Special Report

Least Healthy City in Every State

Overweight Businessman Having his Blood Pressure Taken by a Doctor
Thinkstock

Life expectancy varies by nearly 10 years across U.S. cities. While the United States is the global leader for health spending, it trails many much poorer nations in health outcomes. While a typical resident of San Jose, California has among the highest life expectancies in the world at 82.7 years, a typical resident of Gadsden, Alabama has the same life expectancy as someone living in Honduras — a country which spends 45 times less per person on health care than the United States.

Health outcomes can differ dramatically even within a single state. Within California, for example, there are such stark differences. While only 11.6% of adults in the San Jose-Sunnyvale-Santa Clara area report fair or poor health, more than 25% do in the Visalia-Porterville area. However, more than one in four adults in the Visalia-Porterville area report fair or poor health.

To determine the least healthy city in every state, 24/7 Wall St. reviewed measures of healthy behavior, clinical care, social and economic conditions, the physical environment and other factors in all U.S. metro areas. We constructed an index out of these factors that can capture the health of a city’s residents.

Click here to see the least health city in every state.

Click here to see the healthiest city in every state. 

While residents in these cities are the least healthy compared to the other cities in their state, they are not necessarily the least healthy of all residents statewide. Because of limited access to quality clinical care, poor social and economic conditions, and many other factors, people living in rural areas tend to be less healthy than those living in large cities. Consequently, by some measures, residents of even some of the least healthy metro areas in the country can lead longer, healthier lives than many Americans living in rural areas.

For example, one of the most important measures of an area’s health is the premature death rate. This rate measures the number of deaths of residents younger than 75 years old per 100,000 area residents. Only nine of the 50 cities on this list have a premature death rate higher than the national rate. The highest premature death rate of any metro area is in Beckley, West Virginia.

Smoking and obesity rates are among the most significant behavioral factors affecting a population’s health. As these rates rise, so does the increased risk of many preventable diseases as well as of premature deaths. The smoking and obesity rates in the majority of the cities on this list are higher than the nationwide rates.

Social and economic conditions can also affect the health of residents in a metro area. Because low-income or unemployed residents may not be able to afford adequate health care, the least healthy city in a state tends to be among the poorest. In all but 12 of the 50 cities on this list, the median household income is lower than the national median income. Also, in the majority of these cities, the unemployment rate is higher than the country.

To identify the least healthy city in every state, 24/7 Wall St. created an index modelled after an analysis conducted by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. 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 are for the most recent available year. The index was used to compare all U.S. metropolitan statistical areas as defined by the U.S. Census Bureau. Four states — Delaware, New Hampshire, Rhode Island, Vermont — have only one metropolitan statistical area. In these states, the sole metro area is listed by default.

Mobile, Alabama
Thinkstock

1. Mobile, Alabama
> Premature death rate: 490.3 (per 100,000 residents)
> Adult obesity rate: 36.1%
> Adults without health insurance: 12.9%
> Median household income: $43,844

Office Buildings City Skyline Downtown Anchorage Alaska United States

2. Anchorage, Alaska
> Premature death rate: 345.0 (per 100,000 residents)
> Adult obesity rate: 27.4%
> Adults without health insurance: 15.7%
> Median household income: $76,453

Lake Havasu City-Kingman, Arizona
Thinkstock

3. Lake Havasu City-Kingman, Arizona
> Premature death rate: 498.7 (per 100,000 residents)
> Adult obesity rate: 28.1%
> Adults without health insurance: 17.3%
> Median household income: $38,456

Pine Bluff, Arkansas
Wikimedia Commons

4. Pine Bluff, Arkansas
> Premature death rate: 500.9 (per 100,000 residents)
> Adult obesity rate: 38.3%
> Adults without health insurance: 10.0%
> Median household income: $36,856

Visalia, California
Thinkstock

5. Visalia-Porterville, California
> Premature death rate: 353.9 (per 100,000 residents)
> Adult obesity rate: 29.5%
> Adults without health insurance: 15.3%
> Median household income: $42,863

