There’s no doubt that great strides have been made in Americans’ health over the years. Americans smoke less, are more likely to be insured and live longer. However, significant health disparities remain across the nation, influenced by individual choices, the community and clinical care.

To determine the well-being of Americans, Gallup-Healthways surveyed hundreds of thousands of Americans in 189 metropolitan areas in the United States in 2012 and 2013. The survey recorded the physical and emotional health of the residents, as well as measuring job satisfaction and access to basic needs. The resulting Gallup-Healthways Well-Being Index allows for comparisons between places and over time.

Click here to America’s Healthiest Cities

Click here to see America’s Least Healthy Cities

Not surprisingly, the physical health of residents was influenced by their habits. While less than 20% of Americans surveyed were smokers, more than 34% of Charleston, W.Va., residents smoked, the most in the nation. Residents also reported among the highest rates of obesity in the country.

In America’s healthier areas, on the other hand, smoking rates tended to be much lower. San Jose had the second lowest smoking rate, with just around 11% of respondents reporting a smoking habit. Obesity rates in the areas were among the lowest.

According to Dan Witters, research director for the Gallup-Healthways Well-Being Index, there is a clear relationship between poor physical health outcomes, such as obesity, and many of these habits. “When you’re talking about obesity, the big three are healthy eating, exercise, and smoking.”

Having access to basic needs, such as medical care, medicines, food and shelter, also appeared to play a major role in determining the physical well-being of residents. Witters explained that “providing people with a safe place to exercise” obviously plays a role in regional obesity rates. Additionally, having a personal doctor “increases the probability that they’ll have a trusted professional advising them about their healthy habits.”

In addition to having access to basic needs, a healthy state of mind made a difference in the physical health of many area-residents. In fact, half of the metro areas with the best physical health index scores were also among the least likely to report recent bouts of depression. Emotional states such as anger, stress and sadness became much less common in areas with high physical health scores as well.

Survey participants who were “clinically diagnosed with depression had a significantly elevated probability of carrying around obesity,” Witters said, as well as a variety of other chronic conditions.

Poverty and financial instability can make it very difficult to stay healthy. All but one of the 10 healthiest metro areas had poverty rates considerably lower than the national rate in 2012. Seven of the least healthy metro areas, on the other hand, had poverty rates exceeding the national rate. While access to healthy food has an impact on good nutrition, Witters pointed out that poverty played a greater role.

Many components of staying healthy are learned. If people are poorly educated, they are less likely to know how best to care for themselves. Nine of the least healthy metro areas had college education attainment rates below the national rate. Residents of eight of the healthiest regions, conversely, were considerably more likely to have attained a bachelor’s degree than Americans as a whole.

To identify the best and worst cities for physical health, 24/7 Wall St. reviewed the metropolitan areas with the best and worst scores on the Physical Health Index, part of the Gallup-Healthways Well-Being Index. The Gallup-Healthways Well-Being Index assessed 189 metropolitan statistical areas. The Physical Health Index is one of five subindices included in the groups’ overall score. The index measures physical well-being for the United States, states, metropolitan areas and occupations, based on answers to a variety of questions. In addition to these figures, we also considered income, poverty and educational attainment data from the U.S. Census Bureau, all from 2012.

These are America’s most (and least) healthy cities

America’s Healthiest Cities

10. Washington-Arlington-Alexandria, D.C.-Va.-Md.
> Physical Health Index: 79.7
> Obesity rate: 22.2% (26th lowest)
> Blood pressure: 26.7% (47th lowest)
> Poverty rate: 8.4% (4th lowest)

Washington was one of the healthiest metro areas in the nation. Less than 18% of respondents reported health problems that prevented them from participating in age-appropriate activities, compared with more than 22% of Americans who reported such health problems. Like residents in a number of the healthiest metro areas, Washington-area residents were relatively wealthy and had especially high rates of educational attainment. A typical household earned $88,233 in 2012, more than all but one other metro area. Nearly half of adults living in the region had completed at least a bachelor’s degree that year, also among the best rates nationwide. High incomes and a well-educated population likely contributed to healthy behaviors and relatively few health concerns. Less than 15% of respondents said they smoked regularly, one of the lower smoking rates in the nation.

