The long debate over the Affordable Care Act (ACA) has, if nothing else, put the spotlight on the poor state of the country’s health and health care system. The United States ranks behind most developed nations in life expectancy despite spending more per capita on health care than any other country.

Across the country, health outcomes vary greatly. More than 30% of the adult population of Madera, California, reported being in poor health, while only 6.4% said the same in Ames, Iowa, the healthiest city in the country by our measure. This vast disparity is another issue the ACA is at least in part intended to address. Cities such as Ames — that have populations with extremely high physical and mental well-being — can teach us much about what is necessary to create healthier populations — be it income, healthy behavior, or access to care. 24/7 Wall St. created an index to identify the healthiest city in each state.

Click here to see the healthiest cities in every state.

Each city was ranked based on overall health outcomes, including length and quality of life. Also considered in the index are the range of factors that influence these outcomes. These include healthy behaviors, clinical care, social and economic indicators, and physical environment.

While the healthiest city in most states tends to be healthy relative to the country as a whole, this was not always the case. In states like Mississippi, Alabama, and West Virginia, the the healthiest metro areas scores worse than the national rate in most key metrics. For the most part, however, these cities have excellent health outcomes. Urban dwelling has many positive impacts on the health of a population, including access to healthy food, places to exercise, and the presence of enough jobs to keep people employed and earning the money they need to afford healthy options and health care.

Not surprisingly, healthy behavior tends to correlate strongly with healthier populations. High rates of exercise, for example, were common in these cities compared to the national rates of exercise. Obesity correlates very strongly with many of the leading causes of death in this country, and the healthiest cities’ obesity rates were generally lower than the national rate. Smoking also appeared to be an important health indicator. Only seven of the healthiest cities in each state had above national average smoking rates.

All but a handful of the healthiest cities had high rates of health insurance coverage. There are several reasons for this, explained Bridget Catlin, co-director of the County Health Rankings and Roadmaps Program, While people without insurance can still access care, “those that do will find it easier to access it, and will have choice of care, resources available to them, whereas those that don’t have insurance will have to go to the places that will take them.”

Another important factor in these metro areas is education. Nearly every city with a healthier population has above average rates of adults who have completed at least some college. Better-educated populations are more likely to make better health decisions, but it also come into play in other ways.

“Education definitely contributes to decision-making, but it also contributes to income and then opportunity,” Catlin said. Better-educated people often work in better-paying jobs, which allows them easier access to healthy food and to exercise options — much more than people with lower incomes. “There are multiple pathways going on here, but education is at the crux of increasing people’s opportunity for leading a healthier life.”

24/7 Wall St. created an index modelled after analysis conducted by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. To identify the healthiest city in each state, 24/7 Wall St. reviewed all U.S. metropolitan statistical areas. The index rankings are based on overall health outcomes, a weighted composite of length of life, quality of life, and overall health factors. The health factors component is itself a weighted composite of healthy behaviors, clinical care, social and economic factors, and physical environment measures. All data used were from the most recent available year.

These are the healthiest cities in every state.

1. Fairbanks, Alaska
> Pct. without health insurance: 12.6%
> Pct. food insecure: 10.0%
> Obesity rate: 29.0%
> 2014 unemployment rate: 5.7%

The Fairbanks metro area is the healthiest in Alaska. Just 11% of area adults reported fair or poor health, lower than the statewide percentage of 13.2%, which itself was well below the 16.0% of Americans reporting such low levels of health nationwide. Accessing medical care in Alaska can be a challenge. For every primary care physician in the state, there are 1,191 people, one of the highest ratios compared to other states. In Fairbanks, the ratio is even higher, at 1,432 people for every doctor. Still, the area reports strong health outcomes. For example, 5.6% of babies born in Fairbanks had a low birth weight, lower even than the statewide percentage of 5.8%, which itself was the lowest compared to other states. Fairbanks area residents also had a relatively low incidence of premature death. An estimated 5,862 years are lost per 100,000 people each year in Fairbanks due to preventable death, much lower than the state estimate of 7,321.

2. Auburn-Opelika, Alabama
> Pct. without health insurance: 11.5%
> Pct. food insecure: 11.4%
> Obesity rate: 30.0%
> 2014 unemployment rate: 5.6%

Auburn-Opelika is the healthiest city in Alabama, a state where people report relatively poor health outcomes compared to the nation. While more than 20% of adult state residents reported fair or poor health, for example, 17.5% of adults in Auburn-Opelika reported such poor health. Relatively strong insurance coverage rates likely help Auburn residents stay healthy. Uninsured people are less likely to have a primary care provider or receive preventive care. As a result, health conditions are more often diagnosed at a late stage or not diagnosed at all. Roughly 11.5% of Auburn-Opelika residents did not have health insurance, lower than both the state and the national uninsured rates of 13.6% and 14.5%.