Pueblo riverwalk, Colorado
Wikimedia Commons

6. Pueblo, Colorado
> Premature death rate: 401.9 (per 100,000 residents)
> Adult obesity rate: 26.3%
> Adults without health insurance: 9.1%
> Median household income: $41,974

Wooster Square in New Haven, Connecticut
Thinkstock

7. New Haven-Milford, Connecticut
> Premature death rate: 290.8 (per 100,000 residents)
> Adult obesity rate: 26.3%
> Adults without health insurance: 6.7%
> Median household income: $61,646

Dover, Delaware
Thinkstock

8. Dover, Delaware
> Premature death rate: 379.0 (per 100,000 residents)
> Adult obesity rate: 33.2%
> Adults without health insurance: 7.4%
> Median household income: $55,169

Homosassa Springs, Florida
Wikimedia Commons

9. Homosassa Springs, Florida
> Premature death rate: 445.8 (per 100,000 residents)
> Adult obesity rate: 27.1%
> Adults without health insurance: 13.3%
> Median household income: $38,109

Albany, Georgia
Wikimedia Commons

10. Albany, Georgia
> Premature death rate: 480.3 (per 100,000 residents)
> Adult obesity rate: 35.9%
> Adults without health insurance: 17.8%
> Median household income: $36,805

An aerial view of a Maui beach, Kahului, Hawaii
Thinkstock

11. Kahului-Wailuku-Lahaina, Hawaii
> Premature death rate: 288.1 (per 100,000 residents)
> Adult obesity rate: 22.4%
> Adults without health insurance: 7.7%
> Median household income: $64,563

Lewiston, Idaho (Snake River)
Thinkstock

12. Lewiston, Idaho
> Premature death rate: 384.6 (per 100,000 residents)
> Adult obesity rate: 32.4%
> Adults without health insurance: 12.8%
> Median household income: $44,993

Danville, Illinois
Wikimedia Commons

13. Danville, Illinois
> Premature death rate: 428.0 (per 100,000 residents)
> Adult obesity rate: 37.3%
> Adults without health insurance: 7.7%
> Median household income: $42,548

Muncie, Indiana
Wikimedia Commons

14. Muncie, Indiana
> Premature death rate: 455.6 (per 100,000 residents)
> Adult obesity rate: 31.7%
> Adults without health insurance: 13.1%
> Median household income: $37,900

Davenport, IA
Thinkstock

15. Davenport-Moline-Rock Island, Iowa
> Premature death rate: 343.4 (per 100,000 residents)
> Adult obesity rate: 30.9%
> Adults without health insurance: 8.0%
> Median household income: $51,263

Wichita, Kansas
Thinkstock

16. Wichita, Kansas
> Premature death rate: 370.0 (per 100,000 residents)
> Adult obesity rate: 30.9%
> Adults without health insurance: 11.6%
> Median household income: $51,059

Bowling Green, Kentucky
Wikimedia Commons

17. Bowling Green, Kentucky
> Premature death rate: 415.5 (per 100,000 residents)
> Adult obesity rate: 30.9%
> Adults without health insurance: 9.8%
> Median household income: $43,396

Hammond, LA
Wikimedia Commons

18. Hammond, Louisiana
> Premature death rate: 496.1 (per 100,000 residents)
> Adult obesity rate: 40.3%
> Adults without health insurance: 16.4%
> Median household income: $40,721

Lewiston, Maine
Thinkstock

19. Lewiston-Auburn, Maine
> Premature death rate: 361.7 (per 100,000 residents)
> Adult obesity rate: 32.4%
> Adults without health insurance: 9.9%
> Median household income: $45,765

Cumberland, Maryland
Wikimedia Commons

20. Cumberland, Maryland
> Premature death rate: 379.3 (per 100,000 residents)
> Adult obesity rate: 29.4%
> Adults without health insurance: 5.9%
> Median household income: $37,276

Springfield, Massachusetts
Thinkstock

21. Springfield, Massachusetts
> Premature death rate: 310.5 (per 100,000 residents)
> Adult obesity rate: 26.6%
> Adults without health insurance: 3.5%
> Median household income: $52,546

