Thanks to continued improvement in public health care, Americans today are healthier than ever. The average American is expected to live 79 years, about six years longer than in 1975. The improvement, however, has not been uniform across the United States, and some cities are stuck in the past. In some of the least healthy cities, life expectancy is as low as it was 40 years ago.

To determine the least healthy cities in the country, 24/7 Wall St. compiled an index of various health factors and outcomes. Health factors in an area, including eating and exercise habits of residents, the availability of clinical care, social and economic conditions, and the physical environment, tend to be accurate predictors of an area’s health outcomes — its residents’ length and quality of life.

According to the Centers for Disease Control and Prevention, up to 40% of deaths from the five leading causes are preventable. Premature death can often be prevented through changes to personal behavior. In every metro area in which a larger share of adults smoke, are physically inactive, and are obese than the country as a whole, the premature death rate is high and more years of potential life are lost due to premature death per capita than the national average.

Click here to see the 25 least healthy cities in America.

Residents in many of the least healthy metro areas lack the means necessary to lead a healthy lifestyle. In an email with 24/7 Wall St., Amanda Jovaag, data lead at health advocacy group County Health Rankings & Roadmaps, said, “Income provides economic resources that shape choices about housing, education, child care, food, medical care, and more. As income and wealth increase or decrease, so does health.” In each of the least healthy metro areas, the typical household makes at least $4,700 less than the typical American household.

The number of primary care physicians, dentists, and mental health providers per capita can also dictate the availability of medical care and consequently affect health outcomes. The number of preventable hospitalizations is another indicator of the quality of a metro area’s health care system. In 24 out of the 25 least healthy cities, there are more preventable hospitalizations per capita than the national average of 54 per 1,000 Medicare enrollees.

Access to the health care system is perhaps as important as its quality. In many of the cities with the worst health outcomes, a large share of residents is uninsured. “Those without insurance are often diagnosed at later, less treatable disease stages than those with insurance and, overall, have worse health outcomes, lower quality of life, and higher mortality rates,” Jovaag said.

For a variety of reasons, rural populations tend to be less healthy than urban ones. “The reasons behind this difference are varied,” Jovaag said. “Certainly, resources such as access to clinical care and healthy foods play a role, but we also know that poverty and unemployment are more prevalent in rural counties.” Many of these factors contribute to the differences in health outcomes between rural and urban cities.

As part of a recent epidemic, deaths from drug overdose have been on the rise and have contributed to the first increase in the U.S. death rate in a decade. Injury deaths, a leading cause of which is drug overdose, disproportionately affect many of the communities on this list.

To determine the least healthy cities, 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 least healthy cities, 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. Data on life expectancy came from the Institute for Health Metrics and Evaluation, a global health research center affiliated with the University of Washington.

These are the least healthy cities in every state.

25. Rocky Mount, NC
> Premature death rate: 444.3 per 100,000
> Adult obesity rate: 34.1%
> Pct. adults without health insurance: 13.4%
> Poverty rate: 20.5%

Rocky Mount is one of several low income, rural metropolitan areas in the Southeast among the least healthy in the country. More than one-fifth of Rocky Mount residents live in poverty, and almost half in rural households — each some of the higher shares nationwide. Such factors can hinder the ability to lead a healthy lifestyle and negatively impact health outcomes.

In Rocky Mount, 21.8% of adults report being in fair or poor health, much higher than the 14.0% of adults nationwide who report less than optimal health. Also, for every 100,000 metro area residents, 444 die before the age of 75, one of the highest premature death rates in the country.

24. Farmington, NM
> Premature death rate: 383.7 per 100,000
> Adult obesity rate: 30.3%
> Pct. adults without health insurance: 17.9%
> Poverty rate: 21.5%

A larger share of Farmington residents engage in unhealthy behaviors than nearly any other city in the country. Only 36.4% of the population has access to places for physical activity, a smaller share than any metro area. The area’s adult smoking rate of 21.0% is higher than the national smoking rate of 17.0%, and the area’s adult obesity rate of 30.3% is similarly higher than the national obesity rate.

Farmington also has some of the least accessible health care nationwide. About 18% of residents lack health insurance, nearly the highest uninsured rate of any metro area. Just 54.0% of older women receive proper screening for breast cancer compared to the 63.0% national rate. Similarly, just 54.4% of diabetic Medicare enrollees receive proper monitoring, the smallest share in the country.