3. Phoenix-Mesa-Scottsdale, Arizona
> Pct. without health insurance: 17.4%
> Pct. food insecure: 3.8%
> Obesity rate: 24.6%
> 2014 unemployment rate: 6.0%

While residents of Phoenix-Mesa-Scottsdale are only marginally healthier than statewide residents, they are still the healthiest in Arizona. Area residents are also only marginally healthier than the average American. For example, 15.3% of adults in Phoenix reported being in fair or poor health, compared to 15.6% for the state and 16% of adults across the nation. Still, about 20% of Phoenix-Mesa-Scottsdale residents did not participate in physical activity during their leisure time in the month preceding the survey, a significantly lower proportion than the corresponding nationwide figure of 27%. Physical activity among the area’s population may have contributed to the area’s lower obesity rate. The obesity rate among area adults was 24.6%, significantly less than the national rate of 28%.

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4. Fayetteville-Springdale-Rogers, Arkansas
> Pct. without health insurance: 15.2%
> Pct. food insecure: 7.0%
> Obesity rate: 28.3%
> 2014 unemployment rate: 4.6%

The Fayetteville metro area is the healthiest in Arkansas. Only 14.9% of adults in the metro area reported fair or poor health, a smaller share than the 19.4% of adults statewide. Physical activity is important to both physical and mental health. About 76% of Fayetteville residents have adequate access to locations for physical activity compared to less than 66% of Arkansas residents. It is not surprising therefore that a smaller share of Fayetteville residents are physically inactive compared to the percentage of the entire Arkansas population — 23.9% versus 30.5%, respectively.

5. San Luis Obispo-Paso Robles-Arroyo Grande, California
> Pct. without health insurance: 11.2%
> Pct. food insecure: 1.6%
> Obesity rate: 20.4%
> 2014 unemployment rate: 5.6%

The San Luis Obispo metro area is the healthiest in California, which itself is one of the healthier states in the nation. Healthy behaviors likely contributed to the strong health indicators. Just 10% of area residents reported a smoking habit, lower than the comparable statewide smoking rate of 12.9% and half the comparable national smoking rate. Supermarkets and medical care are also highly accessible to San Luis area residents. Even among low income households, just 1.6% reported low access to food. Nationwide, 5.7% of low income households were food insecure. And while 14.5% of Americans did not have health insurance, 11.2% of the metro area’s residents were uninsured, also lower than the state percentage.

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6. Boulder, Colorado
> Pct. without health insurance: 10.4%
> Pct. food insecure: 2.8%
> Obesity rate: 15.0%
> 2014 unemployment rate: 4.1%

Boulder is the healthiest metro area in Colorado with 9.1% of adults reporting fair or poor health, a smaller share than the 12.8% of adults statewide. Physical activity is important to both physical and mental health, and in order to be physically active people need access to parks and open spaces. Roughly 97.8% of Boulder residents said they have adequate access to locations for physical activity compared to about 92.3% of people in Colorado. Perhaps as a result, just 9.8% of Boulder residents are physically inactive, even lower than the 15.2% of Colorado residents. Based on this measure, Colorado is the most physically active state in the nation.

7. Bridgeport-Stamford-Norwalk, Connecticut
> Pct. without health insurance: 12.7%
> Pct. food insecure: 2.6%
> Obesity rate: 19.6%
> 2014 unemployment rate: 6.4%

Connecticut is one of the healthiest states in the country. Bridgeport-Stamford-Norwalk, the state’s healthiest metro area, is also one of the healthiest cities in the United States. About 20% of area residents did not participate in physical activity during their leisure time in the month preceding the survey, slightly lower than the state figure of 21.7%, and a significantly lower proportion than the corresponding nationwide figure of 27%. The higher rates of physical activity may have contributed to lower than average obesity rates across the area’s population. The obesity rate among adults in Bridgeport-Stamford-Norwalk was 19.6%, significantly lower than the state and national rates of of 24.4% and 28.3%. Also, just 12.7% of the area’s population did not have health insurance, compared to 14.5% nationwide. And only 10.0% of the city’s population reported fair or poor health, compared to 16% nationwide.

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8. Dover, Delaware
> Pct. without health insurance: 8.9%
> Pct. food insecure: 4.8%
> Obesity rate: 32.7%
> 2014 unemployment rate: 6.4%

Dover is the only major metropolitan area in Delaware, a state that ranks generally well in health measures. While the capital area’s population is not as healthy as the state’s population, it still fares better than the nation as a whole. While 12.4% of adults in Delaware reported fair or poor health, 14.7% of adults in Dover said the same. This was still better than the 16% of U.S. adults who reported less than optimal health. Uninsured people are less likely to have primary care providers or receive preventive care. As a result, health conditions often go undiagnosed or are not diagnosed at all. In Dover, just 8.9% residents did not have health insurance, far lower than the national uninsured rate of 14.5%.

9. Naples-Immokalee-Marco Island, Florida
> Pct. without health insurance: 21.0%
> Pct. food insecure: 8.1%
> Obesity rate: 19.9%
> 2014 unemployment rate: 5.9%

The health of Florida’s population is roughly the same as the health of the American population, and Naples is the healthiest metro area in the state. Healthy behaviors likely contributed to the strong health outcomes. And in Naples-Immokalee-Marco Island, 14.5% of residents smoked and 16.9% were physically inactive, each significantly lower proportions than the comparable national rates. Likely as a consequence, the Naples area ranked particularly well in one key measure — premature mortality. An estimated 5,488 years of life are lost annually per 100,000 area residents, well below the estimated 6,622 years lost each year per 100,000 Americans due to preventable deaths.

