered and are continuously enhancing the science of wellbeing and its measurement. We are delivering solutions that create systematic and measurable wellbeing improvement. Through our research, weve built the worlds largest dataset on well-being, including more than two million conversations with Americans about their perceptions of their well-being. At Gallup and Healthways, we can see the world we live in very clearly. Our data allow us to do that. We can help you see your population more clearly too. Because whether youre an individual who wants to live better, an employer who understands well-beings relationship to performance, a healthcare organization focused on improving health outcomes, or a government that wants to improve the economic health of your communityunderstanding the right metrics is the rst and most important step. Ben R. Leedle, Jr., CEO & President, Healthways Jim Clifton, Chairman & CEO, Gallup

iii

well-beingindex.com

FOREWORD

Most people dont understand the breadth, depth, and importance of well-being. As I wrote in Wellbeing: The Five Essential Elements, its far more than health and wealthits the combination of many aspects of life. Well-being is about the interaction between physical health, nding your daily work and experiences fullling, having strong social relationships and access to the resources you need, feeling nancially secure, and being a part of a true community. Well-being is dependent on all of these factors, which makes it complex to measurebut worth the eort, because when people thrive, populations become healthier and less costly, businesses become more productive, and people live more fullling lives. The State of American Well-Being report should serve as a conversation starter and call for action in government oces, businesses, and communities throughout our nation. The report provides unmatched information that allows leaders to understand how their communities stack up and where they can improve. And it brings America into focus with the most comprehensive picture of well-being available. Were all in this togetherhigher well-being improves outcomes for each of us and for any type or size of populationso we all need to make it a priority. If we start by taking note of the current state of our nations well-being and that of our communities, we will know where we stand so we can actively make the necessary changes that will lead to higher well-being, more sustainable lifestyles, and a healthier world for ourselves and those we care about. Tom Rath, New York Times Best-Selling Author

iv

TABLE OF CONTENTS

Letter From the CEOs Foreword Introduction National Results and Top 10 Well-Being Summaries State Rankings Client Perspectives Insights on Americans and Their Well-Being Market Recommendations Community Rankings Congressional District Rankings About the State, Community, and Congressional District Reports

iii iv 1 2 6 12 14 18 20 28 37

INTRODUCTION
Understanding how people think about and experience their lives is essential to designing the interventions that organizations and communities need to solve their biggest challenges. Healthcare costs, health-related behaviors, organizational performance, job creation, and many other important societal challenges require a holistic approach. Simply delivering wellness programs with a singular focus on physical health is not likely to optimize change if we dont consider other aspects of life that either reinforce or work against our best intentions. Measures such as unemployment, GDP, and health statistics are essential, but less than adequate in optimizing change. They reect the past. People make decisions based on what they directly experience. Leaders need to know what their constituents are experiencing today so that they have a better understanding of how todays decisions will impact the future. Well-being encompasses how we think about and experience our lives. The Gallup-Healthways WellBeing Index provides an in-depth, real-time view of Americans perceptions of their well-being. This information gives employers, health plans, health systems, governments, and communities unmatched insight into the state of their populations. The Gallup and Healthways partnership combines decades of clinical and behavioral economics research, and intervention and health leadership expertise to deliver a preeminent source of well-being data in the U.S. and globally. We now have the largest accumulation of well-being data in the world. Our measurement enables public- and private-sector leaders to know where they stand and how to respond to a variety of well-being factors including basic access to necessities, daily health and work-related experiences, and community and social involvement. This robust measurement gives leaders the opportunity to develop and prioritize informed strategies to help their organizations and communities thrive and grow. So why is achieving high levels of well-being a strategic imperative for many organizations? Simply stated, people with higher well-being cost less and perform better. By improving well-being, we can unlock this economic value for organizations and communities. Our research shows a strong link between well-being, healthcare costs, and engagement in the workplace. Each point in wellbeing improvement equates to a decrease in the likelihood of hospital admissions, emergency room visits, and in the likelihood of incurring healthcare costs. Higher well-being is also predictive of key productivity metrics including improved manager- and self-assessed job performance, higher retention, and fewer unplanned absences. After six years and 2 million surveys, Gallup and Healthways continue to advance the science of well-being in areas such as an individuals sense of purpose, social relationships, nancial security, connection to community, and physical healthelements that can be measured and acted upon for each individual. Our scientic measurement helps organizations establish a baseline, benchmark their population, determine gaps, prioritize and implement interventions, and ultimately understand the impact of their investments. Measurement is a foundational step in the process of systematic and meaningful improvement of well-being. For communities and countries, increasing citizens well-being yields a competitive advantage for economic development and job creation, and it lowers disease burden and healthcare costs. For employers, it means greater productivity and lower costs in the workforce, and better business performance. For health plans and health systems, it means improved clinical outcomes and lower costs. And for each of us individually, higher well-being means living a better life. James E. Pope, MD, FACC, Senior Vice President & Chief Science Ocer, Healthways Jim Harter, PhD, Chief Scientist, Workplace Management and Well-Being, Gallup

well-beingindex.com

NATIONAL RESULTS & TOP 10 WELL-BEING SUMMARIES

The Gallup-Healthways Well-Being Index is a barometer of Americans perceptions of their well-being. The national, annual well-being score is unique because while it is aected to some extent by national events, such as economic uctuations or natural occurrences, it also accurately captures a more nuanced picture of the state of our nation across the factors impacting our daily lives. Six domains of well-being comprise the national WellBeing Index, including life evaluation, emotional health, work environment, physical health, healthy behaviors, and basic access. Combined, these domains create a composite score, which has been relatively stable since 2008, but not without upward and downward movement during this time. In 2013, the national score fell to 66.2 from 66.7 in 2012, a statistically signicant decrease that matches the previous low measured in 2011. Contributing to this year-over-year decrease are 2012 to 2013 declines in life evaluation, physical health, and healthy behaviors. Work environment, emotional health, and basic access were unchanged from 2012. Over the six years of our well-being measurement, Americans life evaluations have improved, emotional health and healthy behaviors have remained stable, and basic access, physical health, and work environment have declined. While there are dozens of trends that have impacted the national score since 2008, the three most prominent ones are: Annual decreases in the rate of those with health insurance. The Aordable Care Act has put the national spotlight on health insurance, a part of our basic access measure. The average rate of those with health insurance has been decreasing steadily since 2008 explained in part by increasing rates of unemployment (but persevering even as the labor market has slowly recovered since 2010). Correspondingly, personal doctor usage has also decreased over time. Rising rates of obesity. In 2013, physical health reached its lowest point in the past six years, in large part due to rising rates of obesity, based on self-reported height and weight. The rise in obesity, which had eased somewhat, resumed at alarming rates in 2013. Relatedly, we are also seeing national decreases in rates of healthy eating and exercise. Declining work environment scores. Work environment hit an all-time monthly low in 2009 and has never fully recovered to pre-recession levels. The questions that comprise this measure are designed to gauge atmosphere and relationships in the workplace and are asked of employed individuals. Working Americans are making it clear that a weak labor market has had an adverse impact on managerial and labor relationships. Finally, we note a few interesting trends related to occupations and well-being. Professionals, managers, and business owners have the highest well-being, while transportation, manufacturing and installation, and repair workers consistently have the lowest. Well-being is more important than ever to our nation, be it for the sake of rising healthcare costs, the health and vitality of our citizens, or the productivity and performance of our workers. Our measurement conrms some languishing national trends but also provides a roadmap to improve well-being, which can be accomplished through a determined, shared commitment by policy-makers, business leaders, and individuals.

NATIONAL RESULTS & TOP 10 WELL-BEING SUMMARIES

NATIONAL WELL-BEING SCORE, 20082013
67.5
66.8 66.5

66.7

66.5
66.3 66.2 66.2

65.5
n=355,334

2008 44.5 79.1 51.4 76.9 63.7 83.6

n=353,849

2009 48.1 78.7 49.1 76.6 63.1 82.2

n=352,840

2010 49.8 79.3 48.2 76.9 64.1 82.3

n=353,492

2011 48.8 79.0 47.2 76.7 63.4 81.9

n=353,564

2012 49.5 79.4 47.8 77.0 64.5 82.3

n=178,072

2013 48.2 79.2 48.0 76.4 63.7 81.9

LIFE EVALUATION EMOTIONAL HEALTH WORK ENVIRONMENT PHYSICAL HEALTH HEALTHY BEHAVIOR BASIC ACCESS

AVERAGE WELL-BEING SCORE BY OCCUPATION, 20082013

76.0
73.3
Professional Business Owner

72.3 71.9

Manager, Executive, or Official Other

69.0 68.5

Sales

66.0

Farming, Fishing, or Forestry

68.1
Clerical or Office

67.3 65.7

Construction or Mining

65.3 64.9

Service Transportation

Installation or Repair

63.6

63.5

Manufacturing or Production

56.0 3

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NATIONAL RESULTS AND TOP 10 WELL-BEING SUMMARIES

On the next few pages, we showcase the top 10 well-being states, the top 10 large, mid-size, and small communities, and the top 10 congressional districts. Within these locations, residents report that they are experiencing high well-being, making their lives healthier and more satisfying. These high well-being locations tend to exhibit many shared characteristics, including lower chronic disease rates, lower incidence of obesity, more frequent exercise, less smoking, and a more positive outlook on their communities. These commonalities demonstrate a foundation upon which the top well-being locations can maintain their status as models of well-being in America. The residents in these locations should be celebrated for their success in achieving high well-being, and these communities can serve as examples for others looking to foster well-being in their own communities, states, or nations.

