Think Big: Let’s Make Virginia the Healthiest State in the Country

Richmond marathon. Photo credit: Richmond Times-Dispatch.

by James A. Bacon

Virginia is a great state in which to live but it could be greater. We Virginians need to set bold goals for ourselves.

One such goal, I would humbly submit, would be to make Virginia the healthiest state in the United States. That would be not only audacious, but it would be achievable, it would be measurable, and it would align with broadly shared values.

I was discussing the idea with family and friends over the weekend, and everyone agreed, yeah, that sounds like a great idea. You don’t have to be a Republican or a Democrat, a liberal or a conservative, to want healthier communities. Everyone can jump on board. But setting the goal of becoming Numero Uno in the United States sounded a tad overwhelming to some. Perhaps we should set a lower bar — to become the healthiest state in the Southeast, or maybe the Mid-Atlantic. That sounded like wise advice at the time. But when I checked national health surveys, I discovered that Virginia and its metropolitan regions score respectably well already.

According to the United Health Foundation 2011 survey, Virginia ranked as the 20th healthiest state in the country. It was already the healthiest state in the Southeast, and even the healthiest state in the Mid-Atlantic. Yes, that means that, when ranked by a composite of such indicators as smoking, violent crime, air pollution, occupational fatalities, infant mortality, obesity,  binge drinking and access to health insurance, the Old Dominion actually out-performs Maryland (No. 22), Delaware (No. 30) and North Carolina (No. 32), states whom my companions thought might out-perform us.

That relatively strong performance cannot be attributed solely to the highly educated and health-conscious population of Northern Virginia either. While the Washington metropolitan area did rank No. 1 among the nation’s largest 50 metropolitan regions in the 2012 American Fitness Index (using a different but not entirely dissimilar methodology), Richmond ranked 11th and Virginia Beach 17th.

Thus, while it might constitute a stretch for Virginia to become as healthy as Vermont (No. 1) and New Hampshire (No. 2), the gap is bridgeable. It might take a generation to achieve but the rewards would be immense, both in terms of quality of life and economic development. A healthier population is not only a happier population — that goes without saying — but a wealthier population. A healthier population makes employers more competitive and it drains less from the public treasury.

Thanks to a generous sponsorship of Bon Secours Virginia Health System, Bacon’s Rebellion will begin exploring strategies for making Virginia and its constituent regions, especially Richmond, the healthiest state in the union. At this point in time I foresee developing three main themes (although I reserve the right to wander off topic in the pursuit of interesting stories):

  • Building more walkable, bikable regions. The premise is simple: People who walk more and bicycle more are healthier than those who don’t.
  • Eating healthier food. For the most part, this means eating more locally grown fruits and vegetables — as well as locally grown meats, cheeses and other foodstuffs.
  • Working toward cleaner water and cleaner air. Clean water and air are healthier than unclean water and air. The problem is that achieving further gains can be expensive. Which strategies, I’ll be asking, are cost-effective?

Another way to achieve healthier communities is to address deficiencies in the health care system. How do we make health care more affordable and more accessible? How do we improve medical outcomes? These issues are crucial, too. Given limited resources, however, I have chosen to focus on community health rather than the health care system because it dovetails so well with Bacon’s Rebellion‘s existing Piedmont Environmental Council sponsorship to cover transportation and land use in Virginia. (If someone would like us to cover the health care system, we are open to discussion. Check out our sponsorship page.)

Some readers may be aghast at my selection of themes. Bike trails? Green downtowns? Free-range chickens? Has Bacon gone native… or, worse, liberal? Not at all. I plan to focus on areas that should enjoy buy-in from a large cross-section of the population. But, as always, I will apply libertarian-conservative principles that emphasize private-sector solutions and ground-up civic initiatives, not top-down, command-and-control government rules, regulations and subsidies.

Also, I plan to use the Bacon’s Rebellion blog to launch a broader dialogue. I am working on a series of “idea jams” to get the conversation started on several topics tied to the themes described above. These dialogues are purely experimental. If they work, I’ll keep them going. If they don’t, I’ll pull the plug. So, stay tuned. It should be fun…. and good for you, too!