23. Jonesboro, AR
> Premature death rate: 480.1 per 100,000
> Adult obesity rate: 37.2%
> Pct. adults without health insurance: 12.2%
> Poverty rate: 22.1%

In Jonesboro, 22.1% of residents live in poverty and 40.1% live in rural households, some of the largest shares of any metro area. Poor, rural Americans tend to struggle to find healthy food and quality health care more than wealthy, urban Americans, and as a result they often have worse health outcomes.

In addition, 34.0% of Jonesboro adults do not engage in any physical activity, a larger share than in all but four other U.S. cities. Idle lifestyles can take a toll on physical health. The city’s 37.2% obesity rate is the sixth highest in the country. Jonesboro’s smoking rate of 24.3% is similarly unhealthy, the fourth highest of any metro area.

22. Huntington-Ashland, WV-KY-OH
>Premature death rate: 464.7 per 100,000
> Adult obesity rate: 36.1%
> Pct. adults without health insurance: 8.0%
> Poverty rate: 18.8%

One-third of all Huntington-Ashland adults engage in no physical activity, much more than the nearly one-quarter national share. Lack of exercise may be one reason for the metro area’s high obesity rate, which at 36.1% is one of the highest in the country. The area’s 22.9% smoking rate is also one of the highest.

The unhealthy lifestyles in Huntington-Ashland may also contribute to the high likelihood of premature death. For every 100,000 metro area residents, 465 die before the age of 75, one of the highest premature mortality rates of any city. Huntington’s life expectancy of just 75.3 years is three years shorter than that of the average American.

21. Tuscaloosa, AL
> Premature death rate: 453.5 per 100,000
> Adult obesity rate: 33.3%
> Pct. adults without health insurance: 8.5%
> Poverty rate: 19.7%

While American adults feel physically unhealthy for 3.5 days a month on average, adults in Tuscaloosa report feeling in such a state for 4.6 days on average, nearly the most of any metro area. Frequent feelings of malaise in Tuscaloosa may be partially due to poor clinical care in the metro area.

Tuscaloosa has fewer primary care physicians, dentists, and mental health providers per capita than the country as a whole. This can significantly limit the availability of health care in the metro area. There are also 72.4 preventable hospitalizations per 1,000 Medicare enrollees, one of the highest rates in the country and an indication of low quality care. Another sign of both poor health and health care is the 11.5% of babies born underweight in Tuscaloosa — the ninth largest share.

20. Weirton-Steubenville, WV-OH
> Premature death rate: 487.9 per 100,000
> Adult obesity rate: 34.9%
> Pct. adults without health insurance: 8.8%
> Poverty rate: 16.5%

Decades of heavy pollution from a major steel industry has made Weirton-Steubenville a fairly unhealthy place to live. Soot emissions, which went unregulated until 1987, were shown in studies to significantly impact the area’s mortality rate. Although the steel industry has mostly left the metro area, today there are still 14.1 micrograms of particulate matter per cubic meter of Weirton-Steubenville air, one of the highest concentrations in the nation.

While the metro area’s mortality rate has declined with soot emissions, Weirton-Steubenville still has one of the highest instances of premature death in the country. For every 100,000 Weirton-Steubenville residents, 488 die before the age of 75. An estimated 10,373 years of potential life per 100,000 residents are lost to premature death, the sixth most nationwide.

19. Jackson, MS
> Premature death rate: 453.2 per 100,000
> Adult obesity rate: 33.8%
> Pct. adults without health insurance: 12.1%
> Poverty rate: 19.9%

For every 1,000 Medicare enrollees in Jackson, there are 69.7 preventable hospitalizations, one of the higher such rates and an indication of low quality health care. Jackson also has a higher share of babies, at 13.4%, born with low birthweight than any other metro area — yet another sign of low quality health care as well as of poor health among residents.

In Jackson, 33.8% of adults are obese, much more than the 27.0% national obesity rate. This may be partially due to the state’s large share of residents who do not exercise, which at 31.8% is one of the highest inactivity rates nationwide.

18. Fort Smith, AR-OK
> Premature death rate: 476.6 per 100,000
> Adult obesity rate: 36.5%
> Pct. adults without health insurance: 15.2%
> Poverty rate: 22.0%

Nearly one-third of adults in Fort Smith do not engage in any physical activity, one of the largest shares in the country. This could partially explain the 36.5% of adults in the metro area who are obese, a much larger share than the 27.0% national obesity rate. Fort Smith adults are also more likely to smoke than the average American. The metro area’s smoking rate of 22.7% is one of the highest nationwide.

