At 78.5 years, life expectancy in the United States, while trailing several dozen other countries, has continuously risen in the past century. Leading this upward trajectory are the 25 healthiest U.S. cities. These cities span 14 states and are located across multiple regions, from the Northeast to the Southwest — yet most share several common factors.

In order to determine the healthiest cities in the United States, 24/7 Wall St. examined more than two dozen measures of health factors and health outcomes from the County Health Rankings and Roadmaps program, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Based primarily on measures intended to capture quality and length of life, Rochester, Minnesota is the healthiest U.S. metropolitan area.

Premature death is the most important measure in determining the health of a city. In each of the 25 healthiest U.S. cities, residents are far less likely to die before the age of 75 than the typical American. Though healthy behaviors and social and economic conditions vary among the healthiest cities, in every case, there are multiple identifiable causes for residents’ good health.

Click here to see the 25 healthiest cities in America.

In an interview with 24/7 Wall St., Amanda Jovaag, data lead at County Health Rankings, explained that, in general, “as income and wealth increase … so does health.” People and families that are financially secure are more likely to be able to afford necessary medical treatment and healthy food on a regular basis. Median household incomes exceed the national median in a majority of the healthiest cities in the country. In the San Jose, California metro area, one of the healthiest in the country, the typical household earns $92,960 a year, more than in any other U.S. city.

In addition to sufficient income, health insurance coverage is a crucial component in ensuring individuals get necessary medical treatment and preventative screening. “The uninsured are much less likely to have primary care providers and a source for regular care than the insured,” Jovaag said. Ultimately, “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.” Nationwide, 11.7% of people ineligible for Medicare are uninsured. Uninsured rates in the healthiest U.S. cities are all lower than the national rate, ranging from 3.9% in Mankato, Minnesota, to 10.8% in the Provo-Orem, Utah metro area.

While insurance coverage and income are important, so too are healthy behaviors. Certain behavioral factors and indicators, such as smoking and obesity, can increase the risk of a number of severe conditions and diseases and can significantly detract from quality of life. As a result, obesity and smoking rates were heavily weighted in the ranking of cities by health. Nationwide, 17% of adults identify as smokers, and 27% of adults are obese. The vast majority of the healthiest cities are home to a smaller share of obese residents and smokers than the country as a whole.

24/7 Wall St. created an index modeled 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 25 healthiest 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.

25. Portland-South Portland, ME
> Premature death rate: 274.6 (per 100,000 residents)
> Adult obesity rate: 24.1%
> Pct. adults without health insurance: 8.3%
> Median household income: $58,000

Only about one in every 10 adults in the Portland metro area report being in fair or poor health, the eighth smallest share of any U.S. metro area. Healthy behaviors likely contribute to the overall good health of area adults. Roughly 82% of adults lead physically active lives, one of the largest shares of any U.S. city. Certain unhealthy habits are also relatively rare as only 13.9% of area adults smoke, lower than the 17.0% nationwide smoking rate.

A healthy diet and lifestyle can often depend on financial stability. In Portland, only 11.2% of residents live in poverty, a considerably smaller share than the 15.6% nationwide poverty rate.

24. Lawrence, KS
> Premature death rate: 269.9 (per 100,000 residents)
> Adult obesity rate: 23.3%
> Pct. adults without health insurance: 9.2%
> Median household income: $50,732

Maintaining an active, healthy lifestyle can be contingent on opportunity. In Lawrence, Kansas, 91.3% of the population, one of the higher shares in the country, has adequate access to places for physical activity such as parks and recreation centers. It is not likely a coincidence therefore that about 81% of adults engage in physical activities on a regular basis, a larger share than the 77% of American adults who do.

Along with remaining active, a consistently healthy diet is also crucial to good physical health, and Lawrence residents are much less likely to struggle to afford regular meals than the typical American. Only 13.3% of area residents are food insecure, much lower than the 20.5% of Americans who are.

23. Ann Arbor, MI
> Premature death rate: 254.8 (per 100,000 residents)
> Adult obesity rate: 23.3%
> Pct. adults without health insurance: 5.7%
> Median household income: $60,805

Those with health insurance are more likely to receive regular medical checkups and preventative care than those without insurance. In Ann Arbor, more than 94% of adults are insured — one of the highest rates of any U.S. city. High coverage rates accompany a low premature death rate in the city. For every 100,000 metro area residents, roughly 255 die before age 75, considerably less than the 474 premature deaths per 100,000 residents nationwide.