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10. Atlanta-Sandy Springs-Roswell, Georgia
> Pct. without health insurance: 18.7%
> Pct. food insecure: 7.8%
> Obesity rate: 27.6%
> 2014 unemployment rate: 6.8%

The Atlanta metro area is the healthiest in Georgia. While health indicators for the state are roughly in line with the nation’s, the health of Atlanta’s population ranks above average for mental and physical well-being. Just 12.8% of the area’s adults reported being in fair or poor health, compared to 15.8% of Georgians and 16% of the nation’s adult population. About 21.6% of Atlanta-Sandy Springs-Roswell residents did not participate in physical activity during their leisure time in the month preceding the survey, a significantly lower proportion than the corresponding state and nationwide figures of 24.3% and 27.0%. Physical activity usually contributes to lower than average obesity rates across an area’s population. However, the obesity rate among adults in Atlanta-Sandy Springs-Roswell was 27.6%, only slightly lower than the national rate of 28.3%.

11. Urban Honolulu, Hawaii
> Pct. without health insurance: 5.4%
> Pct. food insecure: 4.0%
> Obesity rate: 22.1%
> 2014 unemployment rate: 4.1%

Honolulu is the healthiest city in Hawaii. In Urban Honolulu, 5.4% of residents did not have health insurance, lower than both the state and national uninsured rates of 6.7% and 14.5%, respectively. People with health insurance are more likely to have primary care providers and receive preventive care. As a result, they are more likely to be diagnosed in the early stages of a disease progression compared to uninsured people. A relatively small uninsured population likely contributed to a relatively low incidence of premature death in the area. An estimated 5,503 years of life were lost annually per 100,000 area residents — this was lower than the state figure of 5,767 years of life lose, and significantly lower than the national figure of 6,622 years of life lost.

12. Boise City, Idaho
> Pct. without health insurance: 14.4%
> Pct. food insecure: 5.7%
> Obesity rate: 27.2%
> 2014 unemployment rate: 4.6%

Boise City ranks as the healthiest metro area in Idaho due to a range of strong health indicators, chief among them healthy behaviors. Healthy behavior is essential to healthy outcomes. In Boise City, 18.0% of residents did not participate in physical activity during their leisure time in the month preceding the survey. This was slightly lower than the statewide proportion of 19.5%, and a significantly lower proportion than the corresponding nationwide figure of 27.0%. Physical activity normally contributes to lower than average obesity rates. The obesity rate among adults in Boise City, however, was 27.2%, roughly in line with the state rate but slightly lower than the national rate of 28.3%. Residents also have the benefit of especially well-managed municipal infrastructure. For example, an extremely low 1.3% of the area’s population was exposed to low quality water, versus 6.5% of state residents and 7.0% of Americans.

13. Champaign-Urbana, Illinois
> Pct. without health insurance: 9.1%
> Pct. food insecure: 3.7%
> Obesity rate: 27.0%
> 2014 unemployment rate: 6.0%

Champaign-Urbana is the healthiest metro area in Illinois. Only 10.2% of adults reported fair or poor health, a smaller share than the 15.1% of statewide adults. Healthy behavior is essential to healthy outcomes. In Champaign-Urbana, only 16.1% of residents smoked and 21.6% were physically inactive in their leisure time in the month preceding the survey, lower proportions than both the state and national rates.

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14. Lafayette-West Lafayette, Indiana
> Pct. without health insurance: 12.5%
> Pct. food insecure: 8.7%
> Obesity rate: 27.0%
> 2014 unemployment rate: 5.1%

Indiana residents are on the whole less healthy than most Americans based on many health metrics. Still, the Lafayette area, which is the healthiest metro area in the state, is healthier than the nation as a whole. Health insurance is important not just because it reduces the economic burden on the sick, but also because it encourages populations to get routine checkups. In Lafayette-West Lafayette, 12.5% of residents did not have health insurance, lower than the state and national uninsured rates of 14.0% 14.5%. Also, healthy behavior is essential to healthy outcomes. In the Lafayette area, 17.7% of residents smoked and 25.9% were physically inactive, each significantly lower than the corresponding state and national rates.

15. Ames, Iowa
> Pct. without health insurance: 4.5%
> Pct. food insecure: 7.6%
> Obesity rate: 25.4%
> 2014 unemployment rate: 2.9%

Outpacing Iowa and the nation in most measures of healthy behavior, Ames is the healthiest city in Iowa, and the healthiest compared with all U.S. cities. Only 6.4% of Ames residents reported fair or poor health, significantly less than the 11.2% of Iowans and the 16.0% of Americans who reported such poor health. This is largely attributable to healthy behavior. Only 10.7% of Ames residents identified as smokers, compared to 17.5% of Iowa residents and 20.0% of Americans. With a relatively small uninsured population, Ames residents were also more likely to receive preventative medical care. Only 4.5% of Ames’ population did not have health insurance, nearly half the corresponding state figure and 10 percentage points lower than the national uninsured rate.