Flint, Michigan
Wikimedia Commons

22. Flint, Michigan
> Premature death rate: 437.8 (per 100,000 residents)
> Adult obesity rate: 36.0%
> Adults without health insurance: 6.6%
> Median household income: $41,879

Duluth, Minnesota
Thinkstock

23. Duluth, Minnesota
> Premature death rate: 338.9 (per 100,000 residents)
> Adult obesity rate: 26.8%
> Adults without health insurance: 5.9%
> Median household income: $47,574

Jackson, ,Mississippi
Thinkstock

24. Jackson, Mississippi
> Premature death rate: 453.2 (per 100,000 residents)
> Adult obesity rate: 33.8%
> Adults without health insurance: 12.1%
> Median household income: $45,366

Joplin, Missouri
Wikimedia Commons

25. Joplin, Missouri
> Premature death rate: 452.1 (per 100,000 residents)
> Adult obesity rate: 32.3%
> Adults without health insurance: 14.4%
> Median household income: $41,562

Great Falls, Montana
Thinkstock

26. Great Falls, Montana
> Premature death rate: 364.4 (per 100,000 residents)
> Adult obesity rate: 29.0%
> Adults without health insurance: 12.2%
> Median household income: $45,091

Grand Island, Nebraska
Wikimedia Commons

27. Grand Island, Nebraska
> Premature death rate: 309.3 (per 100,000 residents)
> Adult obesity rate: 32.7%
> Adults without health insurance: 12.9%
> Median household income: $50,237

Carson City, Nevada
Wikimedia Commons

28. Carson City, Nevada
> Premature death rate: 417.8 (per 100,000 residents)
> Adult obesity rate: 24.1%
> Adults without health insurance: 12.7%
> Median household income: $50,108

Manchester, New Hampshire
Wikimedia Commons

29. Manchester-Nashua, New Hampshire
> Premature death rate: 279.4 (per 100,000 residents)
> Adult obesity rate: 27.3%
> Adults without health insurance: 8.3%
> Median household income: $70,906

Bridgeton, New Jersey
Wikimedia Commons

30. Vineland-Bridgeton, New Jersey
> Premature death rate: 409.2 (per 100,000 residents)
> Adult obesity rate: 33.6%
> Adults without health insurance: 12.4%
> Median household income: $50,603

Farmington, New Mexico
Thinkstock

31. Farmington, New Mexico
> Premature death rate: 383.7 (per 100,000 residents)
> Adult obesity rate: 30.3%
> Adults without health insurance: 17.9%
> Median household income: $48,824

Elmira, New York
Wikimedia Commons

32. Elmira, New York
> Premature death rate: 350.8 (per 100,000 residents)
> Adult obesity rate: 31.9%
> Adults without health insurance: 5.2%
> Median household income: $49,685

Rocky Mount, North Carolina
https://www.flickr.com/photos/harriswalkerphotography/

33. Rocky Mount, North Carolina
> Premature death rate: 444.3 (per 100,000 residents)
> Adult obesity rate: 34.1%
> Adults without health insurance: 13.4%
> Median household income: $39,763

Bismarck, North Dakota
Thinkstock

34. Bismarck, North Dakota
> Premature death rate: 355.6 (per 100,000 residents)
> Adult obesity rate: 30.4%
> Adults without health insurance: 7.2%
> Median household income: $62,375

Springfield, Ohio
Wikimedia Commons

35. Springfield, Ohio
> Premature death rate: 462.2 (per 100,000 residents)
> Adult obesity rate: 30.4%
> Adults without health insurance: 9.3%
> Median household income: $43,011

Lawton, Oklahoma high school
Wikimedia Commons

36. Lawton, Oklahoma
> Premature death rate: 439.2 (per 100,000 residents)
> Adult obesity rate: 34.9%
> Adults without health insurance: 14.0%
> Median household income: $46,283

Grants Pass, OR
Wikimedia Commons

37. Grants Pass, Oregon
> Premature death rate: 405.3 (per 100,000 residents)
> Adult obesity rate: 26.3%
> Adults without health insurance: 11.8%
> Median household income: $37,447