22. State College, PA
> Premature death rate: 230.6 (per 100,000 residents)
> Adult obesity rate: 25.3%
> Pct. adults without health insurance: 5.7%
> Median household income: $50,295

Children born to teenage mothers are at far greater risk of certain serious health conditions, including anemia and high blood pressure. In State College, Pennsylvania, there are less than six teenage births per 1,000 metro area teenage girls, the lowest rate of any U.S. city.

In addition to, and perhaps at least partially because of the low teen birth rate, State College residents are among the least likely in the country to die before age 75. For every 100,000 metro area residents, there are 231 premature deaths, less than half the national rate of 474 premature deaths per 100,000 people.

21. Madison, WI
> Premature death rate: 259.2 (per 100,000 residents)
> Adult obesity rate: 23.9%
> Pct. adults without health insurance: 5.9%
> Median household income: $61,227

Life expectancy in Madison is about two and a half years longer than it is nationwide. Area residents can partially attribute their longevity to healthy lifestyles. More than 83% of adults in the area lead physically active lives, one of the largest shares in the country and considerably higher than the 77% share of American adults who are active. Along with being more active, area residents are less likely to have a smoking habit than most Americans. Only 13.7% of adults in the area smoke, a considerably smaller share than the 17.0% of American adults who do.

20. Santa Rosa, CA
> Premature death rate: 250.5 (per 100,000 residents)
> Adult obesity rate: 21.6%
> Pct. adults without health insurance: 10.0%
> Median household income: $63,799

Less than 12% of adults in the Santa Rosa metro area smoke, one of the lowest smoking rates of any U.S. city and far lower than the 17% nationwide smoking rate. Area residents are also more likely than most Americans to maintain a healthy weight. Only 21.6% of Santa Rosa adults are obese, significantly lower than the 27.0% of American adults who are obese. Lower than average smoking and obesity rates have likely contributed to a higher than average life expectancy. People live an average of nearly two years longer in Santa Rosa than they do on average nationwide.

19. Appleton, WI
> Premature death rate: 256.7 (per 100,000 residents)
> Adult obesity rate: 31.4%
> Pct. adults without health insurance: 5.7%
> Median household income: $60,413

Appleton residents are far more likely to live past the age of 75 than most Americans. For every 100,000 metro area residents, less than 257 die before age 75, considerably less than the roughly 474 premature deaths per 100,000 Americans.

A healthy diet and lifestyle is a crucial component of a long, healthy life, and affording the generally higher costs of fresh nutritious food are not likely a serious concern for many Appleton residents. The typical metro area household earns $60,413 a year, considerably more the national $53,482 median household income. Additionally, only 13.1% of metro area children — who are particularly vulnerable to the negative health effects of malnutrition — live in poverty, one of the lowest child poverty rates in the country.

18. Dubuque, IA
> Premature death rate: 277.3 (per 100,000 residents)
> Adult obesity rate: 27.7%
> Pct. adults without health insurance: 5.2%
> Median household income: $53,410

People with health insurance are far more likely to receive regular medical care and preventative check-ups than those without insurance. In Dubuque, about 95% of residents under the age of 65 have health insurance, one of the best coverage rates in the country. With near universal health coverage, adults in Dubuque are more likely than most Americans to live past the age of 75. Each year, 277 out of every 100,000 residents die before age 75, far fewer than the 474 premature deaths per 100,000 rate nationwide.

17. Lincoln, NE
> Premature death rate: 269.7 (per 100,000 residents)
> Adult obesity rate: 26.3%
> Pct. adults without health insurance: 8.8%
> Median household income: $52,291

Only about one in every 10 adults in Lincoln report being in fair or poor health, the fifth smallest share of any city in the country. Residents can likely attribute their good health to their lifestyles. Adults in Lincoln are more likely to exercise, less likely to smoke, and less likely to be obese than the average American. With better self-reported health and healthier behaviors, life expectancy is nearly two years longer in Lincoln than it is on average nationwide.