TOP STATES
1. 2. 3. 4. 5. 6. 7. 8. 9. North Dakota South Dakota Nebraska Minnesota Montana Vermont Colorado Hawaii Washington

TOP LARGE COMMUNITIES

1. San Jose-Sunnyvale-Santa Clara, CA 2. San Francisco-Oakland-Fremont, CA 3. Washington-Arlington-Alexandria, DC-VA-MD-WV 4. Minneapolis-St. Paul-Bloomington, MN-WI 5. Denver-Aurora, CO 6. Raleigh-Cary, NC 7. Boston-Cambridge-Quincy, MA-NH 8. Austin-Round Rock, TX 9. Seattle-Tacoma-Bellevue, WA 10. San Diego-Carlsbad-San Marcos, CA

10. Iowa

TOP CONGRESSIONAL DISTRICTS

1. California District 14 2. California District 48 3. Colorado District 02 4. Virginia District 08 5. California District 12 6. California District 45 7. California District 18 8. Hawaii District 01 9. District of Columbia 01 10. Virginia District 10
Ranking of 189 Metropolitan Statistical Areas Source: Gallup-Healthways Well-Being Index Survey 2013, n=178,072 U.S. Census Bureau definitions for Metropolitan Statistical Areas (MSAs) were used to define city populations; City Population = below 250,000 (small); 250,000 to 1 million (mid-size); over 1 million (large)

NATIONAL RESULTS AND TOP 10 WELL-BEING SUMMARIES

TOP MID-SIZE COMMUNITIES

1. Provo-Orem, UT 2. Boulder, CO 3. Fort Collins-Loveland, CO 4. Honolulu, HI 5. Ann Arbor, MI 6. Naples-Marco Island, FL 7. San Luis Obispo-Paso Robles, CA 8. Lincoln, NE 9. Portland-South Portland-Biddeford, ME 10. Madison, WI

TOP SMALL COMMUNITIES

1. Bellingham, WA 2. Billings, MT 3. Barnstable, MA 4. Burlington-South Burlington, VT 5. Sioux Falls, SD 6. Charlottesville, VA 7. Medford, OR 8. Prescott, AZ 9. Yakima, WA 10. Topeka, KS

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STATE RANKINGS ANALYSIS

When Gallup and Healthways rst launched the WellBeing Index on January 2, 2008, no one knew which states would someday be considered elite places of well-being and which states would gain the unfortunate distinction of consistently low rankings. There were some indicators, of course. Government organizations such as the Centers for Disease Control and Prevention could tell us, for example, which states had the highest levels of obesity or the lowest rates of smoking. But no instrument as comprehensive as the Well-Being Index had ever been administered on the scale that Gallup and Healthways undertook. The Index gave us state-level perspectives on 55 unique measures of well-being that went far beyond physical wellness and traditional health risk factors. As it turned out, Hawaii, Utah, Minnesota, North Dakota, Colorado, and Montana all distinguished themselves as Americas top well-being states, with an average composite score of 68.4 or higher accumulated over six years of successive nationwide measurement. In recent years, other states have risen to challenge the elite, with Iowa, Nebraska, and Vermont joining Hawaii, Minnesota, Montana, and Colorado as the only states to nish in the top 10 each of the last two years. Of those seven states, only Iowa, Montana, Vermont, and Nebraska have shown improvement each year since 2010, the rst full year since the recession. In examining well-being at the state level, some states are distinguished year after year on certain characteristics reported by their residents. Colorado, for example, is always at or near the best in the nation for the lowest obesity rate. Utah has the fewest smokers. Massachusetts has boasted the highest level of residents with health insurance all six years. New Jersey has the lowest levels of depression. And Vermont rules America every year in produce consumption. Other characteristics, however, emerge as common features of states with high well-being. These are things such as learning new and interesting things daily, which meets an important psychological need. Top well-being states generally do the best job of providing growth opportunities for their residents. Providing residents with safe places to exercise reects high well-being, with elite states like Minnesota and Colorado routinely topping the nation in this regard. Top states are among the best at having workers who use their strengths, thus reaping the rewards of heightened well-being in a variety of ways, including better physical and emotional health. Arguably no state is more invested in well-being than Iowa, where the Healthiest State Initiative (HSI) is a unique partnership of a publicly supported, privately sponsored enterprise intended to lift Iowa to match the nations best. The HSI represents a best-practice in state-level interventions that are administered in collaboration with the Healthways Blue Zones Project, funded by Wellmark and advocated by Iowa Gov. Terry Branstad. Its impact on the well-being of the residents of the state shouldnt be underestimated, as noted by the states accomplishments. Regardless of the formality of the intervention, however, no one should discount the role that leadership plays in engendering well-being among residents. Be it politicians, corporate executives, clergy, school principals, managers of local groceries, or community activists, a well-informed and active leadership is crucial to a states success at building an institutionalized, embedded, and sustained well-being culture. Included within this culture are certain guiding principles by which these leaders should abide, including a shared and uniform denition of well-being, constant and public vigilance in its advocacy, and a clear message that commitment to it in the state will never, ever go away. In this manner, state leaders can fulll an honorable responsibility to the people they lead and to the communities they serve.

STATE MAP BY QUINTILE

WA MT OR ID WY IA NV CA UT CO KS MO KY TN AR MS TX LA FL AL GA SC NE IL IN OH WV VA NC SD ME ND MN WI MI PA MD NJ DE NY VT NH MA CT

RI

AZ

OK NM

AK

HI

TOP QUINTILE

2ND QUINTILE

3RD QUINTILE

4TH QUINTILE

5TH QUINTILE

SURVEY SAMPLE SIZE BY STATE

AL AK AZ AR CA CO CT DE 3,070 564 4,062 1,959 17,053 3,495 2,110 554 FL GA HI ID IL IN IA KS 9,770 5,128 601 1,232 5,958 3,972 2,327 1,871 KY LA ME MD MA MI MN MS 2,755 2,598 1,143 3,223 3,712 5,198 3,690 1,753 MO MT NE NV NH NJ NM NY 3,652 1,034 1,403 1,440 902 4,582 1,514 9,650 NC ND OH OK OR PA RI SC 5,913 547 6,189 2,771 3,064 8,564 599 2,735 SD TN TX UT VT VA WA WV 584 4,138 12,473 2,109 588 4,993 4,897 1,261 WI WY 3,652 558

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STATE RANKINGS BY DOMAIN

Work Environment Work Environment Healthy Behaviors Healthy Behaviors Emotional Health Emotional Health Composite Rank Composite Rank Physical Health Physical Health Life Evaluation Life Evaluation Basic Access Basic Access

1. NORTH DAKOTA 2. SOUTH DAKOTA 3. NEBRASKA 4. MINNESOTA 5. MONTANA 6. VERMONT 7. COLORADO 8. HAWAII 9. WASHINGTON 10. IOWA 11. NEW HAMPSHIRE 12. UTAH 13. MASSACHUSETTS 14. WISCONSIN 15. MAINE 16. ALASKA 17. CALIFORNIA 18. MARYLAND 19. ARIZONA 20. KANSAS 21. TEXAS 22. ILLINOIS 23. NEW JERSEY 24. VIRGINIA 25. OREGON

4 8 1 6 2 30 7 9 10 22 14 5 16 25 27 3 11 18 19 33 12 20 15 17 24

2 3 5 7 6 20 14 4 15 11 12 27 37 10 33 1 26 36 16 9 23 21 34 32 29

1 2 12 8 6 4 13 42 9 11 17 20 29 26 3 45 19 18 15 22 10 28 34 38 30

1 13 3 2 16 6 4 15 28 5 22 26 8 18 27 21 12 17 24 11 19 10 9 20 39

27 25 21 15 3 1 7 2 8 33 18 14 13 19 11 17 5 29 10 37 34 32 26 28 6

29 5 8 2 23 12 11 7 19 3 4 9 1 6 18 34 40 20 42 10 46 24 21 15 27

26. NEVADA 27. GEORGIA 28. DELAWARE 29. IDAHO 30. FLORIDA 31. CONNECTICUT 32. NORTH CAROLINA 33. NEW MEXICO 34. WYOMING 35. NEW YORK 36. PENNSYLVANIA 37. MICHIGAN 38. SOUTH CAROLINA 39. RHODE ISLAND 40. INDIANA 41. LOUISIANA 42. OKLAHOMA 43. MISSOURI 44. TENNESSEE 45. ARKANSAS 46. OHIO 47. ALABAMA 48. MISSISSIPPI 49. KENTUCKY 50. WEST VIRGINIA
8

34 13 21 32 29 31 36 23 46 28 40 43 38 39 45 35 47 41 44 37 48 42 26 49 50

42 18 19 35 24 31 28 8 13 43 41 25 22 48 38 30 39 46 45 47 44 40 17 49 50

5 23 16 31 35 49 27 48 36 47 46 44 33 37 24 21 7 41 39 32 40 43 50 25 14

7 30 47 29 25 14 32 31 40 23 33 35 37 36 41 34 44 38 45 48 42 46 43 49 50

22 35 38 16 12 9 30 4 24 20 31 36 39 23 44 47 48 46 40 41 45 42 43 49 50

47 38 13 25 36 14 37 45 26 22 17 16 33 30 31 48 43 32 35 44 28 39 49 41 50

STATE RANK 2012 - 2013

2012 RANK
1. Hawaii 2. Colorado 3. Minnesota 4. Utah 5. Vermont 6. Montana 7. Nebraska 8. New Hampshire 9. Iowa 10. Massachusetts 11. Maryland 12. South Dakota 13. Wyoming 14. Virginia 15. Washington 16. Connecticut 17. Kansas 18. California 19. North Dakota 20. Wisconsin 21. Maine 22. Idaho 23. Arizona 24. Oregon 25. New Mexico 26. Delaware 27. Texas 28. Illinois 29. Pennsylvania 30. New York 31. Alaska 32. New Jersey 33. Georgia 34. Florida 35. North Carolina 36. Michigan 37. Rhode Island 38. Missouri 39. Nevada 40. South Carolina 41. Oklahoma 42. Indiana 43. Louisiana 44. Ohio 45. Alabama 46. Arkansas 47. Tennessee 48. Mississippi 49. Kentucky 50. West Virginia