Johnstown, Pennsylvania
Thinkstock

38. Johnstown, Pennsylvania
> Premature death rate: 396.5 (per 100,000 residents)
> Adult obesity rate: 29.2%
> Adults without health insurance: 6.1%
> Median household income: $42,304

Providence, Rhode Island 4
Thinkstock

39. Providence-Warwick, Rhode Island
> Premature death rate: 309.9 (per 100,000 residents)
> Adult obesity rate: 27.0%
> Adults without health insurance: 6.1%
> Median household income: $56,267

Florence, South Carolina
Wikimedia Commons

40. Florence, South Carolina
> Premature death rate: 513.5 (per 100,000 residents)
> Adult obesity rate: 36.3%
> Adults without health insurance: 12.8%
> Median household income: $40,673

Rapid City, South Dakota
Thinkstock

41. Rapid City, South Dakota
> Premature death rate: 309.4 (per 100,000 residents)
> Adult obesity rate: 27.8%
> Adults without health insurance: 11.2%
> Median household income: $51,041

Morristown, Tennessee
Wikimedia Commons

42. Morristown, Tennessee
> Premature death rate: 477.9 (per 100,000 residents)
> Adult obesity rate: 29.8%
> Adults without health insurance: 13.2%
> Median household income: $39,822

Odessa, Texas
Wikimedia Commons

43. Odessa, Texas
> Premature death rate: 497.6 (per 100,000 residents)
> Adult obesity rate: 30.9%
> Adults without health insurance: 21.6%
> Median household income: $54,903

Salt Lake City at night, Utah
Thinkstock

44. Salt Lake City, Utah
> Premature death rate: 307.4 (per 100,000 residents)
> Adult obesity rate: 25.4%
> Adults without health insurance: 13.6%
> Median household income: $61,529

Burlington (Chittenden County), Vermont
Thinkstock

45. Burlington-South Burlington, Vermont
> Premature death rate: 265.2 (per 100,000 residents)
> Adult obesity rate: 22.7%
> Adults without health insurance: 4.0%
> Median household income: $62,175

Roanoke, Virginia
Thinkstock

46. Roanoke, Virginia
> Premature death rate: 396.2 (per 100,000 residents)
> Adult obesity rate: 28.9%
> Adults without health insurance: 10.8%
> Median household income: $50,056

Yakima, Washington
Thinkstock

47. Yakima, Washington
> Premature death rate: 341.1 (per 100,000 residents)
> Adult obesity rate: 29.1%
> Adults without health insurance: 16.0%
> Median household income: $43,956

Beckley, West Virginia
Wikimedia Commons

48. Beckley, West Virginia
> Premature death rate: 553.4 (per 100,000 residents)
> Adult obesity rate: 34.5%
> Adults without health insurance: 9.6%
> Median household income: $38,606

Milwaukee, Wisconsin 3
Thinkstock

49. Milwaukee-Waukesha-West Allis, Wisconsin
> Premature death rate: 347.3 (per 100,000 residents)
> Adult obesity rate: 29.6%
> Adults without health insurance: 7.8%
> Median household income: $53,628

Casper, Wyoming
Wikimedia Commons

50. Casper, Wyoming
> Premature death rate: 395.2 (per 100,000 residents)
> Adult obesity rate: 28.1%
> Adults without health insurance: 13.7%
> Median household income: $56,769

Get Ready To Retire (Sponsored)

Start by taking a quick retirement quiz from SmartAsset that will match you with up to 3 financial advisors that serve your area and beyond in 5 minutes, or less.

Each advisor has been vetted by SmartAsset and is held to a fiduciary standard to act in your best interests.

Here’s how it works:
1. Answer SmartAsset advisor match quiz
2. Review your pre-screened matches at your leisure. Check out the advisors’ profiles.
3. Speak with advisors at no cost to you. Have an introductory call on the phone or introduction in person and choose whom to work with in the future

Get started right here.

Thank you for reading! Have some feedback for us?
Contact the 24/7 Wall St. editorial team.