Share this article


(comments below)


(comments below)


  1. DJRippert Avatar


    Great idea. Here’s a first step – raise taxes on tobacco. According to this, Virginia has the second lowest tax on tobacco:

  2. DJRippert Avatar


    You like user pays. Take a look at smoking rates by Virginia health district and tell me more about your plans for implementing user pays policy.

    1. Here’s how I would prefer to structure a user pays system for tobacco use: Allow insurance companies to charge differential rates that reflect real actuarial experience. That way, the money goes back into the insurance pool, lowering rates for non-smokers. Under the current, tax-the-tobacco-companies regime, the tax *does* discourage smoking, but the money goes back to the government, which may or may not use the funds for public health purposes. Basically, Don, your proposal would put more money into the hands of the Richmond Clown Show, which you regard as hopelessly corrupt and inept. Think good and hard if that’s something you really want to do.

      1. DJRippert Avatar


        Great theory if you believe that people who smoke will pay for their insurance. Here’s my intuitive belief – the prevalence of smoking is inversely correlated to income. In other words, the poor tend to smoke less than the rich.

        So, how exactly will the insurance companies get those additional dollars?

        They won’t. I’ll end up paying for it anyway.

        The Imperial Clown Show in Richmond is going to take more money from everybody anyway. Taxing smokers is one way the clowns can get more money without taking it from me. The more people who don’t smoke – the less the clowns need to tax me to pay for the treatment of smoking caused health issues among those who can’t pay their full insurance.

        This is win – win!

        Oh wait – where is Phillip Morris head-quarted again?

        1. DJRippert Avatar

          Correction (typo) … the poor tend to smoke more than the rich.

      2. DJRippert Avatar

        This took about 30 seconds …

        My belief – if you’re not rich enough to (personally) pay for the extra insurance costs you should be assessed then you’re not rich enough to smoke.

        So, Jim – we’re back to taxes. Poor people, who generally can’t afford “smoking premium” insurance, will be the most likely to walk away from a $10 pack of cigs. Rich people, who generally can afford “smoking premium” insurance, will be more likely to fork over the $10 and light up.

        For once, a regressive tax makes pretty good sense.

        Of course, Richmond-based Phillip Morris might not like the idea of their best American customers (poor people, it seems) failing to use their products and sending the related health bills to others.

        Maybe the Richmond-area could just pay the extra health care costs of all Virginia smoking patients since it’s Richmond that benefits by having Phillip Morris in town.

      3. DJRippert Avatar

        Looks like Richmond’s tab for smoking related costs in Virginia comes to $1.6B per year.

        That’s about $1,000 per year per man, woman and child in the Richmond MSA.

        When can the rest of us expect to start seeing that “user pays” tax on Richmonders?

        I mean, the reason that Virginia has the second lowest cigarette tax is because Phillip Morris is head-quartered in Richmond, right? And PM makes lots of contributions to Richmond society, right? So, under the doctrine of “user pays”, the beneficiaries of Phillip Morris being in Richmond should pay for the costs of Phillip Morris being in Richmond, right?

        Let’s make this easy, Jim. You can send you annual check for $1,000 directly to me.

        1. You make a valid point that poor people, who disproportionately engage in smoking, are less likely to access private insurance, therefore they are less likely to be dissuaded by differential insurance rates. A cigarette tax is probably the best way to address that problem.

          But I have to say, I am beginning to find your in-your-face, anti-Richmond attitude wearing thin. I’d probably be more sympathetic to your idea if you didn’t cloak it in anti-Richmond rhetoric… like everything else. So, here’s my response… Northern Virginia has the authority to raise its own cigarette taxes. From the document you cite above:

          “The Northern Virginia Cigarette Tax Board (NVCTB) administers local cigarette taxes for the following 16 Northern Virginia localities: Fairfax County, City of Fairfax, Alexandria, Falls Church, Manassas, Lovettsville, Hillsboro, Middleburg, Haymarket, Dumfries, Purcellville, Leesburg, Warrenton, Clifton, Herndon and Vienna.”