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16. Lawrence, Kansas
> Pct. without health insurance: 11.3%
> Pct. food insecure: 4.1%
> Obesity rate: 24.5%
> 2014 unemployment rate: 4.1%

Lawrence is not only the state’s healthiest metro area, but also one of the healthiest cities in the United States. In the metro area, 11.6% of adults reported fair or poor health, slightly below the 12.7% of Kansas residents and well below the 16% of U.S. adults who reported such poor health. About 18.1% of Lawrence residents did not participate in physical activity during their leisure time in the month preceding the survey, a significantly lower proportion than in the corresponding state and nationwide figures of 24.1% and 27%. The high rates of physical activity likely helped contribute to lower than average obesity rates across the area’s population. The obesity rate among adults in Lawrence was only 24.5%. The obesity rate did not exceed 25% in only 13 states.

17. Lexington-Fayette, Kentucky
> Pct. without health insurance: 12.8%
> Pct. food insecure: 5.1%
> Obesity rate: 28.7%
> 2014 unemployment rate: 5.0%

Lexington-Fayette is the healthiest city in Kentucky. However, Kentucky as a whole is not especially healthy compared to the nation, and neither is the Lexington area. Relatively poor health likely contributed to a relatively high incidence of premature death in the area, for example. An estimated 7,074 years of life were lost annually per 100,000 area residents — while this was lower than the state figure, it was higher than the national incidence of premature death. Similarly, while Lexington area residents were less likely to smoke and less likely to be obese than their statewide peers, the 19.1% smoking rate and 28.7% obesity rate were roughly inline with the respective nationwide proportions.

18. Baton Rouge, Louisiana
> Pct. without health insurance: 14.1%
> Pct. food insecure: 9.6%
> Obesity rate: 34.5%
> 2014 unemployment rate: 5.8%

Louisiana is one of the least healthy states in the country. As a result, despite the fact that Baton Rouge had the best physical and mental well-being scores in the state, it was still less healthy than the nation as a whole. Nearly 35% of Baton Rouge adults were obese, inline with the state’s obesity rate but significantly higher than the national obesity rate of 28.3%. Additionally, 17.7% of adults in Baton Rouge reported less than optimal health. Though this figure was slightly lower than the 19.6% of state residents who reported similarly poor health, it was higher than the national rate of 16.0%

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19. Portland-South Portland, Maine
> Pct. without health insurance: 9.4%
> Pct. food insecure: 4.0%
> Obesity rate: 24.1%
> 2014 unemployment rate: 4.6%

Maine is one of the healthiest states in the country. Consequently, the Portland-South Portland metro areas is not only the state’s healthiest metro area, but also one of the healthiest cities in the United States. Health insurance is important not just because it reduces the economic burden on the sick, but also because it encourages populations to get routine checkups. In Portland, for example, just 9.4% of the population did not have health insurance, compared to 11.2% of state residents and 14.5% of the nation’s population. Healthy habits like frequent physical activity are also important to both physical and mental health. Roughly 84.5% of Portland residents had adequate access to locations for physical activity compared to about 71.6% of people in Maine as a whole. Likely as a result, a smaller share of Portland-South Portland residents were physically inactive compared to the state share — at 17.5% versus 21.4%, respectively. Likely for these reasons, just 10.7% of the city’s population reported fair or poor health versus 16% of Americans.

20. California-Lexington Park, Maryland
> Pct. without health insurance: 8.4%
> Pct. food insecure: 2.6%
> Obesity rate: 26.7%
> 2014 unemployment rate: 5.4%

California-Lexington Park is the healthiest metro area in Maryland. Slightly less than 11% of adults reported fair or poor health, a smaller share than the 12.6% of statewide adults. This may be attributable to the smaller share of California-Lexington Park residents who reported unhealthy habits. Only 12.5% of residents smoked and 14.0% were heavy drinkers, while the percentages of Maryland residents who identified as smokers and who reported drinking at risky levels each exceeded 15%.

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21. Boston-Cambridge-Newton, Massachusetts
> Pct. without health insurance: 4.2%
> Pct. food insecure: 3.3%
> Obesity rate: 22.9%
> 2014 unemployment rate: 5.2%

With only 11.7% of adults reporting fair or poor health, Boston is the healthiest metro area in Massachusetts. Boston is home not only to a number of colleges and universities, but also to a well educated population. Higher levels of education are associated with better employment and higher incomes, which together tend to support healthier lifestyles. In the Boston metro area, 74.4% of adults had completed at least some college, a higher proportion than the corresponding state rate of 71.0%, which itself was among the highest nationwide. Boston’s obesity rate of 22.9% was 1 percentage point lower than the state as a whole and significantly lower than the national rate of 28.3%.

22. Ann Arbor, Michigan
> Pct. without health insurance: 7.9%
> Pct. food insecure: 6.8%
> Obesity rate: 23.6%
> 2014 unemployment rate: 4.8%

Michigan is one of the less healthy states in the country. Still, Ann Arbor, where residents are some of the healthiest in the state, is healthier than the nation as a whole. In Ann Arbor, just 9.6% of adults reported fair or poor health, a much smaller share than the 14.3% of adults in the state and the 16% in the nation who reported such poor health. While areas with high uninsured rates tend to have worse health outcomes, the opposite tends to be true in areas with high insurance coverage rates. In ann Arbor, just 7.9% of residents did not have health insurance, much lower than the state and national uninsured rates of 11.0% and 14.5%. Obesity is one of the primary drivers of preventable chronic diseases, and overweight adults are more likely to report health conditions such as diabetes and heart disease. In Ann Arbor, just 23.6% of the adult population is obese compared to 31.6% of Michigan adults.