2013 RANK
1. North Dakota 2. South Dakota 3. Nebraska 4. Minnesota 5. Montana 6. Vermont 7. Colorado 8. Hawaii 9. Washington 10. Iowa 11. New Hampshire 12. Utah 13. Massachusetts 15. Maine 16. Alaska 17. California 18. Maryland 19. Arizona 20. Kansas 21. Texas 22. Illinois 23. New Jersey 25. Oregon 26. Nevada 27. Georgia 28. Delaware 29. Idaho 30. Florida 31. Connecticut 32. North Carolina 33. New Mexico 35. New York 36. Pennsylvania 37. Michigan 38. South Carolina 39. Rhode Island 40. Indiana 41. Louisiana 42. Oklahoma 43. Missouri 45. Arkansas 46. Ohio 47. Alabama 48. Mississippi 49. Kentucky 50. West Virginia

5TH QUINTILE

44. Tennessee

4TH QUINTILE

34. Wyoming

3RD QUINTILE

24. Virginia

2ND QUINTILE

14. Wisconsin

TOP QUINTILE

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STATE RANKINGS BY YEAR

2013 Rank 2013 Rank

2011

2011

2009

2008

2009

NORTH DAKOTA SOUTH DAKOTA NEBRASKA MINNESOTA MONTANA VERMONT COLORADO HAWAII WASHINGTON IOWA NEW HAMPSHIRE UTAH MASSACHUSETTS WISCONSIN MAINE ALASKA CALIFORNIA MARYLAND ARIZONA KANSAS TEXAS ILLINOIS NEW JERSEY VIRGINIA OREGON

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

19

3 7

21

12 11 7 3 6 5 2 1 8 3

19 31

10 24 20 6 4 3 6 10 1 5 3 27 8 2 6 26

10 14 12 17 6 1 5 1

15 17 12 17 9 8 4 16 19 9 5 7

15 14 16 8 2 1

10 14 11 18 12 20 22 22 26 28 21 25 25 16 24 31 4 4 5 11 9

18 18 18 21

11 13 13 15 15 23 26 29 22 14 17 7 16 11 13

27 27 27 23 22 28 32 26 28 30 32 29 24 29 25 14 15 21 13 17 24 20 28 27 19 10

NEVADA GEORGIA DELAWARE IDAHO FLORIDA CONNECTICUT NORTH CAROLINA NEW MEXICO WYOMING NEW YORK PENNSYLVANIA MICHIGAN SOUTH CAROLINA RHODE ISLAND INDIANA LOUISIANA OKLAHOMA MISSOURI TENNESSEE ARKANSAS OHIO ALABAMA MISSISSIPPI KENTUCKY WEST VIRGINIA

26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

39 40 43 46 44 33 28 31 25 23 26 47 44 37 35 22 23 20 9 10

34 42 37 36 29 16 19 9 20 18

35 30 36 32 38 25 24 23 31 13 21 2 12 7 4

30 34 32 33 37 29 31 30 30 34 36 37 41 34 41 40 33 35 35 32 37 35 33 40 33 42 38 39 43 45 43 36 42 41 42 41 39 38 39 36 38 43 34 38 40 47 41 40 42 43 46 44 47 48 47 44 46 45 47 46 45 45 46 44 39 48 48 48 45 50 49 49 49 49 48 50 50 50 50 49

2008

2012

2010

2012

2010

AVERAGE STATE RANKINGS, 2008 - 2013

TOP QUINTILE
Hawaii Minnesota Utah Colorado Montana North Dakota Alaska Nebraska Vermont* 2.3 4.2 5.3 6.3 6.8 9.0 11.8 12.0 12.2

2ND QUINTILE
Washington 12.7 Massachusetts 13.0 South Dakota Kansas Maryland Wyoming Iowa California Virginia Idaho* 13.7 14.0 14.2 14.3 14.5 16.8 17.3 18.8

3RD QUINTILE
Connecticut* Maine Wisconsin Arizona Oregon* New Mexico* Texas New Jersey Illinois Georgia 18.8 21.0 22.0 22.2 23.8 23.8 24.5 27.0 27.7 27.8

4TH QUINTILE
Pennsylvania New York 31.7 33.5

5TH QUINTILE
Nevada Louisiana Indiana Tennessee Alabama Ohio Arkansas Mississippi Kentucky West Virginia 39.7 40.8 41.2 42.8 44.3 45.7 46.2 47.8 48.8 49.8

North Carolina 33.8 Florida 34.7

South Carolina 35.5 Rhode Island* Delaware* Michigan Oklahoma Missouri 36.2 36.2 37.7 39.2 39.3

New Hampshire* 12.2

*For states with the same average six-year rank value, the state with the higher average overall well-being score over the six-year period receives the higher ranking.

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CLIENT PERSPECTIVES INGERSOLL RAND

At Ingersoll Rand, our goal is to have our employees as engaged and productive as possible to help us advance on our journey to premier performance for our customers and shareholders. We have a diverse set of employees, each with unique needs that vary depending on stage of life and individual circumstance. We aspire to give our employees access to everything they need with the tools and resources that can help them better manage their lives, reduce stress, and increase their overall well-being. We implement a holistic approach, and building a culture of well-being is the centerpiece of that strategy. We are moving beyond wellness where we checked the box on physical factors, and we now focus on the whole individual, addressing additional factors such as work satisfaction, nancial stress, and other personal issues. When we understand a persons well-being, we are able to address more of the underlying root causes that impact their health and productivity. And in improving well-being, we can measurably improve business performance. When our employees know that we care about them and their families, it allows us to set ourselves apart in a competitive job market and we can better retain our employees. Recently, I was at one of our oces for an annual enrollment meeting. When you meet employees who are thankful for having the opportunity to lose weight, stop smoking, and save money to buy a car for their son, thats when you know you are on the path to truly impacting peoples lives. Julie Ham, Global Health Progress Leader, Ingersoll Rand

TEXAS HEALTH RESOURCES

I recently read a quote that said, The best hospital in the community is the one that has the healthiest community around it, and thought that really embodies the mission of Texas Health Resourcescommitted to improving the health of the communities we serve. While this means delivering outstanding care and service to the patients we care for in our hospitals, it also means an additional focus on improving the health and well-being of the people in North Texas. At THR, our aspiration is to go beyond the hospital setting and truly impact our community. As we endeavor to do this, we know that the most innovative health systems in the country are thinking about health beyond the direct measures of physical health. Our emphasis on mind, body, and spirit is an approach that encompasses all the elements of a persons well-being from managing social stresses and nancial pressures, to creating a community that encourages healthy behaviors and work/life balance. As we improve these elements of well-being, the people in our community will live better, more fullled lives, with healthier outcomes and lower costs. Our focus on and mission for well-being is having additional positive impacts on our community. We are attracting some of the best clinicians and business people in the country who understand our vision and want to take part in our well-being journey. At THR, this journey will evolve, transform, and expand our horizons to deliver well-being improvement, all while maintaining an intense focus on our core strengths of excellence, innovation, and outstanding care. Jonathan Scholl, Chief Strategy Ocer, Texas Health Resources

BLUE SHIELD OF CALIFORNIA

Advocating for the well-being of our customers is central to our mission to provide access to quality, aordable healthcare for all Californians. Health plans and providers have traditionally viewed wellness through a medical lens and in the context of treating acute or chronic conditions. But what does being healthy really mean to an individual? For many of us, it goes well beyond the denitions of the medical community to include goals and aspirations, mental and emotional needs, faith and spirituality, nancial security, and interpersonal relationships. Simply

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CLIENT PERSPECTIVES
put, we dont view ourselves as a chart or a diagnosis; well-being is about much more than our weight, blood pressure, or cholesterol. Our goal is to meet our members where they are on their well-being journey, give them the tools they need, and empower and support them to meet their goals. If we can provide the resources a member needs to quit smoking, become more physically active, or develop deeper ties with family and community, then we are on the right path to measurably improving well-being and addressing some of the countrys most important healthcare issues.

Bryce Williams, Vice President of Well-Being, Blue Shield of California

THE HERSHEY COMPANY

Although weve had a long history of engaging our employees in healthy activities, about three years ago we expanded our approach and crafted a global strategy around the health and well-being of our employees. Entering into this process we had a core belief that we could support our employees far beyond their physical health and wellness in programs that included nutrition and exercise, but also that addressed a broader spectrum of activities from health to nancial to community and beyond. We started to ask ourselves questions such as: What are we doing to support our employees nancial health?, How can we support them better in improving their physical health?, and What are we doing to reward philanthropy and community service? An important outcome of that strategic work is our myWell-Being mission statement: To create a global culture of health and vitality that empowers employees and their families to enhance their well-being. This now serves as a core rallying point for all of our employees and we have ongoing initiatives to boost involvement in wellbeing activities across our company. We are engaging leaders to promote well-being and to champion it as a key driver of business value. Jeannie Hanna, Director, Total Rewards Value Proposition, The Hershey Company

CARONDELET HEALTH NETWORK

As a healthcare network, we experience daily that physical wellness does not occur in isolation. You simply have to take into account a broader view to have an impact on both an individuals health and on the systems cost. Our philosophy is to break down the traditional silos that can exist in care delivery and provide patients with a more integrated approach, focusing on the whole personbody, mind, and spirit. We recognize the responsibility we have to our patients emotional, social, and nancial well-being in order to positively impact their physical health. Key to this eort is evolving beyond acute episodic care. Our primary care providers are foundational to this eort, allowing individuals to establish a medical home and a trusting relationship with their doctors. Our goal is to keep the healthy well, course-correct those with health risks, and manage the chronically ill so they can live their very best lives. Ultimately, this will improve outcomes and lower healthcare costs. Our journey began with a well-being initiative for our own employees. This has created a sense of community, camaraderie, and enthusiasm. Its teaching us how we can inspire and empower one another and, more importantly, the larger community we serve. Chris Castellano, EVP & Chief Strategy Ocer, Carondelet Health Network