The unhealthy behaviors in Fort Smith may increase the likelihood of poor physical health and premature death. While the average American feels in poor physical health for 3.5 days a month on average, adults in Fort Smith report feeling in such a state for five days on average, the fifth most of any metro area. There are 477 premature deaths per 100,000 area residents, nearly the highest incidence of premature death in the country.

17. Hot Springs, AR
> Premature death rate: 494.5 per 100,000
> Adult obesity rate: 31.0%
> Pct. adults without health insurance: 13.0%
> Poverty rate: 22.1%

Hot Springs is a small, largely rural, metro area with fewer than 100,000 residents. The typical area household income of just $39,558 a year is significantly less than the $53,482 national median household income. Such low incomes are likely an impediment to leading a healthy lifestyle.

In Hot Springs, 23.2% of adults are smoke, one of the highest smoking rates in the country.
The area also nearly leads the country in deaths from injury. For every 100,000 residents, there are 118 injury deaths — a leading cause of which is drug overdose — the second most of any metro area. Overall, 10,492 years of potential life are lost per 100,000 residents in Hot Springs due to premature death, the fifth most of any city nationwide.

16. Memphis, TN-MS-AR
> Premature death rate: 451.0 per 100,000
> Adult obesity rate: 34.4%
> Pct. adults without health insurance: 13.4%
> Poverty rate: 19.4%

There are 1,034 violent crimes per 100,000 Memphis residents a year, nearly three times the national violent crime rate. Exposure to crime and violence can induce stress and ultimately compromise psychological well-being. Similarly, growing up in a single-parent household can adversely affect mental health. Nearly half of all Memphis children live in single-parent households, the ninth largest share in the country.

Memphis residents feel mentally unhealthy for 4.2 days each month on average, among the most of any city. The metro area reports other poor health outcomes, including low birth weights, which is also a sign of poor health care. In Memphis, 10.8% of all babies are born underweight, one of the largest shares nationwide.

15. Montgomery, AL
> Premature death rate: 438.6 per 100,000
> Adult obesity rate: 32.9%
> Pct. adults without health insurance: 10.9%
> Poverty rate: 18.9%

By multiple socioeconomic measures, Montgomery is one of the least healthy places for children. Just 70.7% of high schoolers graduate within four years, far lower than the national 82.0% graduation rate and an indication that many residents may lack proper resources to make healthy choices.

Montgomery is one of only two metro areas in which more than one in every 100 residents has chlamydia, more than twice the national rate. On average, residents feel in poor mental and physical health for 4.6 and 4.7 days each month, respectively, nearly the most of any metro area. Another sign of an area’s poor health is low birthweight. In Montgomery, 10.9% of all babies are born underweight, the 11th largest share in the country.

14. Morristown, TN
> Premature death rate: 477.9 per 100,000
> Adult obesity rate: 29.8%
> Pct. adults without health insurance: 13.2%
> Poverty rate: 19.6%

One-fifth of Morristown residents live in poverty and 49.0% live in rural areas, each some of the largest shares in the country. Living in poor, rural conditions can limit access to health care and significantly impede the ability to maintain a healthy lifestyle. Just 58.6% of Morristown residents have adequate access to opportunities for physical activity, significantly lower than the 84.0% of all Americans who have such access. More than one-third of residents do not exercise, the eighth largest share of any metro area. While the city’s 29.8% obesity rate is not as high as most of the least healthy U.S. cities, the area’s 22.5% smoking rate is one of the highest nationwide.

13. Charleston, WV
> Premature death rate: 496.8 per 100,000
> Adult obesity rate: 32.3%
> Pct. adults without health insurance: 8.3%
> Poverty rate: 16.1%

Charleston residents have some of the least healthy behaviors of any city. Charleston’s adult smoking rate of 23.6% and inactivity rate of 31.0% are some of the largest of any U.S. metro area. Charleston also nearly leads the country in deaths from injury, the leading cause of which is drug overdose. For every 100,000 residents, there are 104 injury deaths, the seventh highest death rate nationwide.

Area residents also report some of the worst health outcomes. On average, area residents feel in poor physical health 5.0 days per month and in poor mental health for 4.7 days per month, the most and sixth most time spent in such poor states, respectively, of any metro area. Also, 497 Charleston residents per 100,000 die before the age of 75, one of the highest premature death rates in the country.