          Raise your own stinking taxes.

          1. DJRippert Avatar

            Learn your stinking facts, Jim.

            Fairfax County imposes a second $.30 per pack tax on top of the state’s $.30 per pack tax. In fact, the cigarette board imposes that doubling of the state cigarette tax for every jurisdiction it encompasses.

            And Henrico County? Zero. Nada. None. No additional tax on cigarettes.

            So, given that you understand that taxing cigarettes does reduce smoking I assume you also understand that failing to tax cigarettes increases smoking.

            How much should the residents of Northern Virginia be asked to pay for Henrico County’s unwillingness to curb cigarette smoking through the imposition of local taxes on the sale of those cigarettes?

            As I asked before – you claim to like “user pays”. The Richmond area benefits from having Phillip Morris headquartered in Richmond. In turn, Richmond jurisdictions such as Henrico County avoid offending their friends at Phillip Morris by imposing local taxes on cigarettes. This, in turn, increases the smoking rate and costs everybody in the state money for treating the unfortunate victims of cigarette smoking.

            So, I ask once again – hoe much should the Richmond area pay back to the Commonwealth of Virginia for its sad refusal to use the common practice of taxation to reduce the provably deadly practice of smoking?

          2. Like I said before, I agree with your interpretation of the user-pays principle. I’m just tired of your Richmond bashing. Find a way to articulate your principle that isn’t steeped in regional animosity, and I just might go along with you. But that’s probably too much to ask.

            Until then, tax your own stinking cigarettes!

  3. larryg Avatar

    the number one thing is to keep the weight down. Exercise will not keep your weight down unless you’re going to spend 2-3 hours a day at it and most people do not.

    the other thing is that if you are overweight and out of shape – make sure you get frequent lipid panels with A1C screen (that warns you if you are headed towards Type II).

    If you keep your weight under control – exercise will come almost automatically because you’ll feel like hiking or biking or walking just naturally.

    I love one of the “reasons” given for why the US compares less favorably on life expectancy and higher health care costs- the apologists say that we are “unhealthy” compared to other countries.

    so your bar should be not the USA – we suck.

  4. Richard Avatar

    Great idea. Much more productive than arguing about roads and government.

    Have you read Omnivore’s Dilemma? Michael Pollan. Eye-opening discussion of food – how it’s produced, distortions in distribution system and incentives, local vs. nonlocal, health. About a 1/3d of the book is about Polyface Farms, near Staunton, and the Salatins (Joel). Salatin has a lot of opinions/ideas and Baconsrebellion’s coverage of the farm would be quite interesting.

    1. You’re the second person to say I should visit Polyface Farms. I’ll definitely put it on my list. I haven’t read Pollan’s book, but I did see him speak — very powerful.

  5. larryg Avatar

    Oh GEEZE! you don’t need to be an OmniVore to keep your weight under control. More power to you if that’s the way you roll but geeze making weight control all about Omni-Vore just diverts the whole issue.

    In some respects the Omni-Vore movement is yet another excuse that controlling our own weight is someone else’s fault – those that sell us bad food as if we can’t control our own impulses and need a nanny dietitian.

    HOWEVER, I’m ALL FOR looking at promising local farming activities – let’s not just get carried away about it!

    I’m a fattie – fighting the fight. My problem is that I eat too much not that I eat the wrong things. I eat GOOD things. I eat BAD things. But more than anything else I eat TOO MUCH and it’s nobody’s fault but my own.

    I go to the farmers market every week and get “good homegrown stuff… tomatoes, kale, peppers, etc and when I go to the store – I turn every item to the nutrition label to see how much fat, carbs, sugar there is.

    I buy hot dogs with 3 grams of fat… I buy diet drink…I will not buy commercial macaroni salad even though I love it because it has 25 grams of fat so I make my own with lowfat Mayo..but at the end of the day, I’m overweight – and it’s no body’s fault but my own.

    Everyone of us needs to take personal responsibility and stop blaming others.

    it’s not only dumb – it does not work.

    blah blah blah… yadda yadda yadda

    1. DJRippert Avatar

      “In some respects the Omni-Vore movement is yet another excuse that controlling our own weight is someone else’s fault – those that sell us bad food as if we can’t control our own impulses and need a nanny dietitian.”.