23. Rochester, Minnesota
> Pct. without health insurance: 7.1%
> Pct. food insecure: 3.2%
> Obesity rate: 24.6%
> 2014 unemployment rate: 3.6%

Rochester is the healthiest metro area in Minnesota. Only 6.7% of adults reported fair or poor health, a smaller share than the 10.5% of statewide adults who reported such poor health. Home to one of the major locations of the world famous Mayo Clinic, metro area residents’ access to doctors was especially impressive. There were 503 people for every primary care physician in Rochester — fewer than half the amount of people per doctor in Minnesota as a whole. Bad habits are also more rare in Rochester than across the state. Only 13.4% of metro area residents were smokers, compared with 16.2% of people in Minnesota. Additionally, only 15.3% of people in Rochester reported excessive drinking, compared to 19.3% of Minnesota residents.

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24. Hattiesburg, Mississippi
> Pct. without health insurance: 17.9%
> Pct. food insecure: 5.8%
> Obesity rate: 34.3%
> 2014 unemployment rate: 6.6%

Mississippi is perhaps the least healthy state in the nation, and Hattiesburg, the state’s healthiest city, is not especially healthy compared to the rest of the country either. While the incidence of premature death was lower in Hattiesburg than across the state, for example, it was still far worse compared to the nation. An estimated 9,501 years per 100,000 people were lost each year due to preventable deaths, in contrast with the comparable state and national estimates of 10,031 and 6,622 years lost. Mississippi is the only state where the level of premature death exceeded 10,000 years annually. Similarly, while Hattiesburg’s obesity rate of 34.3% was lower than the corresponding state rate, it was significantly higher than the national obesity rate of 28.3%.

25. Columbia, Missouri
> Pct. without health insurance: 8.6%
> Pct. food insecure: 11.6%
> Obesity rate: 25.3%
> 2014 unemployment rate: 4.1%

Missouri ranks average or slightly worse than average in most measures of health. Still, Columbia, which has the best physical and mental well-being scores in the state, is healthier than the nation as a whole. In the metro area, 10.8% of adults reported fair or poor health, a lower share than the 16.0% of adults statewide and nationwide who reported such poor health. The Columbia area ranked particularly well in one key measure — premature mortality. An estimated 5,666 years of life were lost annually per 100,000 area residents — well below the state incidence of premature death of 7,714 years lost. It was also better than the estimated 6,622 years of life lost annually due to preventable deaths nationwide.

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26. Missoula, Montana
> Pct. without health insurance: 16.3%
> Pct. food insecure: 7.9%
> Obesity rate: 21.1%
> 2014 unemployment rate: 4.5%

Montana is one of only a handful of states where the obesity rate did not exceed 25%. About nine in 10 area residents had access to locations for physical activity, like parks and exercise facilities. The availability of these locations supported strong exercise habits among Missoula residents, which also likely helped lower the obesity rate for the metro area. Just over 17% of area residents reported no physical exercise whatsoever in the previous 30 days, nearly 10 percentage points below the comparable national rate. Perhaps as a result, 21.1% of area residents were obese, also one of the lowest rates nationwide.

27. Grand Island, Nebraska
> Pct. without health insurance: 13.4%
> Pct. food insecure: 3.7%
> Obesity rate: 28.6%
> 2014 unemployment rate: 3.7%

Nebraska is one of the healthiest states in the country. Not surprisingly, Grand Island is not only the state’s healthiest metro area, but also one of the healthiest in the United States. In Grand Island, just 13.4% of the population did not have health insurance compared to 14.5% of the nation’s population. Health insurance is important not just because it reduces the economic burden on the sick, but also because it encourages populations to get routine checkups. It is likely that partly for this reason, just 11.1% of the city’s population reported fair or poor health, compared to 12.0% of state residents and 16.0% of the country as a whole.

28. Reno, Nevada
> Pct. without health insurance: 18.2%
> Pct. food insecure: 5.2%
> Obesity rate: 22.2%
> 2014 unemployment rate: 7.4%

Nevada is one of the least healthy states in the country. As a result, despite the fact that Reno has the best physical and mental well-being scores in the state, it is actually less healthy than the nation as a whole by several measures. Due in part to a large uninsured population and a relatively high share of people who either drink excessively or smoke, an estimated 6,952 years of life are lost annually per 100,000 area residents due to preventable deaths — this was slightly lower than the state figure but higher than the national incidence of premature death.

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29. Manchester-Nashua, New Hampshire
> Pct. without health insurance: 10.4%
> Pct. food insecure: 3.4%
> Obesity rate: 27.2%
> 2014 unemployment rate: 4.2%

New Hampshire is one of the healthiest states in the country. Consequently, the Manchester metro area, the state’s only metro area, is one of the healthiest cities in the United States. Health insurance is important not just because it reduces the economic burden on the sick, but also because it encourages populations to get routine checkups. Roughly 10.4% of Manchester-Nashua residents did not have health insurance, roughly inline with the state rate of 10.7%, but lower than the national uninsured rate of 14.5%. People with better employment and higher incomes often also lead healthier lifestyles. Just 4.2% of Manchester’s workforce was unemployed in 2014, one of the lowest rates in the country.