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well-beingindex.com

INSIGHTS ON AMERICANS AND THEIR WELL-BEING

SMOKING
21.5 21.0 20.5 20.0 19.5 19.0 2008 2009 2010 2011 2012 2013 People who report that they smoke are most likely: Male Between the ages of 18 to 29 To have a blue collar job if employed (construction or mining workers have the highest rate) To make less than $36,000 a year To be dissatisfied with the city or area where they live To have a high school degree or less education

People who report that they smoke also report that they:
Have less money for healthcare/medicine: Smokers Non-smokers 68.3% 83.7% Have fewer visits to the dentist: Smokers Non-smokers 48.7% 68.6% Have higher rates of depression: Smokers Non-smokers 27.7% 14.7%

OBESITY
27.5

People who report that they are obese are most likely: Male Between the ages of 45 to 64

26.5

To have a blue collar job if employed (transportation workers have the highest rate) To make less than $36,000 a year To have a technical/vocational education or no high school degree 2008 2009 2010 2011 2012 2013

25.5

24.5

People who report that they are obese also report that they:
Have higher rates of depression: Obese Non-obese 23.7% 15.0% Experience more physical pain: Obese Non-obese 32.7% 21.3% Exercise less: Obese Non-obese 41.0% 55.9%

*The demographic profiles and correlated data are based on 2013 Well-Being Index data.

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INSIGHTS ON AMERICANS AND THEIR WELL-BEING

HEALTH INSURANCE
85.5 People who report that they dont have health insurance are most likely: Male Between the ages of 18 to 29 84.0 To have a blue collar job if employed (construction/mining workers have the lowest rate) To make less than $36,000 a year To have a high school degree or less 81.0 2008 2009 2010 2011 2012 2013

82.5

People who report that they dont have health insurance also report that they:
Have fewer visits to the dentist: No health insurance Health insurance 37.0% 70.5% Have a higher smoking rate: No health insurance Health insurance 33.7% 16.8% Experience more worry: No health insurance Health insurance 40.3% 28.7%

PERSONAL DOCTOR
81.0

People who report that they dont have a personal doctor are most likely: Male Between the ages of 18 to 29

79.0

To have a blue collar job if employed (construction/mining workers have the lowest rate) To make less than $36,000 a year To have a high school degree or less

77.0

75.0 2008 2009 2010 2011 2012 2013

People who report that they dont have a personal doctor report that they:
Have a higher smoking rate: No personal doctor Personal doctor 29.4% 16.9% Have less money for healthcare/medicine No personal doctor Personal doctor 69.9% 83.9% Have fewer visits to the dentist: No personal doctor Personal doctor 44.2% 70.7%

*The demographic profiles and correlated data are based on 2013 Well-Being Index data.

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well-beingindex.com

INSIGHTS ON AMERICANS AND THEIR WELL-BEING

DENTIST VISITS
65.8 65.4 65.0 64.6 64.2 2008 2009 2010 2011 2012 2013 People who report that they havent visited the dentist in the last 12 months are most likely: Male Between the ages of 18 to 29 To have a blue collar job if employed (construction workers have the lowest rate) To make less than $36,000 a year To be dissatisfied with the city or area where they live To be divorced/separated/widowed

People who report that they havent visited the dentist in the last 12 months also report that they:
Have higher heart attack rates: Didnt visit dentist Visited dentist 5.4% 3.0% Have higher rates of obesity: Didnt visit dentist Visited dentist 32.4% 24.3% Have higher rates of diabetes: Didnt visit dentist Visited dentist 14.0% 9.6%

JOB SATISFACTION
89.5 88.5 87.5 86.5 2008 2009 2010 2011 2012 2013

People who report that they are dissatisfied with their job are most likely: Between the ages of 18 to 29 To have a blue collar job if employed (service industry workers have the lowest rate) To make less than $36,000 a year To have less than a high school degree or some college education

People who report that they are dissatisfied with their job also report that they:
Feel less well-rested: Dissatisfied Satisfied 54.1% 70.8% Have higher smoking rates: Dissatisfied Satisfied 27.9% 17.7% Have lower overall well-being scores: Dissatisfied Satisfied 48.9 71.2

*The demographic profiles and correlated data are based on 2013 Well-Being Index data.

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INSIGHTS ON AMERICANS AND THEIR WELL-BEING

EXERCISESENIORS
51.0 Seniors 65+ who report that they exercise 3-7 times per week are most likely: Male To make over $60,000 annually To have a post high school education 48.5

46.0 2008 2009 2010 2011 2012 2013

Seniors 65+ who report that they exercise 3-7 times per week also report that they:
Experience less depression: Exercise No exercise 12.4% 18.8% Experience less back and neck pain: Exercise No exercise 29.3% 38.5% Are able to do many things others their age cannot do because of health issues: Exercise No exercise 75.7% 59.1%

*The demographic profiles and correlated data are based on 2013 Well-Being Index data.

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well-beingindex.com

MARKET RECOMMENDATIONS EMPLOYERS

Move beyond wellness. By taking a more holistic approach and moving from a wellness strategy to one that includes all the facets of an individuals well-being (purpose, social, nancial, community, and physical), employers of all sizes have an opportunity to unlock additional value across their populations. This is value that exists both in terms of lowering healthcare costs and increasing individual performance. By thinking more broadly and implementing a strategy with well-being at its core, employers will be able to more eectively identify the root causes of issues that impact important business metrics such as health outcomes, healthcare costs, job performance, turnover, and absenteeism. Leverage leaders and well-being champions as important inuencers. Successful well-being initiatives are driven by leaders and champions who adopt the tenets of well-being for themselves, encourage others to do so, and actively participate in well-being programs. Small decisions and actions by coordinated, committed, and passionate champions make large dierences to employees in terms of their engagement and motivation. Ultimately, when leaders and champions are engaged, it will have an impact on the culture and success of any wellbeing program. Think about sustained behavior changenot just onetime engagement. Promoting a culture of well-being across your organization is not a one-time activity. Successful programs are those that continually educate and motivate individuals to engage and make systematic changes in their lives that improve their well-being.

COMMUNITIES
Create an environment where physical activity is easy and safe. There are tangible policies that communities can adopt to actively cultivate and improve residents well-being. Bike lanes, sidewalks, convenient public transportation, and walking school buses are examples of public infrastructure and policy improvements that increase natural physical movement in a community. Make the healthy choice the easy choice. In addition to improving physical activity, communities that make healthy choices easy, can measurably improve the wellbeing of their residents. When fruits and vegetables are abundant and accessible, when restaurants oer healthy choices and smaller portions as standard fare, and when social norms are reective of high well-being behaviors, then better outcomes ensue. Communities with high wellbeing share the common characteristics of people who are motivated to achieve their goals, enjoy what they do each day, feel safe and nancially secure, take pride in their communities, and have the supportive relationships and good health they need to get things done each day. Cultivate a clear culture of well-being. Community leaders have an opportunity to lead the charge for wellbeing improvement by promoting social and community activities that reinforce a culture of well-being. Businesses, government, education, healthcare, faith, and the arts can all play a substantial role in improving well-being.

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MARKET RECOMMENDATIONS HEALTH PLANS

Broaden oerings beyond traditional care management. Most health plans have extensive clinical care management programs for their members. These programs have historically focused on improving the quality of care for members with chronic conditions. By moving beyond physical health and broadening oerings to include all of the concepts surrounding well-being, health plans can achieve two important goals. They can more eectively address a larger portion of their population, not just those with chronic illnesses, and they can oer a more holistic spectrum of care to more eectively meet their members needs. Leverage well-being as a dierentiator and as a means to drive loyalty and retention with members. A wellbeing improvement approach to care provides new ways for health plans to interact with their members creating a more partner-oriented relationship. Examples of resources and support that promote high well-being include programs that help increase nancial security and reduce nancial stress, connect members with local farmers markets, and encourage members to participate in philanthropic/charitable community activities. These are just three examples of benets that health plans can provide to meaningfully dierentiate their oerings to employers and within individual markets. These types of programs help engage members in more meaningful ways and ultimately drive improved loyalty and retention across the population.

HEALTH SYSTEMS
Think total population health management. Health systems are evolving to a model that seeks to promote health and well-being and treats individuals with a more integrated and holistic approachone that extends beyond the acute care setting and beyond physical health. Many innovative health systems have already begun this journey with the goal of maximizing the impact they can have on the communities they serve and creating longterm sustainable trends of better health outcomes and lower healthcare costs. Equip physicians with a full understanding of a patients well-being. The most successful health systems will have a physician-led strategy based on well-being. Physicians are and will continue to be a powerful force in engaging people in activities that promote better health; they can also be a similar force for the broader spectrum of activities that promote high well-being. Patient data that include a more complete picture of the individual with all the facets of their well-being will allow providers to prescribe a more comprehensive and eective care plan. Create high-performing, clinically integrated networks. As health systems assume more risk for the health and costs of their population, aligned incentives among patients, physicians, and providers will be crucial. Wellbeing and holistic approaches to care are key platforms for these integrated networks. Leverage well-being as a key dierentiator. Health systems can leverage well-being concepts to build a strong brand centered on health and vitality messages to the communities they serve.

