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Partnership Working in Public Health.

Objectives. To more clearly articulate, and more graphically demonstrate, the impact of poverty on various health outcomes and social conditions by comparing the poorest counties to the richest counties in the United States and to other countries in the world.

Methods. We used 5-year averages for median household income to form the 3141 US counties into 50 new “states”—each representing 2% of the counties in the United States (62 or 63 counties each). We compared the poorest and wealthiest “states.”

Results. We documented dramatic and statistically significant differences in life expectancy, smoking rates, obesity rates, and almost every other measure of health and well-being between the wealthiest and poorest “states” in the country. The populations of more than half the countries in the world have a longer life expectancy than do US persons living in the poorest “state.”

Conclusions. This analysis graphically demonstrates the true impact of the extreme socioeconomic disparities that exist in the United States. These differences can be obscured when one looks only at state data, and suggest that practitioners and policymakers should increasingly focus interventions to address the needs of the poorest citizens in the United States.