Rankings issued for the state earlier this year are causing some concern about whether West Virginia's health is improving.
Some say the Mountain State is slowly recovering, but drastic results won't happen overnight.
A Gallup and Healthways poll released earlier this year surveyed 189 metropolitan areas across the nation in 2012 and determined that Charlestonians were the worse off, with the Huntington-Ashland, Ky., metro area slightly ahead.
In the poll, well-being scores were an average of six things: emotional health, work environment, physical health, healthy behaviors and access to basic necessities.
According to the study, Huntington-Ashland residents reported the worst physical health even though it improved slightly since 2010. Charleston, meanwhile, had the worst emotional health index score.
It wasn't all bad news for West Virginia as the Washington, D.C. metro area, including parts of Virginia, Maryland and West Virginia, reported some of the highest wellbeing in the nation, the study states.
Also released earlier this year was research from County Health Rankings and Roadmaps, ranking West Virginia's counties from top to bottom.
Monongalia, Pendleton, Doddridge, Jefferson, Hampshire, Tucker, Pleasants, Upshur, Putnam and Hardy were the top 10. Consistent with Gallup's research, generally, the eastern and northern parts of the state were scored better and the south generally was the worst.
Ranking at the very bottom are McDowell, Wyoming, Mingo, Logan, Boone and Mercer counties.
When looking at mortality, Monongalia was the best and McDowell was the worst. For morbidity, Pendleton County ranked at the top and Wyoming County was the worst.
According to the data, McDowell County's premature death rate measured in years of potential life loss has been going up for the past 10 years, while West Virginia's average has remained steady but still above the national rate.
Adult smoking, obesity and physical inactivity also were very high in the county. However, obesity, on par with West Virginia's average, has remained somewhat steady in McDowell County while the state's average has been steadily increasing.
Lincoln County actually had the worst obesity rate with Logan County falling slightly behind.
So what's wrong with the Mountain State and will it ever get any better?
Kanawha-Charleston chief health officer Dr. Rahul Gupta said the rankings are important because they should serve as a call to action.
"We are obviously continuing to see a disparaging health outcomes within the state itself," he said.
"It's not only about health. It tells us health is not the only one factor. It's a responsibility of the entire community. So, when we look at a map and see the county health rankings and see if you live in a healthy community, individuals find it easier to live a healthy lifestyle. For example, if you're in a healthier environment, it's easier to make healthier choices. If you live in an unhealthier environment, the opposite is true."
Gupta said it's important to remember that West Virginia didn't become unhealthy overnight, so it will take time to get on the road to recovery.
"It starts by leaders in government, business, health care and others to come together and start to initiate a dialogue."
And he says that's starting to happen in many West Virginia communities.
"We are utilizing the funding through the community transformation grant to work with our partners in McDowell County, Wyoming County and Mercer County," he said. "They are starting dialogue to have people discuss these things and have different factors such as in Reconnecting McDowell and FACES."
Gupta stressed that it's not just about addressing health in West Virginia. Socioeconomic factors, such as poor childhood outcomes, job outcomes and poverty also play a part in health behaviors, he said.
"Tobacco use, obesity as a result of lack of exercise and fewer counties having complete clean indoor air regulations. Again, we have a lot of counties … with a built-in environment for pedestrian and bicycle routes, where you can safely walk to school or work. The difficult terrain doesn't help and makes it challenging in the mountainous areas."
However, he said even though West Virginia's health seems bleak, it is improving slowly.
"I can say this much, that progress is being made. We have more progress today than we did years ago. So, I think we are getting ourselves on the path from a sociocultural standpoint and a health standpoint to put on that path to start change."
However, someone always will have to be last in line on these surveys.
"Rather than say from my perspective that this is ranked 55 or 54, it gives us the opportunity to say there are difficulties in health like difficulties in education and poverty across the state. What that makes us do is start to put focus on the area that needs more development and help those, rather than those who need less. What we're realizing obviously is to empower the local communities. Give them tools that they need to improve and do healthy opportunities and choices, rather than to take a top-down approach."