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well-beingindex.com

COMMUNITY RANKINGS
In understanding and improving Americans well-being, arguably nothing is more important than what is taking place in our nations cities and smaller communities. Many innovative communities are actively setting up public and private interventions to create environments that promote sustainable and measurable well-being improvement. Public infrastructure investments such as bike lanes, sidewalks, and better access to public transportation support the incorporation of more physical activity in daily life. Walking school buses start and end each day energetically and safely for our children and can boost the social well-being of adults. Mobile farmers markets improve access to fresh produce and encourage healthy eating. Local events, like learning and discussion groups, are designed to give residents opportunities for personal growth, and foster social well-being and a sense of true community. These are just some examples of policies that community leaders canand are championing to create sustainable and systemic behavior change and ultimately, higher well-being. Many communities with high well-being are achieving this status by choosing to intentionally cultivate and embrace a clear culture of well-being, where high wellbeing options become the easy and natural choice for their citizens. A culture in which leaders in business, government, education, healthcare, faith, and the arts act on the philosophy that fostering and improving wellbeing for their citizens is how we do things around here. In this way, our communities can lead the charge for wellbeing improvement and make a meaningful impact at the national level.

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COMMUNITY RANKINGS

Circle size representative of number of survey respondents

TOP QUINTILE
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Provo-Orem, UT Boulder, CO Fort Collins-Loveland, CO Honolulu, HI San Jose-Sunnyvale-Santa Clara, CA Ann Arbor, MI Naples-Marco Island, FL San Luis Obispo-Paso Robles, CA San Francisco-Oakland-Fremont, CA Lincoln, NE Washington-Arlington-Alexandria, DC-VA-MD-WV Bellingham, WA

13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

Minneapolis-St. Paul-Bloomington, MN-WI Portland-South PortlandBiddeford, ME Billings, MT Madison, WI Barnstable, MA Denver-Aurora, CO Raleigh-Cary, NC Burlington-South Burlington, VT Lancaster, PA Sioux Falls, SD Boston-Cambridge-Quincy, MANH Bremerton-Silverdale, WA Des Moines-West Des Moines, IA

26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38.

Holland-Grand Haven, MI Santa Rosa-Petaluma, CA Kennewick-Pasco-Richland, WA Omaha-Council Bluffs, NE-IA Austin-Round Rock, TX Durham, NC Seattle-Tacoma-Bellevue, WA Charlottesville, VA Salinas, CA Peoria, IL San Diego-Carlsbad-San Marcos, CA Lynchburg, VA Salt Lake City, UT

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well-beingindex.com

COMMUNITY RANKINGS

Circle size representative of number of survey respondents

2ND QUINTILE
39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. Bridgeport-Stamford-Norwalk, CT Harrisburg-Carlisle, PA Santa Barbara-Santa Maria-Goleta, CA Atlanta-Sandy Springs-Marietta, GA Los Angeles-Long Beach-Santa Ana, CA Fayetteville, Springdale-Rogers, AR-MO Greeley, CO Ogden-Clearfield, UT Oxnard-Thousand Oaks-Ventura, CA Rochester, NY Albany-Schenectady-Troy, NY Indianapolis-Carmel, IN

51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63.

Phoenix-Mesa-Scottsdale, AZ Cedar Rapids, IA Charlotte-Gastonia-Concord, NC-SC Dallas-Fort Worth-Arlington, TX Kansas City, MO-KS Norwich-New London, CT Portland-Vancouver-Beaverton, OR-WA Colorado Springs, CO Columbus, OH Houston-Sugar Land-Baytown, TX Roanoke, VA Orlando-Kissimmee, FL Baton Rouge, LA

64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76.

Duluth, MN-WI Richmond, VA Spokane, WA Chicago-Naperville-Joliet, IL-IN-WI El Paso, TX Eugene-Springfield, OR Hartford-West Hartford-East Hartford, CT Lansing-East Lansing, MI Nashville-Davidson-MurfreesboroFranklin, TN Reading, PA Reno-Sparks, NV San Antonio, TX Tucson, AZ

22

COMMUNITY RANKINGS

Circle size representative of number of survey respondents

3RD QUINTILE
77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. Bradenton-Sarasota-Venice, FL Columbia, SC Davenport-Moline-Rock Island, IA-IL Greenville-Mauldin-Easley, SC Huntsville, AL Sacramento-Arden-ArcadeRoseville, CA Wichita, KS Anchorage, AK Grand Rapids-Wyoming, MI Lafayette, LA Lexington-Fayette, KY Milwaukee-Waukesha-West Allis, WI

89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100.

Savannah, GA Visalia-Porterville, CA Boise City-Nampa, ID Buffalo-Niagara Falls, NY Olympia, WA Medford, OR Syracuse, NY Winston-Salem, NC Albuquerque, NM Baltimore-Towson, MD Fresno, CA Philadephia-Camden-Wilmington, PA-NJ-DE-MD

102. Prescott, AZ 103. St. Louis, MO-IL 104. Oklahoma City, OK 105. Port St. Lucie, FL 106. Vallejo-Fairfield, CA 107. Canton-Massillon, OH 108. Green Bay, WI 109. Kalamazoo-Portage, MI 110. 111. New York-North New Jersey-Long Island, NY-NJ-PA Charleston-North CharlestonSummerville, SC Virginia Beach-Norfolk-Newport News, VA-NC

112. Gainesville, FL 113.

101. Pittsburgh, PA

114. Manchester-Nashua, NH

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well-beingindex.com

COMMUNITY RANKINGS

Circle size representative of number of survey respondents

4TH QUINTILE
115. Utica-Rome, NY 116. Yakima, WA 117. Erie, PA 118. Greensboro-High Point, NC 119. Montgomery, AL 120. New Orleans-Metairie-Kenner, LA 121. Ocala, FL 122. Springfield, MA 123. Worcester, MA 124. Miami-Fort Lauderdale-Pompano Beach, FL

127. Akron, OH 128. Killeen-Temple-Fort Hood, TX 129. Riverside-San Bernardino-Ontario, CA

140. Asheville, NC 141. Augusta-Richmond County, GA-SC 142. Cincinnati-Middletown, OH-KY-IN 143. York-Hanover, PA 144. Las Vegas-Paradise, NV 145. Birmingham-Hoover, AL 146. Clarksville, TN-KY 147. McAllen-Edinburg-Mission, TX 148. Stockton, CA 149. Cape Coral-Fort Myers, FL 150. Knoxville, TN 151. Modesto, CA 152. Tampa-St. Petersburg-Clearwater, FL

130. Salem, OR 131. Trenton-Ewing, NJ 132. Cleveland-Elyria-Mentor, OH 133. Toledo, OH 134. Tulsa, OK 135. Memphis, TN-MS-AR 136. Pensacola-Ferry Pass-Brent, FL 137. Springfield, MO 138. Lakeland-Winter Haven, FL 139. Palm Bay-Melbourne-Titusville, FL

125. Tallahassee, FL 126. Wilmington, NC

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COMMUNITY RANKINGS

Circle size representative of number of survey respondents

5TH QUINTILE
153. Fort Wayne, IN 154. Little Rock-North Little RockConway, AR Providence-New Bedford-Fall River, RI-MA Allentown-Bethlehem-Easton, PA-NJ

164.

Myrtle Beach-North Myrtle BeachConway, SC

177. Scranton-Wilkes Barre, PA 178. Bakersfield, CA 179. Chattanooga, TN-GA 180. Evansville, IN-KY 181. Mobile, AL 182. Shreveport-Bossier City, LA 183. Columbus, GA-AL 184. Beaumont-Port Arthur, TX 185. Hickory-Lenoir-Morganton, NC 186. Spartanburg, SC 187. Redding, CA 188. Charleston, WV 189. Huntington-Ashland, WV-KY-OH

165. Flint, MI 166. Fort Smith, AR-OK 167. Jackson, MS 168. Kingsport-Bristol, TN-VA 169. Topeka, KS 170. Binghamton, NY 171. Corpus Christi, TX 172. Dayton, OH 173. Hagerstown-Martinsburg, MD-WV 174. South Bend-Mishawaka, IN-MI Youngstown-Warren-Boardman, 175. OH-PA 176. Rockford, IL

155. New Haven-Milford, CT 156. 157.

158. Detroit-Warren-Livonia, MI 159. Jacksonville, FL 160. Poughkeepsie-NewburghMiddletown, NY

Deltona-Daytona Beach-Ormond 161. Beach, FL 162. Fayetteville, NC 163. Louisville-Jefferson County, KY-IN