12. Alexandria, LA
> Premature death rate: 499.9 per 100,000
> Adult obesity rate: 36.1%
> Pct. adults without health insurance: 14.6%
> Poverty rate: 20.2%

In Alexandria, 20.2% of residents live in poverty and 46.2% live in rural areas, some of the largest shares in the country. Poor, rural Americans tend to have less access to healthy food and health care than wealthy, urban Americans, and as a result they often have worse health outcomes.

Nearly one-fourth of all Alexandria adults smoke, the second largest share in the country. The metro area’s 36.1% obesity rate is also fairly high and is likely a factor in the area’s high incidence of premature death. There are 500 premature deaths per 100,000 Alexandria residents, the seventh highest incidence of any metro area.

11. Anniston-Oxford-Jacksonville, AL
> Premature death rate: 520.7 per 100,000
> Adult obesity rate: 32.0%
> Pct. adults without health insurance: 10.7%
> Poverty rate: 21.7%

In Anniston-Oxford-Jacksonville, 21.7% of residents live below the poverty line, a much higher poverty rate than the 15.6% national rate. Residents of less wealthy areas tend to exhibit less healthy behaviors, and Anniston-Oxford-Jacksonville is no exception. The metro area’s adult smoking rate of 23.8% and physical inactivity rate of 33.6% are among the highest such figures in the country.

The high poverty, along with the high smoking and inactivity rates, have likely contributed to the area’s high premature death rate. For every 100,00 metro area residents, 521 die before the age of 75, the third highest premature death rate nationwide.

10. Macon, GA
>Premature death rate: 507.5 per 100,000
> Adult obesity rate: 30.9%
> Pct. adults without health insurance: 14.7%
> Poverty rate: 23.3%

The median household income in Macon of $39,609 a year is much lower than the typical American household income of $53,482 annually. The low income is likely an impediment to leading a healthy lifestyle. The area has above average smoking, obesity, and inactivity rates, as well as nearly the highest incidence of premature death in the country. Residents of Macon are expected to live for just 74.4 years, more than four years less than the national life expectancy of 78.5 years.

9. Shreveport-Bossier City, LA
> Premature death rate: 466.8 per 100,000
> Adult obesity rate: 34.5%
> Pct. adults without health insurance: 13.9%
> Poverty rate: 19.4%

A high school education significantly increases the chances of making healthy choices later in life. In Shreveport-Bossier City, only 70.0% of high schoolers graduate within four years, far lower than the national 82.0% graduation rate. Also, Shreveport-Bossier City is one of just four metro areas in which more than half of all children live in single-family households, which can also negatively impact the health of children.

Unhealthy behaviors in the metro area may also contribute to poor health outcomes. In Shreveport-Bossier City, 22.9% of adults smoke and 34.5% are obese, each some of the highest such rates nationwide. Also, 467 Shreveport-Bossier City residents per 100,000 die before the age of 75, one of the highest premature death rates of any metro area.

8. Gadsden, AL
> Premature death rate: 546.4 per 100,000
> Adult obesity rate: 34.7%
> Pct. adults without health insurance: 12.4%
> Poverty rate: 19.6%

Just 44.0% of Gadsden residents have access to places for physical activity, the second smallest share in the country. As a result, as many as 32.5% of metro area adults do not engage in any physical activity, a much larger share than the 23.0% national inactivity rate. Gadsden adults exhibit other relatively unhealthy behaviors, including the area’s 22.3% adult smoking rate and 34.7% obesity rate, each higher than the corresponding national figures.

As a result, Gadsden has some of the worst health outcomes in the nation. On average, residents feel in poor mental and physical health for 5.1 and 5.0 days per month, the most and third most time spent in such a state of any metro area. Also, 546 Gadsden residents per 100,000 die before the age of 75, the second worst premature death rate in the country.

7. Florence, SC
>Premature death rate: 513.5 per 100,000
> Adult obesity rate: 36.3%
> Pct. adults without health insurance: 12.8%
> Poverty rate: 22.0%

In Florence, 22.0% of residents live in poverty and 44.9% live in rural areas, some of the largest respective shares in the country. Like many poor, rural populations, Florence adults tend to be less healthy than the average American. Of all adults in the metro area, 21.5% smoke and 36.3% are obese, each some of the highest rates of any metro area.

Unhealthy behaviors are likely one reason for the high incidence of premature death in Florence. For every 100,000 residents, 514 die before the age of 75, the fourth most of any city in the country. Florence residents are expected to live for just 73.8 years, almost five years shorter than the national life expectancy of 78.5 years.