      I am not too sure of that.

      Let me try a little Bacon-speak:

      If factory farming were forced to pay for the fully allocated costs of its business approach it would have to charge the end consumer considerably more money in order to turn a profit. This is especially true of factory raised products at the top of the food chain such as corn raised beef. Faced with the “true cost” of the factory raised food they eat, consumers would seek more affordable substitutes. Often, they would replace high calorie, high order, high “true” cost products like beef with low calorie, low order, low “true” cost products like vegetables. In the long run, they would be healthier.

      Letting factory farms trash the environment by polluting that environment for free not only leads to an ecological mess but also leads to a knock on effect – poor health.

  6. Peter Galuszka Avatar
    Peter Galuszka

    Sounds great! Less filling!
    But it also sounds like a rich person talking. The worst data on health comes from the state’s poorest people who are stricken for whatever reason — culture, DNA, diet, culture, the tobacco industry which pays for CULTURE for the rich.
    Somehow you don’t address infant mortality, diabetes, education, etc. In another blog, you’ll talk about illegit babies and the “underclass.”Now, you are telling them to ride a bike and shop at Whole Foods.
    Am I missing something? Or is this merely the view from the upper middle class resort mountain?

    1. “Somehow you don’t address infant mortality, diabetes, education, etc.”

      That’s right. I’m trying to focus on a finite number of themes where the potential exists to make a difference. Sorry, I’m just one guy. I can’t do it all. I’m flattered, though, that you think I can.

  7. Darrell Avatar

    I think the quickest way to implement this is have Bloomberg move down to Virginia and run for Governor. He has proven plans that would not only make us healthier, but reduce the gun violence as well. I hear he is available for a new challenge, and it seems he has a keen interest in the state and it’s policies. Isn’t he also a Democratic Party Republican? What a chance to bring about bi-partisanship in the GA. He would blow Cooch and Bolling out of the water. Bloomberg, he’s high class elite instead of inbred elite.

  8. larryg Avatar

    re: factory farming and fat people who smoke

    I think it is a mistake to equate all factory food with not paying their allocated costs and in turn causing people to buy cheaper but badder food.

    You’ve just made sausage with your “point”.

    SOME factory food DOES benefit from an environmental damage subsidy but no one makes you eat MORE food than you should whether that food is bad factory food or the finest organic/omnivore food.

    Overeating is the problem. Factory farming may also be a farming but conflating the two exemplifies politics today when we link multiple issues together to form a philosophical “movement”.

    We make excuses for over eating. We want to blame others. We want to blame producers of food. Of Good Food “desserts”.

    It’s not the factory food that makes us fat – it’s putting too much of it down the gullet which is the same thing that would happen if you put too much organic/omnivore food down the gullet.

    I’m really Hot on this. The whole blame game thing is now endemic in virtually all of our politics. We blame. Name the issue and we blame. We refuse to take personal responsibility anymore for our role in why our institutions are failing us and the ” bad factory food made me fat” is an excellent example IMHO. The Clown Show made us approve more development than we have roads for. Colleges raise tuition and we pay it bu blame them. We won’t increase the gas tax but we blame VDOT for congestion. etc, etc, etc.

    We are one of the most obese countries in the world compared to other countries and I’m going out on a limb here but my view is that it has nothing whatsoever to do with factory food and everything to do with eating more than we should because food is so cheap .

    1. Larry is right, Americans need to assume more personal responsibility. Unless we do, there will never be enough money to support all the government hand-outs that people want. Boomergeddon, baby, Boomergeddon.

  9. larryg Avatar

    re: tying insurance rates to lifestyle.

    IF we did not have EMTALA and MedicAid that might work but if someone ends up with a much higher premium because of bad habits and as a consequence decides not to buy insurance – then eventually you and I will pay for their health care.

    If you want Life Insurance and you smoke – it will cost you a lot more but not buying life insurance does not usually end up with the bill sent to other taxpayers.