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16. Corvallis, OR
> Premature death rate: 228.7 (per 100,000 residents)
> Adult obesity rate: 19.7%
> Pct. adults without health insurance: 7.6%
> Median household income: $49,338

Like most of the healthiest cities in the country, only a small share of Corvallis residents are not financially secure. For example, just 7.3% of area children live in poverty, one of the lowest shares on the country. The ability to afford food and health care can greatly improve a resident’s ability to lead a healthy life, life expectancy in Corvallis is 81.2 years, the seventh highest of any city in the country. Area residents may be able to attribute the high life expectancy to high levels of physical activity. In Corvallis, 86.8% of adults have physically active lifestyles, a much larger share than the 77.0% of adults nationwide.

15. Fargo, ND-MN
> Premature death rate: 280.0 (per 100,000 residents)
> Adult obesity rate: 27.5%
> Pct. adults without health insurance: 6.7%
> Median household income: $53,634

Employment is important to personal health for a variety of reasons, including providing regular income and often, health insurance. Only 2.4% of the workforce in Fargo is out of a job, the lowest unemployment rate of any U.S. metropolitan area. With low unemployment, Fargo residents are more likely to have health insurance and less likely to live in poverty than most Americans. Adults in Fargo report an average of only 2.7 mentally unhealthy days and 2.7 physically unhealthy days per month, each among the least in the country.

14. San Francisco-Oakland-Hayward, CA
> Premature death rate: 241.7 (per 100,000 residents)
> Adult obesity rate: 19.5%
> Pct. adults without health insurance: 7.8%
> Median household income: $80,008

Financial stability is often a crucial component of good health. Those with higher incomes are less likely to struggle to afford healthy food or medical treatment. Residents of the San Francisco metro area are among the wealthiest in the country. The typical area household earns $80,008 a year, far more than the $53,482 the typical American household earns annually. Due in part to higher incomes, only 11.9% of residents struggle to afford food, one of the smallest food insecurity rates of any city in the country.

Further contributing to good overall health, San Francisco area residents are relatively active. Roughly 85% of metro area adults are regularly physically active. In comparison, only 77% of American adults regularly participate in physical activity in their leisure time.

13. Minneapolis-St. Paul-Bloomington, MN-WI
> Premature death rate: 253.1 (per 100,000 residents)
> Adult obesity rate: 25.4%
> Pct. adults without health insurance: 5.8%
> Median household income: $68,019

Only about one in every 10 adults in the Minneapolis-St. Paul-Bloomington area report being in fair or poor health, a smaller share than in all but a handful of other U.S. metro areas. The metro area has certain advantages that are conducive to a healthy population. Venues for physical activity such as parks and recreation centers are common as 94% of the Twin Cities population has adequate access to these areas. Nationwide, only 84% of the population has such access. Area residents are also unlikely to struggle to find adequate health care. There are more than 90 primary care physicians for every 100,000 metro area residents, a far greater share than the roughly 76 primary care doctors for every 100,000 Americans.

12. St. Cloud, MN
> Premature death rate: 251.6 (per 100,000 residents)
> Adult obesity rate: 27.4%
> Pct. adults without health insurance: 5.5%
> Median household income: $54,985

When it comes to staying active, residents of the St. Cloud metro area are at a distinct disadvantage. Only 68.3% of area residents have adequate access to places for physical activity such as recreation centers or parks. In contrast, 84.0% of Americans have adequate access to such locations. Despite the disadvantage, area residents are slightly more likely to regularly participate in physical activity than most Americans. In the St. Cloud metro area, 79% of adults are physically active compared to 77% of American adults.

Remaining active is an important component of a healthy lifestyle, and life expectancy in St. Cloud is about three years longer than it is across the country.

11. Fort Collins, CO
> Premature death rate: 232.3 (per 100,000 residents)
> Adult obesity rate: 18.9%
> Pct. adults without health insurance: 8.7%
> Median household income: $58,844

Only 9.8% of the Fort Collins metro area adults report being in fair or poor health, a considerably smaller share than the 14.0% of American adults who do. Better than average self-reported health outcomes are likely partially the result of area residents’ healthy behaviors and lifestyles. Only 18.9% of Fort Collins adults are obese, the fourth smallest obesity rate of any city in the country. In addition, only 12.7% of adults in Fort Collins are smokers, far fewer than the 17.0% nationwide smoking rate.