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well-beingindex.com

COMMUNITYSURVEY SAMPLE SIZE

Akron, OH Albany-SchenectadyTroy, NY Albuquerque, NM AllentownBethlehem-Easton, PA-NJ Anchorage, AK Ann Arbor, MI Asheville, NC Atlanta-Sandy Springs-Marietta, GA Augusta-Richmond County, GA-SC Austin-Round Rock, TX Bakersfield, CA Baltimore-Towson, MD Barnstable, MA Baton Rouge, LA BeaumontPort Arthur, TX Bellingham, WA Billings, MT Binghamton, NY BirminghamHoover, AL Boise City-Nampa, ID Boston-CambridgeQuincy, MA-NH Boulder, CO Bradenton-SarasotaVenice, FL BremertonSilverdale, WA BridgeportStamford-Norwalk, CT 1,024 1,729 1,905 1,482 721 605 998 8,118 1,004 2,784 1,190 4,843 580 1,303 674 509 459 545 2,225 1,321 7,446 661 1,389 611 BuffaloNiagara Falls, NY BurlingtonSouth Burlington, VT CantonMassillon, OH Cape CoralFort Myers, FL Cedar Rapids, IA CharlestonNorth CharlestonSummerville, SC Charleston, WV Charlotte-GastoniaConcord, NC-SC Charlottesville, VA Chattanooga, TN-GA Chicago-NapervilleJoliet, IL-IN-WI CincinnatiMiddletown, OH-KY-IN Clarksville, TN-KY Cleveland-ElyriaMentor, OH Colorado Springs, CO Columbia, SC Columbus, GA-AL Columbus, OH Corpus Christi, TX Dallas-Fort WorthArlington, TX Davenport-MolineRock Island, IA-IL Dayton, OH DeltonaDaytona BeachOrmond Beach, FL Denver-Aurora, CO 1,302 Des MoinesWest De Moines, IA 2,037 512 672 1,045 600 1,174 642 3,009 467 1,033 11,967 3,494 533 3,123 1,436 1,413 475 2,904 545 8,897 799 1,522 997 5,148 1,210 Detroit-WarrenLivonia, MI Duluth, MN-WI Durham, NC El Paso, TX Erie, PA EugeneSpringfield, OR Evansville, IN-KY Fayetteville, NC Fayetteville, Springdale-Rogers, AR-MO Flint, MI Fort CollinsLoveland, CO Fort Smith, AR-OK Fort Wayne, IN Fresno, CA Gainesville, FL Grand RapidsWyoming, MI Greeley, CO Green Bay, WI GreensboroHigh Point, NC Greenville-MauldinEasley, SC HagerstownMartinsburg, MD-WV HarrisburgCarlisle, PA HartfordWest HartfordEast Hartford, CT 5,506 619 1,037 877 676 919 789 638 906 721 728 573 880 1,224 490 1,210 566 529 1,366 1,177 506 1,269 Hickory-LenoirMorganton, NC HollandGrand Haven, MI Honolulu, HI Houston-Sugar Land-Baytown, TX Huntington-Ashland, WV-KY-OH Huntsville, AL IndianapolisCarmel, IN Jackson, MS Jacksonville, FL KalamazooPortage, MI Kansas City, MO-KS Kennewick-PascoRichland, WA Killeen-TempleFort Hood, TX KingsportBristol, TN-VA Knoxville, TN Lafayette, LA LakelandWinter Haven, FL Lancaster, PA LansingEast Lansing, MI Las VegasParadise, NV LexingtonFayette, KY Lincoln, NE Little Rock-North Little Rock-Conway, AR Los Angeles-Long Beach-Santa Ana, CA 656 466 1,014 7,450 558 954 3,125 936 2,280 538 3,779 613 665 614 1,495 475 908 972 783 2,395 850 696 1,268

2,305

14,119

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COMMUNITYSURVEY SAMPLE SIZE

Louisville-Jefferson County, KY-IN Lynchburg, VA Madison, WI ManchesterNashua, NH McAllen-EdinburgMission, TX Medford, OR Memphis, TN-MS-AR MiamiFort LauderdalePompano Beach, FL MilwaukeeWaukeshaWest Allis, WI Minneapolis-St. PaulBloomington, MN-WI Mobile, AL Modesto, CA Montgomery, AL Myrtle BeachNorth Myrtle BeachConway, SC NaplesMarco Island, FL Nashville-DavidsonMurfreesboroFranklin, TN New HavenMilford, CT New OrleansMetairie-Kenner, LA New York-North New Jersey-Long Island, NY-NJ-PA NorwichNew London, CT Ocala, FL Ogden-Clearfield, UT 2,452 540 1,222 733 681 581 2,000 6,340 Oklahoma City, OK Olympia, WA OmahaCouncil Bluffs, NE-IA OrlandoKissimmee, FL Oxnard-Thousand Oaks-Ventura, CA Palm BayMelbourneTitusville, FL Pensacola-Ferry PassBrent, FL Peoria, IL PhiladephiaCamdenWilmington, PA-NJ-DE-MD Phoenix-MesaScottsdale, AZ Pittsburgh, PA Port St. Lucie, FL 744 604 525 3,093 1,394 1,762 23,003 533 616 1,384 Portland-South Portland-Biddeford, ME Portland-VancouverBeaverton, OR-WA PoughkeepsieNewburghMiddletown, NY Prescott, AZ ProvidenceNew BedfordFall River, RI-MA Provo-Orem, UT Raleigh-Cary, NC Reading, PA Redding, CA Reno-Sparks, NV 2,596 712 1,853 2,995 1,194 1,169 957 698 Richmond, VA RiversideSan BernardinoOntario, CA Roanoke, VA Rochester, NY Rockford, IL Sacramento-ArdenArcade-Roseville, CA Salem, OR Salinas, CA Salt Lake City, UT San Antonio, TX San Diego-CarlsbadSan Marcos, CA San FranciscoOaklandFremont, CA San Jose-SunnyvaleSanta Clara, CA San Luis ObispoPaso Robles, CA Santa Barbara-Santa Maria-Goleta, CA Santa RosaPetaluma, CA Savannah, GA 618 2,632 1,189 2,125 718 484 825 ScrantonWilkes Barre, PA Seattle-TacomaBellevue, WA ShreveportBossier City, LA Sioux Falls, SD South BendMishawaka, IN-MI Spartanburg, SC Spokane, WA 2,306 5,616 680 1,877 539 3,259 844 607 2,417 2,901 4,077 5,815 2,196 649 637 883 589 1,092 6,843 746 478 616 502 1,215 Springfield, MA Springfield, MO St. Louis, MO-IL Stockton, CA Syracuse, NY Tallahassee, FL TampaSt. PetersburgClearwater, FL Toledo, OH Topeka, KS Trenton-Ewing, NJ Tucson, AZ Tulsa, OK Utica-Rome, NY Vallejo-Fairfield, CA Virginia BeachNorfolk-Newport News, VA-NC Visalia-Porterville, CA WashingtonArlington-Alexandria, DC-VA-MD-WV Wichita, KS Wilmington, NC Winston-Salem, NC Worcester, MA Yakima, WA York-Hanover, PA Youngstown-WarrenBoardman, OH-PA 1,247 871 4,995 779 1,241 678 4,324 1,111 492 657 2,203 1,919 585 545 3,050 615 10,312 1,113 804 1,082 1,337 543 875 1,078

3,043 6,591 757 736

9,835

7,655 5,360 731 1,145 4,453 947

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CONGRESSIONAL DISTRICT RANKINGS

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CONGRESSIONAL DISTRICT RANKINGS

TOP QUINTILE
Rank District Sample Size Rank District Sample Size Rank District Sample Size Rank District Sample Size

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

CA-14 CA-48 CO-02 VA-08 CA-12 CA-45 CA-18 HI-01 DC-01 VA-10 CA-17 CO-06 UT-03 MN-02 WA-01 GA-06 CA-33 MD-08 TX-32 CA-11 WA-07 KS-03 MA-08

839 751 1,860 1,589 912 1,068 1,067 682 1,286 1,443 833 1,263 1,782 1,239 1,673 1,328 1,265 1,021 593 1,129 1,578 1,294 926

24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46.

MN-03 NY-10 MA-05 NE-02 MN-04 TX-03 CA-52 NC-09 CA-53 NJ-07 VA-11 CA-49 TX-07 WI-05 MN-01 IL-09 NY-17 HI-02 AZ-06 WI-02 NC-04 PA-18 TX-02

1,743 969 1,127 1,149 1,387 1,379 913 1,401 508 1,506 922 1,062 976 1,335 1,504 840 727 849 1,698 1,511 1,354 1,211 1,685

47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69.

CA-15 FL-07 MN-06 VA-07 IL-05 NE-01 IL-07 MO-02 TX-10 ME-01 AZ-09 VT-01 TX-21 GA-07 PA-07 MD-06 TX-24 MA-04 CA-20 NC-13 MD-04 UT-01 LA-06

742 1,082 1,075 1,268 811 1,495 488 1,450 1,337 1,555 839 1,710 1,509 876 1,157 1,469 1,105 1,277 813 887 1,148 1,831 1,003

70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87.

CA-24 IA-01 IA-04 TX-26 IL-06 MN-05 OH-16 VA-01 IL-11 FL-21 TX-31 WA-02 CA-02 CO-01 FL-23 CO-04 PA-16 CA-39

1,295 1,764 1,682 776 1,341 1,122 736 1,813 757 981 934 1,305 1,669 1,867 853 1,448 1,032 700

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CONGRESSIONAL DISTRICT RANKINGS

2ND QUINTILE
Rank District Sample Size Rank District Sample Size Rank District Sample Size Rank District Sample Size

88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110.

MA-07 MT-01 OR-01 CA-26 CO-07 IA-03 PA-06 WI-03 PA-02 GA-05 NJ-05 IN-05 ND-01 SD-01 CA-04 NH-02 MA-09 CA-30 UT-02 TX-22 CA-28 IL-14 OH-12

1,074 3,308 1,641 941 1,044 1,613 1,761 1,606 869 1,106 1,310 1,455 1,621 1,812 1,588 1,233 1,264 716 2,100 684 1,105 806 964

111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133.

MD-05 MD-03 VA-06 NE-03 WA-09 MA-03 NH-01 NV-03 IL-18 NY-16 GA-11 ID-02 AZ-05 MA-06 IL-08 CT-02 CA-27 MI-14 NY-03 NY-27 CA-42 MN-08 WY-01

1,000 1,523 1,432 1,377 987 1,004 1,343 861 1,016 595 1,090 1,897 1,440 1,167 658 1,363 1,091 481 905 1,187 877 1,474 1,784

134. 135. 136. 137. 138. 139. 140. 141. 142. 143. 144. 145. 146. 147. 148. 149. 150. 151. 152. 153. 154. 155. 156.

GA-04 AZ-08 PA-08 WI-08 NJ-11 CT-04 TX-19 CA-22 IA-02 NY-12 WA-04 CA-03 RI-02 WA-10 FL-18 FL-22 TX-25 FL-19 TX-09 CO-03 CO-05 MI-08 NJ-12

1,251 1,374 1,261 1,224 984 967 1,047 767 1,625 722 1,583 1,318 801 995 1,137 729 971 1,221 665 1,673 1,554 984 832

157. 158. 159. 160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173. 174.

NY-20 MI-02 IL-10 MI-07 TX-28 CA-05 CA-50 CA-38 WA-05 OR-05 WA-08 CA-07 AK-01 SC-02 IL-13 CT-05 KS-01 NM-01

1,389 1,401 795 1,466 579 833 1,005 813 1,779 1,466 1,570 719 1,474 1,513 1,330 927 1,578 1,653

30

CONGRESSIONAL DISTRICT RANKINGS

3RD QUINTILE
Rank District Sample Size Rank District Sample Size Rank District Sample Size Rank District Sample Size

175. 176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 196. 197.