9. San Francisco-Oakland-Fremont, Calif.
> Physical Health Index: 79.7
> Obesity rate: 19.7% (11th lowest)
> Blood pressure: 24.9% (26th lowest)
> Poverty rate: 11.9% (51st lowest)

Residents of the San Francisco metro area were among the nation’s most likely to practice healthy behaviors that can promote good health outcomes. Nearly 87% of respondents said they did not smoke, the fifth highest rate in the nation. Also, more than 70.6% of respondents told Gallup they had eaten healthy all day within the past day, and nearly 63% stated they had had regularly eaten fruits and vegetables. Both were among the highest rates in the nation. As a result, residents were able to avoid a number of serious health problems. For example, relatively few respondents had been told by a doctor that they had high blood pressure or cholesterol. Also, less than 20% of respondents surveyed were obese, among the lowest rates in the nation. By keeping their cholesterol, blood pressure and weight under control, residents were also able to avoid more serious consequences. Respondents were less likely than Americans in most metro areas to indicate they had previously suffered a heart attack or that they were diabetic.

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8. Minneapolis-St. Paul-Bloomington, Minn.-Wis.
> Physical Health Index: 79.8
> Obesity rate: 22.7% (31st lowest)
> Blood pressure: 22.7% (9th lowest)
> Poverty rate: 10.7% (24th lowest)

Residents of the Twin Cities area were among the most likely to say they had access to basic needs that could promote good health. More than 95% of respondents said they had a safe place to exercise, and more than 90% said they had health insurance, both among the highest rates in the nation. Respondents’ good health also gave them enough energy to get things done, and a large number noted that their health did not prevent them from participating in their usual activities. Residents from the Minneapolis-St. Paul metro area were quite wealthy, and therefore likely better able to afford medicine, healthy food and medical care. Median household income was more than $66,000 in 2012, among the highest in the nation, and just 10.7% of people lived below the poverty line, versus almost 16% nationwide.

7. Denver-Aurora, Colo.
> Physical Health Index: 79.8
> Obesity rate: 19.3% (6th lowest)
> Blood pressure: 22.2% (7th lowest)
> Poverty rate: 12.7% (tied for 66th lowest)

A low obesity rate was one major reason the Denver metro area was one of the nation’s healthiest. Less than one in five Denver-area residents were considered obese, considerably lower than the more than one in four of all Americans. According to a recent article from The Guardian, Denver is a “fitness mecca,” with a well-established biking infrastructure and exercise culture. Unsurprisingly, residents of the Denver area were more likely than the vast majority of Americans to exercise on a regular basis, with more than 57% reporting 30-minute exercise sessions at least three times weekly. Regular exercise cannot only limit obesity, but also promotes overall physical health. The region also had one of America’s lowest poverty rates, with less than 13% living under the poverty line. Poverty is linked to poor health outcomes because residents with low incomes often lack health education and the resources needed to afford healthy food, medicine and care service.

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6. Lafayette, La.
> Physical Health Index: 79.9
> Obesity rate: 28.1% (66th highest)
> Blood pressure: 28.8% (84th lowest)
> Poverty rate: 17.9% (127th highest)

The Lafayette metro area had some of the nation’s healthiest residents despite their unhealthy choices. Just 43.4% of respondents said they exercised regularly, the worst rate in the nation. People in Lafayette were also less likely than Americans nationwide to eat healthy foods and more likely to smoke. Despite their behaviors, residents were among the most likely Americans to report feeling well-rested and to say they were able to participate in age-appropriate activities. Only 9.2% of respondents had asthma, among the lowest rates in the nation. Still, the high rate of smoking may pose problems for residents who are asthmatic. The Centers for Disease Control and Prevention identifies tobacco smoke as one of the leading triggers for asthma attacks.

