Wellness in America depends on culture and where you live

A massive new analysis suggests Americans don’t just differ in what they earn or how long they live – they also differ in how they experience wellness.

Drawing on more than 325,000 survey responses collected over eight years, researchers found clear regional differences in wellness.

People in the Northeastern and Midwestern regions tend to score higher on “traditional” wellness, which includes physical health, finances, and social support.

Many Southern regions, by contrast, rank higher on “existential” wellness, such as purpose, meaning, and a strong sense of community identity. The pattern lines up with centuries-old settlement histories that still shape local norms today.

Measuring wellness two ways

The team worked with data from the Gallup-Healthways Well-Being Index spanning 2009–2016 and grouped responses into two broader composites.

“Traditional” wellness bundles tangible aspects of life – physical and mental health, financial security, and day-to-day social support.

“Existential” wellness captures the less tangible side – purpose, personal growth, community belonging, and living in line with one’s values.

Separating the two helps explain why some places thrive on paper (jobs, hospitals, income) yet still report a thinner sense of meaning – or the reverse.

An old map explains modern feelings

To test whether regional culture matters in wellness, the researchers turned to the American Nations Model.

This framework divides the U.S. into historical “nations” based on who settled there first. Think Yankeedom, the Deep South, Greater Appalachia, El Norte, and others.

Each region inherited durable folkways about trust, autonomy, community, and authority. Even after accounting for education and income, these cultural footprints predicted distinctive wellness profiles where people live.

The headline split was clear. Northeastern and Midwestern regions, including Yankeedom, leaned higher on traditional wellness.

Several Southern and frontier-legacy regions – such as the Deep South, Greater Appalachia, El Norte, and parts of the Far West – leaned higher on existential wellness.

In other words, the balance of “health and money” versus “purpose and belonging” shifts in systematic ways across the cultural map.

Wellness differences stand out

Statistically, the contrasts weren’t subtle. In within-region comparisons, traditional wellness significantly exceeded existential wellness in Yankeedom.

Existential wellness was higher in the Deep South and especially Greater Appalachia – the largest reversal in the set.

Several other regions showed smaller or no gaps, demonstrating that not every place fits a single mold.

These effects held in mixed-effects models that controlled for education and income and accounted for clustering within metropolitan areas.

Culture, race, and wellness

The study also looked at Black and Hispanic residents across regions. Patterns generally echoed the broader map.

Black and Hispanic respondents tended to show higher traditional wellness in Northeastern and Midwestern regions. They also reported higher existential wellness in Southern regions.

Notably, Black respondents showed consistently lower traditional wellness than white respondents across regions. In the Northeast and Midwest, they also fared worse on existential wellness.

Together, these patterns suggest that material constraints and structural disparities remain powerful drivers.

At the same time, the relatively stronger existential scores in many Southern contexts may reflect the buffering role of community networks and cultural identity.

Cultural roots of wellness

Culture shapes where institutions flourish (hospitals, schools, civic groups), how people relate to one another (trust, norms of reciprocity), and what counts as a good life (autonomy vs. solidarity, achievement vs. belonging).

Those long-running preferences influence migration, policy choices, and investments that, over time, help set the table for different “flavors” of well-being.

The authors found the pattern persisted even after adjusting for education and income, and they reported model checks to reduce issues like multicollinearity among predictors.

That suggests the American Nations framework isn’t just a clever historical story – it adds real explanatory power to why wellness feels different in different parts of the country.

Wellness policy must fit culture

If you want to boost well-being, focusing only on income or clinics may miss what makes people feel whole in a given place.

In regions that already score high on traditional metrics, investing in community identity, public spaces, and opportunities for contribution might move the needle on meaning and purpose.

In places rich in existential wellness but poorer on traditional metrics, policies that improve access to preventive care, stable work, and safety nets could pay outsized dividends.

Put simply, the study argues that wellness strategies work best when they respect the cultural ecologies where people live – strengthening what’s already strong while shoring up what’s thin.

Limits – and a next step

This is an observational study using self-reported survey data; it can’t prove cause and effect. The American Nations borders blur in real life, people move, and city-level differences within regions can be large.

Still, with more than 325,000 respondents across 110 metro areas and eight years of data, the signal is hard to ignore.

The authors call for digging into mechanisms: Which specific institutions or community practices best translate cultural inheritance into day-to-day well-being?

And which levers – health infrastructure, schooling, neighborhood design, civic organizations – offer the highest return in each region?

Place and culture shape wellness

Where you live doesn’t just shape your paycheck and your hospital bill. It also shapes how you experience a good life – whether that’s feeling financially secure and physically well, or feeling rooted in purpose and community.

The United States’ oldest settlement patterns still echo in those experiences today.

They remind policymakers that the most effective pathways to human flourishing may look different from Boston to Birmingham to El Paso.

The study is published in the journal PLOS One.

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