WI-06 NY-21 WI-07 VA-04 CA-32 AL-06 NY-24 AZ-02 KS-04 NY-25 CA-47 ID-01 MN-07 UT-04 OR-04 TX-20 OH-14 TX-23 CA-13 NY-04 TX-12 CA-16 TX-17

1,564 1,390 1,442 1,018 572 1,533 1,283 1,750 1,257 1,213 725 1,965 1,564 886 2,226 1,084 949 689 936 815 1,202 880 1,053

198. 199. 200. 201. 202. 203. 204. 205. 206. 207. 208. 209. 210. 211. 212. 213. 214. 215. 216. 217. 218. 219. 220.

NY-18 SC-01 CA-19 PA-12 WA-06 FL-09 CA-36 MA-02 TN-05 CA-35 CA-25 MI-11 NY-22 CA-44 VA-02 AZ-01 MO-06 OR-03 OH-03 NJ-04 GA-03 OR-02 OK-05

928 1,460 641 1,734 1,830 860 1,007 1,331 1,480 581 905 906 1,388 403 1,447 1,625 1,206 1,559 1,422 1,153 1,415 2,185 1,299

221. 222. 223. 224. 225. 226. 227. 228. 229. 230. 231. 232. 233. 234. 235. 236. 237. 238. 239. 240. 241. 242. 243.

AZ-03 IN-03 VA-05 PA-05 NJ-09 FL-01 CA-10 NJ-03 IL-17 OH-07 MD-01 MI-10 AR-03 NY-02 SC-04 AZ-04 NV-02 CA-01 CT-01 CA-29 FL-10 CA-31 CA-09

1,059 1,375 1,820 1,620 698 1,512 906 1,350 1,286 1,413 1,709 828 1,509 796 1,085 1,501 1,499 1,890 1,492 621 942 666 902

244. 245. 246. 247. 248. 249. 250. 251. 252. 253. 254. 255. 256. 257. 258. 259. 260. 261.

TX-16 NY-23 NC-06 FL-16 OH-05 MD-07 MI-01 TX-08 NY-26 TN-08 IL-03 FL-11 PA-04 FL-15 DE-01 PA-09 OH-01 NM-03

741 1,536 1,464 1,446 1,333 746 1,530 1,092 1,261 1,514 832 1,295 1,605 928 1,658 1,617 1,491 1,323

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CONGRESSIONAL DISTRICT RANKINGS

4TH QUINTILE
Rank District Sample Size Rank District Sample Size Rank District Sample Size Rank District Sample Size

262. 263. 264. 265. 266. 267. 268. 269. 270. 271. 272. 273. 274. 275. 276. 277. 278. 279. 280. 281. 282. 283. 284.

ME-02 MA-01 NY-07 OK-01 GA-10 TX-36 WA-03 TX-04 NC-02 IN-04 MO-05 NJ-01 MO-01 TX-06 FL-13 AL-05 TX-11 NM-02 NC-12 CA-37 IL-16 FL-14 NY-19

1,684 1,318 1,107 1,701 966 795 1,696 1,324 2,045 1,456 1,329 1,166 1,340 1,344 1,234 1,396 1,389 1,607 470 765 1,178 937 1,284

285. 286. 287. 288. 289. 290. 291. 292. 293. 294. 295. 296. 297. 298. 299. 300. 301. 302. 303. 304. 305. 306. 307.

PA-10 CA-46 AR-02 CA-43 TX-14 NY-01 MI-04 NJ-06 NC-07 OH-04 MI-09 CA-51 TX-01 LA-01 FL-06 NY-05 FL-26 NC-01 CT-03 AZ-07 FL-12 FL-27 NV-04

1,598 636 1,355 377 1,179 1,046 1,386 1,042 1,305 1,585 1,235 892 1,246 1,521 1,385 663 657 1,634 1,273 946 1,369 361 658

308. 309. 310. 311. 312. 313. 314. 315. 316. 317. 318. 319. 320. 321. 322. 323. 324. 325. 326. 327. 328. 329. 330.

IL-04 FL-08 IN-06 MI-03 PA-03 PA-15 PA-13 IL-02 GA-01 IL-12 NC-11 LA-02 MO-04 OK-04 IN-01 TX-34 MD-02 RI-01 MO-07 WI-01 KY-03 CA-40 TX-30

822 1,395 1,475 1,036 1,884 1,268 768 701 1,222 1,301 1,407 874 1,426 1,514 1,254 468 1,501 1,005 1,387 1,689 1,305 455 716

331. 332. 333. 334. 335. 336. 337. 338. 339. 340. 341. 342. 343. 344. 345. 346. 347. 348.

NC-05 NY-06 PA-11 OH-11 CA-41 TX-27 KS-02 OK-03 KY-06 CA-21 SC-03 FL-02 IN-09 TX-15 TN-02 PA-17 OH-10 LA-03

1,788 560 1,230 1,225 822 882 1,446 1,764 1,137 1,172 1,299 1,316 1,188 961 1,422 1,090 1,069 1,296

32

CONGRESSIONAL DISTRICT RANKINGS

5TH QUINTILE
Rank District Sample Size Rank District Sample Size Rank District Sample Size Rank District Sample Size

349. 350. 351. 352. 353. 354. 355. 356. 357. 358. 359. 360. 361. 362. 363. 364. 365. 366. 367. 368. 369. 370. 371.

SC-06 TX-13 NY-11 CA-34 IL-15 TN-04 NY-09 FL-04 MS-01 IL-01 MS-03 PA-14 NJ-08 MI-12 CA-23 TN-07 OH-15 OH-13 GA-13 NC-08 AL-03 TN-06 NY-08

745 1,236 572 492 1,116 1,607 421 1,373 1,361 1,249 1,218 1,498 853 907 768 1,422 733 1,033 595 1,291 1,370 1,254 819

372. 373. 374. 375. 376. 377. 378. 379. 380. 381. 382. 383. 384. 385. 386. 387. 388. 389. 390. 391. 392. 393. 394.

GA-09 TX-29 MI-06 IN-07 KY-04 NC-10 FL-25 MO-03 FL-17 WI-04 CA-06 AL-02 FL-05 NC-03 FL-03 SC-05 IN-02 OK-02 VA-03 FL-20 KY-02 CA-08 GA-08

1,376 344 1,117 980 1,356 1,442 448 1,273 989 1,142 939 1,377 1,099 1,358 1,266 1,181 1,515 1,512 1,172 1,023 1,589 1,493 979

395. 396. 397. 398. 399. 400. 401. 402. 403. 404. 405. 406. 407. 408. 409. 410. 411. 412. 413. 414. 415. 416. 417.

TX-05 NJ-10 SC-07 VA-09 NJ-02 GA-12 IN-08 OH-02 OH-09 GA-02 AL-04 AL-01 OH-08 PA-01 OH-06 MI-05 TN-09 WV-01 NY-14 LA-04 NY-13 NV-01 TN-01

1,194 608 1,007 1,430 1,145 1,033 1,443 1,008 939 1,176 1,411 1,276 1,080 1,411 1,420 1,032 685 1,218 719 1,406 705 923 1,489

418. 419. 420. 421. 422. 423. 424. 425. 426. 427. 428. 429. 430. 431. 432. 433. 434.

KY-01 TN-03 WV-02 MS-02 LA-05 AL-07 GA-14 FL-24 AR-01 TX-18 AR-04 MO-08 NY-15 MS-04 MI-13 WV-03 KY-05

1,706 1,443 1,217 1,256 1,246 785 796 706 1,505 568 1,363 1,213 450 1,033 576 1,202 1,374

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CONGRESSIONAL DISTRICT RANKINGSALPHABETICAL

District Rank

CA-08 CA-09 CA-10 CA-11 CA-12 CA-13 CA-14 CA-15 CA-16 CA-17 CA-18 CA-19 CA-20 CA-21 CA-22 CA-23 CA-24 CA-25 CA-26 CA-27 CA-28 CA-29 CA-30

393 243 227 20 5 193 1 47 196 11 7 200 65 340 141 363 70 208 91 127 108 240 105 242 179 17 352 207 204 281

CA-38 CA-39 CA-40 CA-41 CA-42 CA-43 CA-44 CA-45 CA-46 CA-47 CA-48 CA-49 CA-50 CA-51 CA-52 CA-53 CO-01 CO-02 CO-03 CO-04 CO-05 CO-06 CO-07 CT-01 CT-02 CT-03 CT-04 CT-05

164 87 329 335 131 288 211 6 286 185 2 35 163 296 30 32 83 3 153 85 154 12 92 239 126 303 139 172

DE-01

258

GA-01 GA-02

316 404 218 134 97 16 60 394 372 266 121 400 367 424

IL-07 IL-08 IL-09 IL-10 IL-11 IL-12 IL-13 IL-14 IL-15 IL-16 IL-17 IL-18 IN-01 IN-02 IN-03

53 125 39 159 78 317 171 109 353 282 229 119 322 388 222 271 99 310 375 401 343

AK-01 AL-01 AL-02 AL-03 AL-04 AL-05 AL-06 AL-07 AR-01 AR-02 AR-03 AR-04 AZ-01 AZ-02 AZ-03 AZ-04 AZ-05 AZ-06 AZ-07 AZ-08 AZ-09

169 406 383 369 405 277 180 423 426 287 233 428 213 182 221 236 123 42 304 135 57

F
FL-01 FL-02 FL-03 FL-04 FL-05 FL-06 FL-07 FL-08 FL-09 FL-10 FL-11 FL-12 FL-13 FL-14 FL-15 FL-16 FL-17 FL-18 FL-19 FL-20 FL-21 FL-22 FL-23 FL-24 FL-25 FL-26 FL-27 226 342 386 356 384 299 48 309 203 241 255 305 276 283 257 247 380 148 151 391 79 149 84 425 378 301 306

