Vermont's Health Ranking: Great for Headlines, Harder for Rural Families
Vermont’s ranking is being carried by a handful of counties that don’t represent most of the state’s geography, or most of its working-age population.
Updated April 15, 2026: A paragraph has been added to the methodology section reflecting national research on rural-urban health disparities in state rankings, prompted by reader feedback.
Vermont ranked third in the nation in the 2025 America’s Health Rankings, behind only New Hampshire and Massachusetts. The ranking reflects genuine policy achievements: near-universal insurance coverage — just 4.2 percent of residents are uninsured, third-lowest in the country — strong cancer screening rates, high childhood immunization rates, and a public health infrastructure that outperforms most states on multiple measurable indicators.
But state rankings are averages. And Vermont’s average is being carried by a handful of counties that don’t represent most of the state’s geography, or most of its working-age population.
The data tells a sharper story.
The Gap
According to county health research Compass Vermont reviewed, life expectancy in Vermont ranges from 81.3 years in Chittenden County to 76.2 years in Orleans County — a 5.1-year gap between the state’s healthiest and least healthy counties.
Rutland County, home to Vermont’s second-largest city and one of the state’s higher-poverty counties, posts a life expectancy of 76.9 years — below the national average of approximately 77.5 years, according to the National Vital Statistics System. Bennington and Caledonia counties both sit at 76.7 years, also below the national norm.
The counties at the top — Addison (81.0), Chittenden (81.3), Orange (79.6), Washington (79.0) — share a demographic profile documented in the Vermont State Health Assessment: higher household incomes, higher educational attainment, and proximity to the state’s primary academic medical center.
Chittenden County alone accounts for roughly 26 percent of Vermont’s adult population, according to the 2022 Vermont Behavioral Risk Factor Surveillance System report published by the Vermont Department of Health — and its outsized performance in the rankings shapes the state’s national reputation disproportionately.
The Behaviors Behind the Numbers
Life expectancy differences of this magnitude are correlated with measurable differences in health behavior. The Vermont Behavioral Risk Factor Surveillance System — administered annually by the Vermont Department of Health in collaboration with the CDC, with the 2022 report published in January 2024 — tracks chronic conditions and health behaviors county by county.
Obesity is the most striking finding. According to the 2022 BRFSS report, Essex County posts a 45 percent adult obesity rate — 16 points above Vermont’s state average of 29 percent and 11 points above the national average of 34 percent. Orleans County is at 36 percent, Franklin County at 35 percent. All three are flagged by the Vermont Department of Health as statistically higher than Vermont overall.
Hypertension follows the same geography. The 2022 BRFSS report shows Orleans County adults reporting hypertension at 37 percent and Rutland County at 36 percent — both statistically higher than the state average of approximately 32 percent. Chittenden County comes in at 25 percent, the only county statistically lower than the state average.
Smoking compounds the picture. Vermont Department of Health county data briefs show Orleans County’s adult smoking rate at 23 percent against a state average of approximately 17 percent and Chittenden County’s rate of 13 percent. Rutland County smokes at approximately 17 percent. Franklin County is flagged as above the state average.
COPD — chronic obstructive pulmonary disease — tells the same story. According to the 2022 BRFSS report, Orleans County is the only Vermont county flagged as statistically higher than the state average at 12 percent, versus Vermont’s 7 percent.
Disability status reinforces the pattern. The 2022 BRFSS report shows Orleans County’s adult disability rate at 32 percent — statistically the highest in the state. Chittenden County’s is 21 percent — statistically the lowest. That 11-point gap is itself a proxy for the accumulated weight of chronic illness, economic stress, and limited access to preventive care.
The Vermont Department of Health’s 3-4-50 framework — which identifies three behaviors (tobacco use, physical inactivity, and poor diet), four chronic diseases (cancer, heart disease, type 2 diabetes, and lung disease), and more than 50 percent of all deaths in Vermont — is most visible in the counties where those behaviors are most concentrated.
The Food System That Isn’t
Vermont has one of the most celebrated local food cultures in the country. It also has food deserts.
The Vermont Department of Health estimates that 30 percent of residents of low-income towns in the state are more than 15 minutes from a grocery store — a figure cited in peer-reviewed research published in the journal Agriculture and Human Values (Ren et al., 2023). In a state with limited public transportation outside of its larger towns, that distance is a meaningful barrier.