    When it comes to health care insurance, we debate it as if people without insurance will suffer their own fates when the reality is – that as long as we have the EMTALA law – the health care provider of last resort is you and me.

    there is no way around this reality as long as the EMTALA long continues to exist. The more we wipe out ObamaCare – the more we transfer costs to those who do have insurance.

    So opposition to ObamaCare – to REPEAL ObmaCare without repealing EMTALA is a Pyrrhic victory at best.

    If you really want to get rid of govt health care – you have to repeal EMTALA AND you have to be willing to watch 5 yr old die from appendicitis because their parents can’t pay and hospitals can deny them care.

    This has to be one of the most foolish debates in the history of the country.

    We pretend that by repealing ObamaCare, we repeal govt health care.

    The entire purpose of ObamaCare was to encourage people to buy insurance so that they’d have some skin in the payment game rather than dumping everything on the taxpayer through EMTALA and MedicAid.

    When you ask the opponents what “Replace” means it’s “free market principles” which – is somewhat a curious phrase that makes me wonder how free market “principles” compare and contrast with a truly unfettered free market but more than that – if you do not get rid of EMTALA you’re still back at square one with regard to the people who do not have insurance.

    Nothing on the REPLACE side of REPEAL actually deals with this fundamental issue.

  10. larryg Avatar

    re: “high class elite rather than inbred elite”

    ow ow ow! Good ONE!

    re: health care, ObamaCare, lifestyle choices, “free market principles”, et all, ad nauseum

    the essential position of the anti-ObamaCare, anti ANY govt healthcare is to PRESUME that the govt (you and I) will not pick up the expense tab for the uninsured and the truth is that not only will we pick up the tab via EMTALA cost-shifting but MedicAid.

    People without insurance put off going to the doctor and getting treated for Diabetes Type II until their organs start failing or their heat is so seriously compromised that they need open heart surgery.

    We pretend that we will not pay for this if these folks do not have insurance so killing ObamaCare will keep them from costing us money.

    If only this were true, I’d actually AGREE with the logic even if I found the morality of it abhorrent.

    but the reality is that we end up paying and that’s the reason we pay about twice as much per capita as every other country.

    Singapore which has more smokers than us spends 2-3K per capita.

    So we seem to be bound and determined to take the dumb path just so we can pretend we don’t pay for those that do not have insurance or will not or cannot buy it.

    Not a single opponent of ObamaCare has advocated that along with repealing ObamaCare that we should repeal EMTALA. Not one.

    it’s as if it’ not an issue when in my view it is the central issue.

    EMTALA makes all of us the providers of last resort.

    When I actually see the GOP and anti-ObamaCare folks recognize this in their position – I’ll take them more seriously as to their stated intent.

  11. susan.clapp Avatar

    I’m a researcher at the Weldon Cooper Center at UVa, and I thought you might be interested to see my recently published “Stat Chat” about Virginia’s Health Rankings – I wrote the piece to get the word out about the annual rankings, and also wrote this blog post with a little extra information I dug up while writing the piece:

    I like the idea of working to make VA the healthiest state in the country, and agree it’s an initiative we can all get behind.

  12. Susan, Thanks for the citation. Stat Chat is one of my favorite blogs (you have wonderful wonky stuff published nowhere else), but I had missed this particular post. … I’d subscribe to your RSS feed, but I don’t see where I can do it.

  13. Smoking is not the main issue… Even though it would be wonderful to get everyone to quit. I know how Mr. Bacon, you need to email me for the answer at and put in the Re: Smoking Problem Solution Request.

  14. Other major subtraction to make a safer and healthier state is concentration on what is allowed in the food system of your state. Look at the Fluoride which is the high toxic waste of the metal production, especially war materials! They say is is healthy for teeth but the truth is that it makes the teeth so strong, they become brittle! This also goes for the bones when it is in the water. It is already proven that aluminum collects in the brain and causes Alzheimer’s. This is now causing one out of 88 babies born today with serious behavorial problems such as autism. Permanent disfigurement from this hidden organ tissues ande bones depleting calcium levels, anemia, shall I go on?

Leave a Reply