5. Madison, Wis.
> Physical Health Index: 79.9
> Obesity rate: 20.8% (16th lowest)
> Blood pressure: 22.0% (6th lowest)
> Poverty rate: 12.7% (tied for 66th lowest)

Madison area residents were among the most likely Americans to say they had access to basic needs that could promote good health. Nearly 90% of respondents said they had enough money for health care, medicine and food in the past 12 months, more than in any other metro area. Good access to basic needs, alongside limited poverty and a well-educated population, all likely contributed to the good physical health of area residents. Madison residents were among the least likely to have been diagnosed with diabetes — just 7.2% said they were diabetic compared with more than 11% of all Americans. And only 2.2% of respondents said they had been told by a doctor that they suffered from a heart attack, versus nearly 4% nationwide.

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4. Naples-Marco Island, Fla.
> Physical Health Index: 80.0
> Obesity rate: 16.5% (2nd lowest)
> Blood pressure: 31.3% (55th highest)
> Poverty rate: 13.8% (91st lowest)

Respondents from Naples were among the most likely people surveyed by Gallup to note that they felt well-rested and had enough energy to get things done, both indicators of good physical health. Another major reason the area was rated so well for physical health was the low obesity rate. Just 16.5% of those surveyed said they were obese, the second lowest rate in the nation. People also often indicated they practiced healthy behaviors that contribute to lowered obesity rates, such as eating well and not smoking. Three-fourths of people surveyed said they had consistently eaten healthy food within the past day.

3. Charlottesville, Va.
> Physical Health Index: 80.1
> Obesity rate: 18.7% (4th lowest)
> Blood pressure: 27.4% (64th lowest)
> Poverty rate: 13.9% (98th lowest)

Residents of the Charlottesville metro area were the least likely to report health problems that prevented them from participating in age-appropriate activities. Nearly 85% of respondents said they were able to do what similarly aged peers normally did, the most in the nation. Also, less than 19% of respondents were considered obese, one of the lowest rates in the nation, and recurring pain was also relatively infrequent. Both obesity and recurring pain are factors that can potentially limit people’s ability to participate in age-appropriate activities. Emotional well-being may have also contributed to the area’s overall good state of health. Respondents were less agitated by and large — more than nine in 10 survey participants said they were not angry at all in the past 24 hours, better than residents of all but two other metro areas.

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2. San Jose-Sunnyvale-Santa Clara, Calif.
> Physical Health Index: 80.6
> Obesity rate: 19.5% (8th lowest)
> Blood pressure: 23.6% (13th lowest)
> Poverty rate: 10.8% (28th lowest)

Healthy behaviors likely contributed to the good state of health in the San Jose region. Barely 10% of area inhabitants identified themselves as smokers, less than in all but one other metro area. Nearly 80% said their health did not keep them from going about their day-to-day lives, the best rate nationwide. The area’s median household income of $90,737 in 2012 was the highest nationwide, and its poverty rate of 10.8% was among the lowest. Higher incomes likely helped residents take better care of their health. More than 75% of respondents said they had visited a dentist within the past 12 months — also among the highest proportions in the United States.

1. Holland-Grand Haven, Mich.
> Physical Health Index: 80.9
> Obesity rate: 23.4% (44th lowest)
> Blood pressure: 23.9% (17th lowest)
> Poverty rate: 11.3% (37th lowest)

Holland area residents exercised less than the majority of Americans. They were also less likely to eat healthy all day compared to most Americans. Despite unhealthy habits, however, Holland metro area residents were the nation’s healthiest. Nearly nine in 10 survey participants said they had enough energy to get things done the day before, better than in all but a handful of metro areas. Also, proportionally fewer respondents suffered from chronic pain than respondents nationwide did. Just 24% reported recurring neck or back pain, compared with more than 30% nationally. And less than one in five survey participants said they had regular knee or leg pain, also nearly the lowest rate in the nation. Like many of the cities with the best health, the Holland area’s poverty rate was significantly lower than the national rate.