30. Trenton, New Jersey
> Pct. without health insurance: 12.9%
> Pct. food insecure: 3.1%
> Obesity rate: 23.7%
> 2014 unemployment rate: 5.7%

Trenton residents reported an average of 4.6 physically or mentally unhealthy days in the month preceding the survey — less than the average 6.6 days reported by New Jersey residents. Healthy behavior is essential to healthy outcomes. In Trenton, 13.3% of residents smoked, 15.5% were binge drinkers or heavy drinkers, and 22.8% were physically inactive in the month preceding the survey, all lower proportions than the corresponding state rates. Some of these healthy habits may have also helped lower the area’s obesity, which at 23.7%, was among the lowest in the nation.

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31. Santa Fe, New Mexico
> Pct. without health insurance: 17.2%
> Pct. food insecure: 10.5%
> Obesity rate: 14.2%
> 2014 unemployment rate: 5.4%

Santa Fe is the healthiest city in New Mexico despite the fact that 17.2% of its population did not have health insurance, a much larger share than the national uninsured rate of 14.5%. Physical activity is important to both physical and mental health. Roughly 82.2% of Santa Fe residents had adequate access to locations for physical activity compared to about 75.1% of people in New Mexico as a whole. Correspondingly, a smaller share of Santa Fe residents were physically inactive compared to the share of New Mexico residents — 12.0% versus 19.8%, respectively.

32. Ithaca, New York
> Pct. without health insurance: 9.6%
> Pct. food insecure: 5.8%
> Obesity rate: 23.8%
> 2014 unemployment rate: 4.3%

With only 11.9% of adults reporting fair or poor health, Ithaca is the healthiest metro area in New York. Notably, Ithaca is home not only to several colleges and universities, but also to a well educated population. Higher levels of education are associated with better employment and higher incomes, which together tend to support healthier lifestyles. In the Ithaca metro area, 80.1% of adults had completed at least some college, a higher proportion than the state share of 65.7%. Ithaca residents had relatively healthy lifestyles. Only 12.5% of the population identified as smokers compared to 16.6% across the state. On the other hand, a larger share of Ithaca residents were physically inactive compared to the share of New York residents as a whole — 24.6% versus 23.5%, respectively. However, each were lower than the national percentage of 27.0%.

33. Raleigh, North Carolina
> Pct. without health insurance: 13.5%
> Pct. food insecure: 3.7%
> Obesity rate: 28.8%
> 2014 unemployment rate: 4.9%

Physical activity is important to both physical and mental health. Roughly 84.5% of Raleigh residents reported having adequate access to locations for physical activity, such as parks and exercise facilities, compared to about 75.8% of people across the state. Correspondingly, a smaller share of Raleigh residents are physically inactive compared to the share of all of North Carolina residents — 19.9% versus 24.9%, respectively. The physically active area residents likely contributed to Raleigh’s better health outcomes. Additionally, a smaller share of Raleigh residents were uninsured than in both North Carolina and across the country — generally lower uninsured rates contribute to better health outcomes.

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34. Fargo, North Dakota
> Pct. without health insurance: 8.6%
> Pct. food insecure: 2.9%
> Obesity rate: 26.6%
> 2014 unemployment rate: 2.7%

Though North Dakota’s obesity rate of 29.5% was slightly higher than the national rate of 28.3%, Fargo’s obesity rate of 26.6% was lower than both. Fargo residents were also more physically active than their counterparts in the rest of the state. Just 15.4% of Fargo residents did not participate in physical activity during their leisure time in the month preceding the survey, significantly lower than the corresponding statewide figure of 24.8%. Additionally, Fargo residents experienced an average of only 2.6 physically unhealthy days per month, a rate roughly in line with North Dakota’s rate, though significantly less than the nationwide rate of 3.7 days.

35. Columbus, Ohio
> Pct. without health insurance: 11.6%
> Pct. food insecure: 3.7%
> Obesity rate: 30.7%
> 2014 unemployment rate: 4.8%

Despite some relatively widespread bad habits and poor health outcomes, Columbus is the healthiest city in Ohio. The 30.7% obesity rate in Columbus was higher than both the national and statewide rates of 28.3% and 30.2%. Additionally, 18.1% of Columbus area adults reported excessive drinking, a slightly higher share than the 15.0% of Americans and 17.5% of Ohio residents who reported either binge or heavy drinking. However, Columbus residents were significantly more physically active than the average Ohioan. Slightly less than 10% of Columbus residents do not participate in physical activity during their leisure time in the month preceding the survey, a significantly lower proportion than the corresponding statewide figure of 26.2%.