6. Monroe, LA
> Premature death rate: 465.7 per 100,000
> Adult obesity rate: 35.3%
> Pct. adults without health insurance: 16.0%
> Poverty rate: 24.8%

Monroe is one of the least healthy places for children. In the metro area, 38.3% of children live in poverty, one of the highest child poverty rates in the country. Children living in single-parent households are at higher risk for depression, substance abuse, and unhealthy behaviors. In Monroe, as many as 50.7% of children live in single-parent households, the third largest such share.

Almost one in every 100 Monroe residents has chlamydia, and more than one in 20 teenage girls between the ages of 15 and 19 give birth, each some of the highest rates in the country. A sign of both poor health and poor health care, 12.6% of all babies born in Monroe are underweight, the fifth largest share nationwide.

5. Albany, GA
>Premature death rate: 480.3 per 100,000
> Adult obesity rate: 35.9%
> Pct. adults without health insurance: 17.8%
> Poverty rate: 26.8%

Poverty can result in an increased risk of mortality, disease, depression, and unhealthy behaviors. Albany’s 26.8% poverty rate is the eighth highest of any metro area and likely hinders the ability of many residents to maintain a healthy lifestyle.

Only 63.8% of Albany residents have adequate access to places for physical activity, a much smaller share than the 84.0% national share. Access to food is similarly low — 31.8% of metro area resident do not have reliable access to food, one of the largest shares nationwide, which likely contributes to the high obesity and premature mortality rates among Albany residents.

4. Mobile, AL
>Premature death rate: 490.3 per 100,000
> Adult obesity rate: 36.1%
> Pct. adults without health insurance: 12.9%
> Poverty rate: 19.9%

The average Mobile adult feels in poor mental shape for five days a month on average, far longer than the 3.5 days the average American feels in such a state. Poor mental health outcomes in Mobile may be tied to multiple unhealthy behavioral and socioeconomic factors in the area.

Mobile’s 36.1% obesity rate and 29.6% inactivity rate are both far higher than the corresponding national figures. Additionally, nearly one-fifth of area residents live in poverty, and 7.0% of the workforce is unemployed, each some of the highest such figures in the country.

3. Hammond, LA
> Premature death rate: 496.1 per 100,000
> Adult obesity rate: 40.3%
> Pct. adults without health insurance: 16.4%
> Poverty rate: 21.7%

A large share of Hammond residents are relatively poor and lack access to many of the resources necessary to maintain a healthy lifestyle. The typical Hammond household makes just $40,721 a year, and just 61.7% have adequate access to locations for physical activity, such as parks and recreation centers, each some of the lowest such figures in the country.

Clinical care in the area is also subpar. The metro area has fewer than half as many primary care physicians and mental health providers per capita than the country as a whole, and nearly the most preventable hospitalizations of any city. Coupled with the area’s unhealthy behavior — Hammond is the only city in which more than two in five residents are obese — Hammond is ranked as the third least healthy place in the country.

2. Pine Bluff, AR
> Premature death rate: 500.9 per 100,000
> Adult obesity rate: 38.3%
> Pct. adults without health insurance: 10.0%
> Poverty rate: 24.2%

In Pine Bluff, 51.4% of children live in single-parent households and 44.4% of children live in poverty, the second and third largest such shares in the country. Such living situations can negatively impact the mental health of children. Pine Bluff also has among the worst teen birth and chlamydia rates nationwide.

Unhealthy behaviors are relatively common amongst Pine Bluff residents. The metro area’s 25.5% smoking rate, 36.2% inactivity rate, and 38.3% obesity rate are respectively the highest, second highest, and third highest such rates in the country. Also, 501 Pine Bluff residents per 100,000 die before the age of 75, nearly the highest premature death rate of any metro area.

1. Beckley, WV
> Premature death rate: 553.4 per 100,000
> Adult obesity rate: 34.5%
> Pct. adults without health insurance: 9.6%
> Poverty rate: 18.6%

A large share of Beckley residents are relatively poor and lack access to resources necessary to maintain a healthy lifestyle. The typical household in the area makes just $38,606 a year, and only 47.2% of residents have adequate access to opportunities for physical activity, each some of the lowest figures in the country.

The city’s 22.9% smoking rate, 34.5% obesity rate, and 34.5% inactivity rate are also among the highest of any metro area. Beckley also leads the country in injury deaths, a leading cause of which is drug overdose. For every 100,000 metro area residents, 121 die of an injury, more than twice the national rate. Also, 553 Beckley residents per 100,000 die prematurely before age 75, the highest premature death rate in the country.

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