Click here to see America’s Least Healthy Cities

America’s Least Healthy Cities

10. Little Rock-North Little Rock-Conway, Ark.
> Physical Health Index: 72.2
> Obesity rate: 35.1% (5th highest)
> Blood pressure: 37.8% (5th highest)
> Poverty rate: 15.1% (134th lowest)

Unhealthy behaviors may help explain the poor physical health of Little Rock area’s residents. Just 56.4% of respondents told Gallup they ate healthy all day the previous 24 hours, the worst rate nationwide. Additionally, more than one-quarter of survey respondents were smokers, compared with less than 20% of Americans nationwide. Although Little Rock residents were more likely than most Americans to exercise, more than 35% were classified as clinically obese in 2013, among the largest proportions in the country. A high obesity rate may have contributed to other health issues inflicting area residents. More than 37% of survey respondents had been told by a medical practitioner that they had high blood pressure, worse than all but four other metro areas.

9. Spartanburg, S.C.
> Physical Health Index: 71.9
> Obesity rate: 30.0% (34th highest)
> Blood pressure: 36.3% (10th highest)
> Poverty rate: 20.0% (70th highest)

More than 30% of Spartanburg residents surveyed told Gallup they were unable to participate in age appropriate activities due to their health. This was one of the highest rates in the nation and one of a number of physical health problems that plagued residents. Even worse, 36.3% of respondents said they had high blood pressure, 13.7% said they had been diagnosed with diabetes and nearly 6% said they had previously suffered a heart attack — all among the worst rates in the nation. One contributing factor may be people’s unhealthy behaviors. Less than 48% of respondents exercised regularly, among the lowest rates in the nation. Also, 27.5% of people stated they smoked, one of the highest rates in America.

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8. Chattanooga, Tenn.-Ga.
> Physical Health Index: 71.7
> Obesity rate: 29.7% (40th highest)
> Blood pressure: 35.7% (14th highest)
> Poverty rate: 15.8% (164th lowest)

Less than 80% of respondents living in the Chattanooga metro area said they had enough energy to accomplish what they needed to the day before, worse than all but two other metro areas. Also, nearly 31% of respondents had health problems that hindered their ability to participate in age appropriate activities. Low incomes in the region may be contributing to the poor physical health of residents — median household income was just $43,475 in 2012, considerably lower than the national median of $51,371 that year. Low incomes may have limited Chattanooga-area residents’ ability to access basic needs, such as health care, which in turn may have also contributed to poor physical health. While the percentage of area residents covered by health insurance was inline with the national rate, just three-quarters of respondents said they had enough money for health care and medicine, among the lowest rates nationwide.

7. Clarksville, Tenn.-Ky.
> Physical Health Index: 71.6
> Obesity rate: 33.8% (8th highest)
> Blood pressure: 29.3% (92nd highest)
> Poverty rate: 19.3% (93rd highest)

Clarksville-area residents were among the nation’s most likely to be obese, with 33.8% considered obese based on their height and weight. Residents were also exceptionally likely to report recurring pains, with more than 37% stating they suffered from neck or back pain and more than 35% stating they suffered from leg or knee pain, both among the highest rates in the country. Residents’ poor health was not just limited to physical ailments. People in the Clarksville area were more likely than Americans in most metro areas to have felt angry and among the least likely to have felt happy within the previous day. Both measures are important components of emotional health, for which Clarksville was among the worst rated metro areas in the nation.

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6. Fort Smith, Ark.-Okla.
> Physical Health Index: 71.4
> Obesity rate: 29.8% (38th highest)
> Blood pressure: 35.4% (16th highest)
> Poverty rate: 22.6% (32nd highest)

Like most metro areas with poor physical health scores, health issues prevented many Fort Smith residents from participating in age-appropriate activities. Nearly 35% of survey respondents said health problems prevented them from performing activities people their age normally perform, worst among all areas surveyed. Chronic pain was likely an obstacle to usual activities for many residents. Nearly 40% of respondents reported recurring neck or back pains, second worst nationwide. In addition to poor health, residents suffered from poor economic conditions. Median household income was just $36,061 in 2012, among the lowest in the nation. Further, more than 22% were living in poverty that year, also among the worst rates in the United States.