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36. Oklahoma City, Oklahoma
> Pct. without health insurance: 16.9%
> Pct. food insecure: 7.9%
> Obesity rate: 31.0%
> 2014 unemployment rate: 4.0%

Oklahoma is one of the least healthy states in the country. As a result, although Oklahoma City is the healthiest in the state, the metro area is still less healthy than the nation as a whole. The Oklahoma City area ranked particularly poorly in one key measure — premature mortality. An estimated 8,474 years of life are lost annually per 100,000 area residents due to preventable deaths — significantly above the national incidence of premature death of 6,622 years lost per 100,000 people annually. Compared to national averages, the city also ranked worse in other key health metrics such as obesity, days of poor mental and physical health, and health insurance coverage.

37. Corvallis, Oregon
> Pct. without health insurance: 7.8%
> Pct. food insecure: 4.6%
> Obesity rate: 20.8%
> 2014 unemployment rate: 5.3%

Oregon is the second most physically active state in the country. Only 16.1% of residents reported no physical activity in the month preceding the survey — more than 10 percentage points lower than the corresponding national figure. An even smaller 15.4% share of Corvallis residents reported no leisure time physical activity, likely contributing to the city’s relatively low obesity rate. About 21% of adults in Corvallis were obese, significantly less than the state’s obesity rate of 26.8%.

38. State College, Pennsylvania
> Pct. without health insurance: 7.0%
> Pct. food insecure: 3.1%
> Obesity rate: 23.9%
> 2014 unemployment rate: 4.1%

Home to Pennsylvania State University, it is perhaps no coincidence that State College residents have higher educational attainment rates than their fellow residents across Pennsylvania. More than 71% of area residents had at least some college education, nearly 10 percentage points higher than the statewide rate of 61.9%. Higher levels of education often lead to better employment and higher incomes, which together tend to support healthier lifestyles. In State College, 10.3% of adults rated their health fair or poor, a smaller share than the 14.2% of adults in the state who reported such poor health.

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39. Providence-Warwick, Rhode Island
> Pct. without health insurance: 9.0%
> Pct. food insecure: 4.5%
> Obesity rate: 28.6%
> 2014 unemployment rate: 7.5%

Providence-Warwick is the only major metropolitan area in Rhode Island. It extends throughout most of the state and also into parts of Massachusetts. Not surprisingly, the metro area has similar health statistics to its home state, which is roughly average. What might be surprising, however, is area’s high health insurance coverage rate because areas with high insurance coverage rates tend to have better health outcomes. And in Providence-Warwick, just 9% of residents did not have health insurance, lower than the national uninsured rate of 14.5%. Residents reported 3.7 physically unhealthy days per month, roughly the same as the national average.

40. Hilton Head Island-Bluffton-Beaufort, South Carolina
> Pct. without health insurance: 18.9%
> Pct. food insecure: 8.3%
> Obesity rate: 24.4%
> 2014 unemployment rate: 5.7%

South Carolina is one of the least healthy states in the country. Still, the Hilton Head metro area, which was the healthiest in the state, is statistically healthier than the nation as a whole. About 17.7% of Hilton Head Island residents did not participate in physical activity during their leisure time in the month preceding the survey, a significantly lower proportion than the corresponding nationwide figure of 27.0%. Physical activity likely contributed to lower than average obesity rates across the area’s population. The obesity rate among adults in Hilton Head was 24.4%, lower than the national rate of 28.3%.

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41. Sioux Falls, South Dakota
> Pct. without health insurance: 9.1%
> Pct. food insecure: 4.9%
> Obesity rate: 27.7%
> 2014 unemployment rate: 2.8%

By many measures, South Dakota is one of the healthiest states in the country. Consequently, Sioux Falls, the state’s healthiest metro area, is also one of the healthiest cities in the United States. Sioux Falls residents reported an average of 2.4 days of poor mental health and 2.4 physically unhealthy days per month, significantly less than the 3.4 mentally unhealthy days and 3.7 physically unhealthy days reported across the country. It is likely that Sioux Falls residents sought more preventative care and had regular checkups that people nationwide because the area’s uninsured rate was 9.1%, much lower than the national uninsured rate of 14.5%.

42. Nashville-Davidson–Murfreesboro–Franklin, Tennessee
> Pct. without health insurance: 13.5%
> Pct. food insecure: 5.9%
> Obesity rate: 31.3%
> 2014 unemployment rate: 5.2%

Tennessee is one of the least healthy states in the country. And while the Nashville metro area was the healthiest region in the state, it is not especially healthy compared to the nation as a whole. The metro area’s obesity rate of 31.3% was only slightly lower than the state’s adult obesity rate of 32%, in contrast with the nationwide rate of 28.3%. Roughly 73.5% of the region’s residents had adequate access to locations for physical activity compared to about 70.3% of statewide residents. Again, each of these figures were lower than the national percentage of 85.0%. A smaller share of the Nashville metro region’s residents were physically inactive compared to the share of Tennessee residents as a whole — 26.7% versus 30.3%, respectively.

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43. Austin-Round Rock, Texas
> Pct. without health insurance: 17.4%
> Pct. food insecure: 8.1%
> Obesity rate: 23.5%
> 2014 unemployment rate: 4.2%

Physical activity is important to both physical and mental health. In Austin, the healthiest metro area in Texas, 17.8% of residents reported no leisure time physical activity versus 27.0% of Americans who reported similar levels of inactivity. Perhaps as a result, Austin’s obesity rate of 23.5% was about 5 percentage points lower than the national rate. Additionally, only 12.9% of area adults reported fair or poor health, a smaller share than the 17.8% of statewide adults who reported such poor health.