Research from that same peer-reviewed study found that poverty is the dominant factor in food access: low-income Vermonters are three times less likely to have good access to fresh, healthy food, and seven times less likely to eat fresh produce weekly, compared to Vermonters above the poverty line. At a Rutland focus group conducted as part of the research, a community member told researchers: “There are many food deserts and dead zones in Rutland, and people may not know how to apply for EBT.”
Into that gap, dollar stores have moved. Dollar General and Dollar Tree have expanded into Vermont communities with limited grocery options. In 2019, the Vermont Attorney General’s Office reached a $1.75 million settlement with Dollar General over deceptive pricing practices, finding 362 pricing errors at 22 Vermont locations. As part of that settlement, $100,000 was directed to the Vermont Foodbank. Jane Kolodinsky, a food economist at the University of Vermont, described the core problem in an interview with VTDigger: dollar stores tend to carry more processed food laden with calories and saturated fat, and while their presence technically addresses geographic access, it doesn’t address nutritional access. “I worry there will be a proliferation of places where you can get food, and the conversation goes away,” she told VTDigger in 2019. “But that shuts off the conversation of what kind of food people have access to.”
The Access Barrier
According to a February 2026 New America report on Vermont rural health access, rural Vermonters must travel up to 3.6 times farther than urban residents to reach hospital-based care. With fewer providers and longer distances, preventive care is harder to access, and chronic conditions are more likely to go unmanaged until they require acute intervention.
Research on rural Medicare beneficiaries nationally — including a 2019 study published in Health Affairs — finds a 40 percent higher rate of preventable hospitalizations and a 23 percent higher mortality rate in rural counties compared to urban counties. Vermont’s rural counties, with their documented patterns of higher chronic disease burden and lower provider density, are consistent with that national pattern.
What Vermont’s Rankings Actually Measure
The 2025 America’s Health Rankings third-place result reflects genuine statewide achievements. The ranking analyzes 99 measures of health and well-being drawn from 31 data sources, and Vermont’s performance across insurance coverage, clinical access, and preventive care is real.
But the ranking is a population-weighted average across approximately 645,000 residents — a population in which Chittenden County represents more than one in four adults. When Chittenden residents live to 81.3 years on average, they lift the state’s number measurably. When Orleans County residents live to 76.2, the state ranking absorbs it.
Vermont is not unique in this dynamic. America's Health Rankings' own analysis finds that the nation's 10 most rural states average significantly worse health outcomes than the 10 least rural states — and the gap is largest specifically in the health outcomes category. Peer-reviewed research using County Health Rankings data found that rural counties were getting worse on most health measures between 2015 and 2019, and doing so faster than urban counties, widening the disparity. The same compositional problem that makes Vermont's third-place ranking an incomplete picture of Orleans County likely applies to nearly every high-ranking state whose urban anchor carries the statewide average. Vermont is a case study in a national measurement problem. What makes its story worth telling locally is that the gap is documented, the geography is specific, and the policy implications are immediate.*
The counties with the strongest health outcomes share a documented demographic profile: higher incomes, higher educational attainment, and better access to care. The counties at the bottom — Orleans, Rutland, Caledonia, Bennington, Essex — are rural, lower-income, and further from the infrastructure that Vermont’s ranking is built on.
A RiseVT study that directly measured height and weight for 1,688 elementary school children — 98 percent of the student population in grades 1, 3, and 5 in Franklin and Grand Isle counties — found that 41 percent were overweight or obese. Essex County posts a 45 percent adult obesity rate. Orleans County has the highest disability rate in the state, the highest hypertension rate outside Rutland, and a COPD rate nearly double the Vermont average.
Vermont’s third-place national ranking is accurate. It is also a statewide average that includes both the county with an 81-year life expectancy and the county where residents die five years sooner. For Vermonters in Orleans, Rutland, Essex, Caledonia, and Bennington counties, the state’s national health reputation describes a Vermont that is statistically real — and personally distant.
Compass Vermont is reader-supported independent journalism covering Vermont policy, politics, and the stories that matter to the people who live here. If this reporting is useful to you, consider becoming a paid subscriber at compassvermont.substack.com.
It may be that most states rankings are skewed for the same reasons, and a valid comparison would take an analysis of each state as was done in this article for vermont.
My wife is a physician at UVM. When we moved here in 2011, there were similar headlines about VT being one of the healthiest states. But her initial reaction was that VT had the unhealthiest patient population she'd ever seen. There was a massive health divide between the top and bottom of the economic ladder.