The West Virginia Paradox
America's highest health burden. Near-average resilience. Something is protecting these communities beyond what the numbers predict.
Key Finding
If resilience were purely determined by health burden, West Virginia should be at the bottom. Instead, tight-knit communities, multi-generational networks, and cultural factors appear to provide unmeasured protective effects.
Highest Burden States Compared
States ranked by average health burden. Note how resilience doesn't track linearly with burden.
| Rank | State | Avg Burden | Avg Resilience | Population |
|---|---|---|---|---|
| 1 | West Virginia | +0.973 | 0.000 | 1.3M |
| 2 | Mississippi | +0.850 | 0.000 | 1.5M |
| 3 | Alabama | +0.752 | 0.000 | 3.0M |
| 4 | Arkansas | +0.648 | 0.000 | 1.9M |
| 5 | Louisiana | +0.552 | 0.000 | 2.6M |
| 6 | Oklahoma | +0.531 | 0.000 | 2.7M |
| 7 | Kentucky | +0.529 | 0.000 | 3.1M |
| 8 | Ohio | +0.509 | 0.000 | 9.3M |
| 9 | Tennessee | +0.446 | 0.000 | 5.0M |
| 10 | South Carolina | +0.378 | 0.000 | 3.3M |
| 11 | Missouri | +0.341 | 0.000 | 4.1M |
| 12 | Indiana | +0.335 | 0.000 | 4.9M |
| 13 | Kansas | +0.253 | 0.000 | 2.2M |
| 14 | Georgia | +0.215 | 0.000 | 4.6M |
| 15 | Michigan | +0.215 | 0.000 | 8.3M |
West Virginia Counties
County-level breakdown reveals significant variation within the state. University towns like Monongalia (WVU) show particularly high resilience.
Most and Least Resilient Tracts
Highest Resilience
- 54061010202 Monongalia+4.094
- 54061010600 Monongalia+4.022
- 54061010901 Monongalia+3.394
- 54061010800 Monongalia+2.870
- 54061011600 Monongalia+2.739
- 54061010700 Monongalia+2.719
- 54037972506 Jefferson+2.357
- 54037972702 Jefferson+2.139
- 54037972402 Jefferson+2.108
- 54011001300 Cabell+2.092
Lowest Resilience
- 54011001500 Cabell-2.031
- 54039000700 Kanawha-2.003
- 54055001800 Mercer-1.992
- 54055002200 Mercer-1.900
- 54047953900 McDowell-1.819
- 54019020201 Fayette-1.802
- 54089000700 Summers-1.713
- 54099020300 Wayne-1.698
- 54053955000 Mason-1.671
- 54055001700 Mercer-1.620
Possible Explanations
Social Cohesion
West Virginia's population has lower mobility than most states. Multi-generational families and tight-knit communities may provide informal support systems that buffer against health challenges.
Adapted Expectations
Communities may have developed coping mechanisms over generations of economic challenge. Cultural resilience and community identity could provide psychological protective factors.
University Effect
Monongalia County (home to WVU) shows dramatically higher resilience. Educational infrastructure creates spillover benefits that extend beyond the campus.
Measurement Limitations
Our burden index may not capture all relevant factors. The paradox could also reflect unmeasured protective factors or limitations in how we measure health outcomes.