📊 Mixed Health Picture

North Dakota presents a complex health profile with notable strengths and concerning challenges. With a small population of approximately 783,000 (4th smallest state), the state maintains below-average heart disease mortality but faces significant issues in other areas.

Life expectancy stands at 76.9 years, slightly below the national average. The state continues to benefit from a young population and strong economic growth, but faces unique health challenges related to its rural character and resource-based economy.

💊 Emerging Drug Crisis – Women Particularly Affected

While North Dakota historically maintained one of the lowest drug overdose rates nationally (47th), recent data shows concerning trends, particularly among women. Between 2020-2022, drug death rates among women aged 20-44 increased by 111% in North Dakota (from 12.3 to 26.0 deaths per 100,000) – the second-largest increase in the nation after Mississippi.

This dramatic increase represents a significant shift for a state that previously had minimal drug overdose issues, and highlights the changing nature of the opioid crisis affecting even previously low-risk populations.

⚠️ Workplace Safety Crisis

North Dakota remains the 3rd most dangerous state to work in, with 9.7 deaths per 100,000 workers (behind only Alaska and Wyoming). This high workplace fatality rate is primarily driven by the state’s oil, gas, and agricultural industries, which involve inherently hazardous work environments.

The Bakken oil boom has contributed significantly to workplace hazards, with many workers facing risks from heavy machinery, hazardous materials, and challenging working conditions.

🍺 Alcohol-Related Health Issues

North Dakota continues to struggle with alcohol-related health problems:

• 2nd highest excessive drinking rate nationally (behind Wisconsin)
• 6th highest liver disease death rate (15 per 100,000)
• 3rd highest hypertension death rate (12.1 per 100,000)

These interconnected issues reflect the state’s culture of heavy drinking and its health consequences.

👶 Young and Growing Population

North Dakota maintains several favorable demographic characteristics:

• 4th youngest median age nationally (35.4 years)
• Tied for highest fertility rate with South Dakota (70.6 per 1,000 women age 15-44)
• 8th fastest population growth (13.3% between 2010-2019)
• Strong economic growth from energy sector development

✅ Notable Health Advantages

Despite challenges, North Dakota maintains several health strengths:

• Low drug overdose rate historically (47th nationally at 11.4 per 100,000)
• 14th lowest homicide rate (3.1 per 100,000) with only 21 total homicides annually
• 4th lowest poisoning death rate historically (11.0 per 100,000)
• Heart disease mortality below US average (152.8 vs 173.8 nationally)
• Strong rural healthcare infrastructure for a sparsely populated state

🚬 Lifestyle Challenges

North Dakota faces several lifestyle-related health concerns:

• 12th highest smoking rate (19.1% of adults)
• 13th highest obesity rate (tied with Missouri)
• High rates of mental health challenges including 17th highest suicide rate
• Cultural acceptance of heavy drinking contributing to liver disease

⚠️ Insurance Considerations for North Dakota Residents

North Dakota’s mixed health profile requires careful consideration for life insurance applications. We recommend that clients first apply for no physical exam life insurance when healthy, particularly if they haven’t received a full physical from their primary doctor within the last 12 months.

For those who don’t qualify for no-exam policies, traditional fully underwritten life insurance policies remain viable options.

🏗️ Occupational Risk Considerations

Given North Dakota’s status as the 3rd most dangerous state to work in, residents in high-risk occupations should strongly consider:

• Additional accidental death coverage
• Occupational accident insurance
• Higher life insurance coverage amounts to account for workplace risks

Workers in oil, gas, agriculture, and construction industries should be particularly mindful of these considerations.

🩺 Health-Related Underwriting Factors

North Dakota residents should be aware that certain factors may affect life insurance underwriting:

• Alcohol use: Given high rates of excessive drinking, alcohol history may receive scrutiny
• High blood pressure: 3rd highest hypertension death rate may affect hypertension underwriting
• Smoking: 12th highest smoking rate requires consideration for smoker-friendly policies

🏥 Healthcare System Performance

North Dakota’s healthcare system showed mixed performance during COVID-19. Initially, the state had the 5th highest COVID-19 death rate in 2020 (122.5 per 100,000), but improved to 15th highest by 2021 (206 per 100,000).

The state spends $13,204 per resident on healthcare (15th highest nationally), reflecting both the high costs of rural healthcare delivery and the state’s strong economy from energy sector growth.

🏥 Current Health Outlook

By 2024, COVID-19 is no longer among the leading causes of death in North Dakota. The state continues to face the ongoing challenges of rural healthcare delivery, an aging population in many counties, and the health impacts of its resource-extraction economy.

Recent IHME forecasting suggests that female health-adjusted life expectancy (HALE) in North Dakota will remain unchanged through 2050 – one of only three states where women’s health outlook neither improves nor declines significantly.

Data Sources

Centers for Disease Control and Prevention, National Center for Health Statistics, 2024-2025

America’s Health Rankings, United Health Foundation, 2024 Reports

USAFacts, Leading Causes of Death Analysis, 2024

Institute for Health Metrics and Evaluation (IHME), 2024 US Health Forecasts

CDC National Vital Statistics System, 2023-2024

March of Dimes, 2024 Report Card for North Dakota

National Institute on Drug Abuse (NIDA), Drug Overdose Data 2024

U.S. Census Bureau, Population Estimates, 2024-2025

Bureau of Labor Statistics, Workplace Fatality Data, 2024