5. Redding, Calif.
> Physical Health Index: 71.4
> Obesity rate: 27.6% (82nd highest)
> Blood pressure: 30.1% (78th highest)
> Poverty rate: 16.6% (166th highest)

Nearly a third of Redding area respondents said health problems prevented them from participating in age-appropriate activities, and 36.9% said their health kept them from their usual routines. Both rates were among the highest in the nation. Recurring pain was a common problem for many respondents, but even worse, 10.7% of those surveyed said they had previously been diagnosed with cancer, one of the highest rates in the nation. Drug use has also been a major health issue in the area. Shasta County, which makes up the Redding metro area, is considered part of the Central Valley High Intensity Drug Trafficking Area, and use of hard drugs such as methamphetamine has been cited as a problem in the county.

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4. Columbus, Ga.-Ala.
> Physical Health Index: 70.7
> Obesity rate: 32.5% (13th highest)
> Blood pressure: 32.8% (36th highest)
> Poverty rate: 18.7% (102nd highest)

Individuals in the Columbus metro area were among the nation’s most likely to suffer from recurring pain and a lack of energy. Only 68.2% said their health allowed them to take part in age-appropriate activities, one of the lowest rates in the nation. Columbus residents were among the least likely to eat healthy on a daily basis. Less than 60% of survey respondents said they ate healthy all day the previous day, worse than all but two metro areas reviewed. Financial constraints explain poor eating habits more than any other factor. More than 20% of residents were on food stamps in 2012, and just 67.1% of residents told Gallup they were able to afford food at all times the year before — among the worst rate in the nation. By comparison, 80.9% of Americans reported sufficient resources for food.

3. Kingsport-Bristol-Bristol, Tenn.-Va.
> Physical Health Index: 70.5
> Obesity rate: 30.9% (25th highest)
> Blood pressure: 40.6% (3rd highest)
> Poverty rate: 16.4% (176th highest)

Kingsport area residents suffered from a variety of health issues the past few years, including chronic pain and heart problems. More than 31% of respondents reported recurring knee and leg pain, and 40.6% complained of high blood pressure, both among the nation’s worst rates. The region’s health concerns may be tied to low rates of educational attainment and low incomes. Less than 20% of Kingsport area adults had at least a bachelor’s degree in 2012, a considerably lower rate than the nearly 30% of Americans with at least a bachelor’s degree. The area was also not particularly wealthy. A typical family in the Kingsport metro area earned just $37,769 in 2012, among the lowest median incomes nationwide.

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2. Charleston, W.Va.
> Physical Health Index: 69.0
> Obesity rate: 34.6% (6th highest)
> Blood pressure: 45.4% (2nd highest)
> Poverty rate: 15.0% (130th lowest)

Fewer survey respondents from Charleston said they were well-rested and had enough energy to go about their day during the previous day than those in all but one other metro area. Just two-thirds of respondents said health problems did not prevent them from participating in age-appropriate activities, second worst among all areas reviewed. Poor behaviors may have played a role in respondents’ poor physical health. Area residents had the highest smoking rate in the country, with more than one-third reporting a smoking habit. Poor emotional health can often be associated with poor physical health as well, and people in Charleston did not fare well on emotional health measures either. For example, only 52.1% of respondents said they learned something new or interesting in the previous 24 hours, less than any other metro area reviewed.

1. Huntington-Ashland, W.Va.-Ky.-Ohio
> Physical Health Index: 66.2
> Obesity rate: 39.5% (the highest)
> Blood pressure: 46.9% (the highest)
> Poverty rate: 18.3% (111th highest)

No metro area rated worse than Huntington for physical health. Nearly 40% of area residents were considered obese, the most of any metro area reviewed. Additionally, nearly 47% of residents had high blood pressure and 34.4% had been diagnosed as having high cholesterol, the highest rates of any metro area. Residents also were among the most likely Americans to suffer serious health consequences. Nearly 10% had previously suffered a heart attack, again worse than any metro area. Additionally, 12.5% of the population had been diagnosed with cancer, third most in the nation. Poor healthy behaviors, such as high smoking rates and limited exercise, may have been contributing factors to residents’ poor health. Additionally, limited access to basic needs, such as health care and medicine, may have also played a role.

Click here to America’s Healthiest Cities

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