44. Logan, Utah
> Pct. without health insurance: 12.4%
> Pct. food insecure: 8.8%
> Obesity rate: 22.4%
> 2014 unemployment rate: 3.2%

Healthy behavior is essential to healthy outcomes and Utah is home to the smallest share of smokers and the second smallest share of excessive drinkers in the country. In Logan, the healthiest city in Utah, unhealthy behavior is even less pervasive. Only 4.6% of residents reported smoking, 6.3% said they were binge or heavy drinkers, and 13.9% reported no leisure time physical activities, all smaller proportions than both the nation and the state.

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45. Burlington-South Burlington, Vermont
> Pct. without health insurance: 6.2%
> Pct. food insecure: 2.8%
> Obesity rate: 23.2%
> 2014 unemployment rate: 3.3%

The Burlington-South Burlington area is the only metro area in Vermont. While this means it is the healthiest metro by default, residents were still on the whole healthier than the rest of the state, which itself was one of the healthiest in the nation. Vermont residents lose an estimated 5,430 years per 100,000 people annually due to preventable deaths, one of the lowest such estimates nationwide. In Burlington, an estimated 4,770 years were lost per 100,000 residents. Also, 10.6% of Vermonters rated their health fair or poor, nearly the lowest such percentage compared with other states. In Burlington, and even lower 9.1% of residents rated their health so low.

46. Harrisonburg, Virginia
> Pct. without health insurance: 14.7%
> Pct. food insecure: 5.5%
> Obesity rate: 28.4%
> 2014 unemployment rate: 5.2%

Healthy behavior is essential to healthy outcomes. In Harrisonburg, 12.5% of residents smoked, and 11.0% were binge or heavy drinkers, each well below the respective state proportions of 17.5% and 15.9%. In addition, about 22.9% of Harrisonburg residents did not participate in physical activity during their leisure time in the month preceding the survey, a lower proportion than in the corresponding nationwide figure of 27%. Healthy behaviors help lower the incidence of premature death. In the Harrisonburg area, an estimated 5,310 years per 100,000 people were lost each year due to preventable deaths, well below the comparable state and national estimates of 6,192 and 6,622 of years lost.

47. Bellingham, Washington
> Pct. without health insurance: 14.3%
> Pct. food insecure: 6.1%
> Obesity rate: 25.1%
> 2014 unemployment rate: 6.7%

Strong socioeconomic factors contributed to strong health outcomes in the Bellingham area. For example, higher educational attainment rates help lead to better economic outcomes, which in turn help support healthier habits and access to medical care. Just 17.1% of children lived in poverty in the state, compared to a rate of 18.6% in the state, and 22.0% of the nation’s children.

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48. Morgantown, West Virginia
> Pct. without health insurance: 11.9%
> Pct. food insecure: 8.8%
> Obesity rate: 30.1%
> 2014 unemployment rate: 4.7%

By many measures, West Virginia is the least healthy state in the country. As a result, despite the fact that Morgantown had the best overall health in the state, it was still less healthy than the nation as a whole. Slightly more than 17% of Morgantown adults rated their health fair or poor, a slightly larger share than the 16.0% of adults in the United States who rated their health so poor. About 27% of the area’s population were not physically active, a figure roughly in line with the national figure, though slightly lower than the 32.5% of West Virginians who were physically inactive. The healthiest city in West Virginia also had an obesity rate of 30.1%, nearly 3 percentage points higher than the national obesity rate.

49. La Crosse-Onalaska, Wisconsin
> Pct. without health insurance: 7.8%
> Pct. food insecure: 4.8%
> Obesity rate: 22.5%
> 2014 unemployment rate: 4.4%

Wisconsin residents led the nation in binge drinking — 24.4% of adults reported the habit versus 15% of Americans. In the La Crosse-Onalaska area, the binge drinking rate was even higher, at 25.7%. Despite the prevalence of the unhealthy habit, metro area residents were among the least likely to rate their own health poorly. Just 7.3% of area residents reported fair or poor health, well below the statewide share of 11.8% and less than half the national share of 16.0%. As is often the case, relatively strong economic conditions in the La Crosse area may also have helped lead to better health outcomes. The 2014 unemployment rate of 4.4%, for example, was lower than both the state and national jobless rates.

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50. Cheyenne, Wyoming
> Pct. without health insurance: 11.4%
> Pct. food insecure: 5.9%
> Obesity rate: 26.9%
> 2014 unemployment rate: 4.5%

Physical activity is important to both physical and mental health. Roughly 66.9% of Cheyenne residents had adequate access to locations for physical activity compared to about 68.1% of the state’s population and 85.0% of the nation. Despite more limited access, a smaller share of Cheyenne residents were physically inactive compared to the share of all of Wyoming residents — 22.4% versus 22.8% respectively. The healthiest city in Wyoming is also notable for a less admirable statistic. About 40% of fatal automotive accidents were attributable to alcohol, a significantly higher share than the corresponding nationwide figure of 31%.

Due to a data processing error, a previous version of this article excluded the healthiest cities in Hawaii and Alaska. They are now included.  

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