GA-03 GA-04 GA-05 GA-06 GA-07 GA-08 GA-09 GA-10 GA-11 GA-12 GA-13 GA-14

H
HI-01 HI-02 8 41

IN-04 IN-05 IN-06

I
IA-01 IA-02 IA-03 IA-04 ID-01 ID-02 IL-01 IL-02 IL-03 IL-04 IL-05 IL-06 71 142 93 72 186 122 358 315 254 308 51 74

IN-07 IN-08 IN-09

K
KS-01 KS-02 KS-03 KS-04 KY-01 KY-02 KY-03 KY-04 173 337 22 183 418 392 328 376

C
CA-01 CA-02 CA-03 CA-04 CA-05 CA-06 CA-07 238 82 145 102 162 382 168

CA-31 CA-32 CA-33 CA-34 CA-35 CA-36 CA-37

D
DC-01 9

G
34

CONGRESSIONAL DISTRICT RANKINGSALPHABETICAL

District Rank

MI-01 MI-02 MI-03 MI-04

250 158 311 291 410 374 160 155 295 232 209 362 432 128 38 14 24 28 75 49 187 132 274 54 379 320 272 214 326 429

MS-01 MS-02 MS-03 MS-04 MT-01

357 421 359 431 89

NJ-06 NJ-07 NJ-08 NJ-09 NJ-10 NJ-11

292 33 361 225 396 138 156 174 279 261 416 237 118 307 290 234 129 194 300 332 264 371 355 25 351 143 415 413 430 120

NY-17 NY-18 NY-19 NY-20 NY-21 NY-22 NY-23 NY-24 NY-25 NY-26 NY-27

40 198 284 157 176 210 245 181 184 252 130

OK-03 OK-04 OK-05 OR-01 OR-02 OR-03 OR-04 OR-05

338 321 220 90 219 215 189 166

KY-05 KY-06

434 339

L
LA-01 LA-02 LA-03 LA-04 LA-05 LA-06 298 319 348 414 422 69

MI-05 MI-06 MI-07 MI-08 MI-09 MI-10 MI-11

N
NC-01 NC-02 NC-03 NC-04 NC-05 NC-06 NC-07 NC-08 NC-09 NC-10 NC-11 NC-12 NC-13 ND-01 NE-01 NE-02 NE-03 NH-01 NH-02 NJ-01 NJ-02 NJ-03 NJ-04 NJ-05 302 270 385 44 331 246 293 368 31 377 318 280 66 100 52 27 114 117 103 273 399 228 217 98

NJ-12 NM-01 NM-02 NM-03 NV-01 NV-02 NV-03 NV-04 NY-01 NY-02 NY-03 NY-04 NY-05 NY-06 NY-07 NY-08 NY-09 NY-10 NY-11 NY-12 NY-13 NY-14 NY-15 NY-16

P
PA-01 PA-02 PA-03 408 96 312 256 224 94 61 136 259 285 333 201 314 360 313 86 346 45

M
MA-01 MA-02 MA-03 MA-04 MA-05 MA-06 MA-07 MA-08 MA-09 MD-01 MD-02 MD-03 MD-04 MD-05 MD-06 MD-07 MD-08 ME-01 ME-02 263 205 116 64 26 124 88 23 104 231 324 112 67 111 62 249 18 56 262

MI-12 MI-13 MI-14 MN-01 MN-02 MN-03 MN-04 MN-05 MN-06 MN-07 MN-08 MO-01 MO-02 MO-03 MO-04 MO-05 MO-06 MO-07 MO-08

O
OH-01 OH-02 OH-03 OH-04 OH-05 OH-06 OH-07 OH-08 OH-09 OH-10 OH-11 OH-12 OH-13 OH-14 OH-15 OH-16 OK-01 OK-02 260 402 216 294 248 409 230 407 403 347 334 110 366 191 365 76 265 389

PA-04 PA-05 PA-06 PA-07 PA-08 PA-09 PA-10 PA-11 PA-12 PA-13 PA-14 PA-15 PA-16 PA-17 PA-18

R
RI-01 RI-02 325 146

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well-beingindex.com

CONGRESSIONAL DISTRICT RANKINGSALPHABETICAL

District Rank

TN-08 TN-09

253 411 297 46 29 269 395 275 36 251 152 55 278 195 350 289 344 244

TX-17 TX-18 TX-19 TX-20 TX-21 TX-22 TX-23 TX-24 TX-25 TX-26 TX-27 TX-28 TX-29 TX-30 TX-31 TX-32 TX-34 TX-36

197 427 140 190 59 107 192 63 150 73 336 161 373 330 80 19 323 267

U
UT-01 UT-02 UT-03 UT-04 68 106 13 188

W
WA-01 WA-02 WA-03 WA-04 WA-05 77 212 390 178 223 113 50 4 398 10 34 58 WA-06 WA-07 WA-08 WA-09 WA-10 WI-01 WI-02 WI-03 WI-04 WI-05 WI-06 WI-07 15 81 268 144 165 202 21 167 115 147 327 43 95 381 37 175 177

WI-08

137

S
SC-01 SC-02 SC-03 SC-04 SC-05 SC-06 SC-07 SD-01 199 170 341 235 387 349 397 101

WV-01 WV-02 WV-03 WY-01

412 420 433 133

TX-01 TX-02 TX-03 TX-04 TX-05 TX-06 TX-07 TX-08 TX-09

V
VA-01 VA-02 VA-03 VA-04 VA-05 VA-06 VA-07 VA-08 VA-09 VA-10 VA-11 VT-01

T
TN-01 TN-02 TN-03 TN-04 TN-05 TN-06 TN-07 417 345 419 354 206 370 364

TX-10 TX-11 TX-12 TX-13 TX-14 TX-15 TX-16

36

ABOUT THE STATE, COMMUNITY, AND CONGRESSIONAL DISTRICT REPORTS

SURVEY DATES
The most recently updated data in this report were based on data collected in these time periods: State Results: January 2 through December 29, 2013 Community and Congressional District Results: January 2 through December 30, 2012 and January 2 through December 29, 2013 national average for Well-Being was 66.2, Life Evaluation 48.2, Emotional Health 79.2, Physical Health 76.4, Healthy Behaviors 63.7, Work Environment 48.0, and Basic Access 81.9.

WELL-BEING INDEX DOMAINS

The Life Evaluation Index is partially based on the Cantril SelfAnchoring Striving Scale and combines the evaluation of ones present life situation with ones anticipated life situation ve years from now. The Emotional Health Index is primarily a composite of respondents daily experiences, asking respondents to think about how they felt yesterday along nine dimensions. The Physical Health Index is comprised of questions related to: Body Mass Index, disease burden, sick days, physical pain, daily energy, history of disease, and daily health experiences. The Healthy Behavior Index includes items measuring life style habits with established relationships to health outcomes. The Work Environment Index surveys workers on several factors to gauge their feelings and perceptions about their work environment. The Basic Access Index is based on 13 items measuring residents access to food, shelter, healthcare, and a safe and satisfying place to live.

SAMPLE INFORMATION
Yearly Gallup-Healthways Well-Being Index surveys completed by respondents aged 18 and older: 2013: 178,072 2012: 353,564 2011: 353,492 2010: 352,840 2009: 353,849 2008: 355,334

Maximum sample sizes for most recent results included in this report: States: 17,053 respondents Communities: 23,003 respondents Congressional Districts: 3,308 respondents Minimum sample sizes for most recent results included in this report: States: 547 respondents Communities: 459 respondents Congressional Districts: 344 respondents

POSITION SCALE
Each state is positioned from 1-50, based on composite scores as compared to all states. Each congressional district is positioned from 1-434, based on composite scores as compared to all congressional districts. Each Metropolitan Statistical Area (community) is positioned from 1-189, based on composite scores as compared to all Metropolitan Statistical Areas.

MARGIN OF ERROR
In years that overall national results were based on more than 350,000 respondents, one can say with 95% condence that the margin of sampling error for those results is 0.2 percentage points. In 2013, for results based on 178,072 respondents, one can say with 95% condence that the margin of sampling error for those results is 0.3 percentage points. Margin of sampling error of composite results at various sample sizes: 0 (bottom) 100 (top) Scale For results based on 5,000, 0.4 For results based on 1,000, 0.9 For results based on 500, 1.3 For results based on 300, 1.6 In addition to sampling error, question wording and practical diculties in conducting surveys can introduce error or bias into the ndings of public opinion polls.

WELL-BEING INDEX METHODOLOGY OVERVIEW

Interviews are conducted with respondents on landline telephones and cellular phones, with interviews conducted in Spanish for respondents who are primarily Spanish-speaking. Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline telephone and cellphone numbers are selected using randomdigit-dial methods. Landline respondents are chosen at random within each household on the basis of which member had the most recent birthday. Samples are weighted to correct for unequal selection probability, nonresponse, and double coverage of landline and cell users in the two sampling frames. They are also weighted to match the national demographics of gender, age, race, Hispanic ethnicity, education, region, population density, and phone status (cellphone only/landline only/both, cellphone mostly, and having an unlisted landline number). Demographic weighting targets are based on the most recent Current Population Survey gures for the aged 18 and older U.S. population. Phone status targets are based on the most recent National Health Interview Survey. Population density targets are based on the most recent U.S. Census. All reported margins of sampling error include the computed design eects for weighting.

WELL-BEING INDEX COMPOSITE RESULT

The Well-Being Index composite result is an average of six domains: life evaluation, emotional health, physical health, healthy behaviors, work environment, and basic access. Among states, overall Well-Being Index results ranged from a high of 70.4 (North Dakota) to a low of 61.4 (West Virginia). The 2013

37