The five healthiest counties are in the northern and eastern parts of the state: Monongalia, Pendleton, Doddridge, Jefferson and Hampshire. The five unhealthiest counties are in coalfield counties in Southern West Virginia: McDowell, Wyoming, Mingo, Logan and Boone.

The county health rankings annually assess nearly every county in all 50 states based on high school graduation rates, obesity, smoking, family and social support and other factors that influence health.

This year's rankings also include the number of dentists per resident and other new measures.

Dr. Rahul Gupta, executive director and health officer for the Kanawha-Charleston Health Department, said the rankings are very similar to those from years past. They reinforce what health officials already knew, which is that poverty, unemployment and a lack of education go hand in hand with poor health.

"We can't improve one without the other," Gupta said. "For a lot of people, education is their ticket out of poverty."

Kanawha County ranks 37th in the state; Putnam County ranks ninth.

Gupta said the health of a community is about more than just hospitals.

Improving health will demand that health officials work together with businesses and organizations from all sectors, Gupta said.

"Improvements and changes in health always begin from the ground up," Gupta said.

Ted Krafczyk, public information officer for the Monongalia County Health Department, said the county's high ranking reflects efforts from community organizations and hospitals, as well as local, state and federal agencies that promote good health.

Monongalia County has biking and walking trails where residents can exercise, he said. The county's low unemployment rate also has a positive effect on health, he said.

"If they can go to work and have a good job," Krafczyk said, "that certainly is a big plus in your life."

At the opposite end of the spectrum is McDowell County.

McDowell County Commission President Gordon Lambert said much of the county's health problem is related to drug abuse.

"We're probably number one in the state, and the state was number one [nationwide] from deaths by overdosing," Lambert said.

West Virginia tied with New Mexico for the most prescription-drug overdoses in 2008, according to a November 2012 policy brief from the U.S. Centers for Disease Control and Prevention.

Lambert said the county needs more Suboxone clinics to treat drug-addicted residents, but officials are having trouble getting the funding to pay for them.

"We asked for help with Suboxone clinics and ended up with one that can see 12 people," Lambert said. "We probably need one to see 500 people."

As a result, McDowell residents travel "all over" for treatment, he said.

Lambert pointed to community agencies such as McDowell County's F.A.C.E.S. (Families, Agencies, Children Enhancing Services) that aims to, among other things, combat the county's high drug abuse rates.

The county also has a fitness center where residents can exercise at no cost, he said.

For the complete county list, go to www.countyhealthrankings.org.

Reach Lori Kersey at lori.ker...@wvgazette.com or 304-348-1240.