But John Manning also acknowledges that residents with chronic diseases who need regular medical care tend to move off the island. He also says county residents tend to have higher than average incomes and higher than average educations, which are both associated with better health.

The second annual report from the University of Wisconsin's Population Health Institute and the Robert Wood Johnson Foundation found the healthiest counties after San Juan are Kittitas, Whitman, Island and King.

The report finds the least healthy of Washington's 39 counties to be Ferry County in rural northeastern Washington, which has a higher poverty rate and a higher unemployment rate than the state average.

Full List Of 2011 County Health Rankings For Washington