10. La Crosse-Onalaska, WI-MN
> Premature death rate: 273.4 (per 100,000 residents)
> Adult obesity rate: 25.2%
> Pct. adults without health insurance: 5.4%
> Median household income: $51,160

Living in poverty can lead to unhealthy lifestyles and ultimately to increased prevalence of medical conditions and an increased risk of premature death. In the La Crosse-Onalaska metro area, only 6% of children live in poverty, the lowest share of any city in the country. A lower childhood poverty rate likely plays a role in the lower than average premature death rate in the metro area. There are about 273 deaths before age 75 for every 100,000 residents, far fewer than the 474 per 100,000 national premature death rate.

9. Mankato-North Mankato, MN
> Premature death rate: 249.8 (per 100,000 residents)
> Adult obesity rate: 28.7%
> Pct. adults without health insurance: 3.9%
> Median household income: $54,112

Those with health insurance are far more likely than those without to receive necessary and preventative medical screening. In the Mankato metro area, more than 96% of residents under age 65 are insured, the fifth largest share of any U.S. city. In addition to widespread medical coverage, area residents are more likely than most Americans to be physically active in their leisure time. Perhaps partly as a result life expectancy is about two years longer in the metro area than it is across the country.

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

Only 8.9% of adults in the Burlington metro area report being in fair or poor health, the smallest share of any city in the country. While the city outranks all others in self-reported health measures, Burlington residents tend to be healthier than the average American by several objective measures as well. Area residents are less likely to be obese than most Americans, and only 4% of those too young to qualify for Medicare are uninsured, a smaller share than in all but a handful of other U.S. cities. Life expectancy is about two years longer in Burlington than it is on average across the country.

7. Logan, UT-ID
> Premature death rate: 226.2 (per 100,000 residents)
> Adult obesity rate: 23.0%
> Pct. adults without health insurance: 9.9%
> Median household income: $49,915

Logan residents have relatively healthy lifestyles. Only 9.0% of adults in the area are smokers, and only 11.2% of adults drink excessively, the third and fourth lowest figures, respectively, of any city in the country. Area residents are also more likely to engage in regular physical activity than most Americans. Nearly 84% of area adults participate in a physical activity at least once a month, while only 77% of American adults are regularly physically active.

6. Provo-Orem, UT
> Premature death rate: 250.6 (per 100,000 residents)
> Adult obesity rate: 23.3%
> Pct. adults without health insurance: 10.8%
> Median household income: $60,647

Only 9.2% of Provo-Orem residents drink excessively, and only 7.0% are smokers, each the smallest such share in the country. Religious affiliation likely explains the scarcity of unhealthy habits in the Provo-Orem metro area. Much of the city’s population identifies as Mormon, a religion that expressly forbids the use of alcohol or tobacco. Partly as a result, life expectancy is about two years longer in the metro area than it is across the United States.

5. Iowa City, IA
> Premature death rate: 249.2 (per 100,000 residents)
> Adult obesity rate: 23.7%
> Pct. adults without health insurance: 5.8%
> Median household income: $55,030

Employment can be important for personal health in a number of ways. Those who are employed have regular income and often health insurance through work. Only 2.7% of the Iowa City workforce is out of a job, the sixth lowest 2015 unemployment rate of any city in the country. Low unemployment likely contributes to a low uninsured rate. Only 5.8% of those ineligible for Medicare do not have health insurance, less than half the national 11.8% uninsured rate. With less joblessness, a relatively small share of area children live in poverty. Children are more susceptible to the negative health outcomes associated with malnutrition. Only 8.0% of children in Iowa city live below the poverty line, the fourth smallest share in the country.

4. Boulder, CO
> Premature death rate: 209.0 (per 100,000 residents)
> Adult obesity rate: 13.3%
> Pct. adults without health insurance: 7.3%
> Median household income: $69,407

By many measures, Boulder is one of the healthiest cities in the country. More than 90% of area adults lead physically active lives, the largest share of any U.S. metro area. Regular physical activity can help individuals maintain a healthy weight and have longer lives. Only 13.3% of adults in Boulder are obese, the lowest obesity rate of any U.S. city and well below the 27.0% national rate. In addition, there are 209 deaths before age 75 for every 100,000 area residents, the second lowest premature death rate in the country and less than half the national premature death rate.

3. Ames, IA
> Premature death rate: 214.3 (per 100,000 residents)
> Adult obesity rate: 25.6%
> Pct. adults without health insurance: 5.9%
> Median household income: $51,270

Those who are employed are more likely to have health insurance coverage, and those with insurance are more likely to receive regular medical care and preventative screening. In Ames, only 2.4% of the workforce is out of a job, tied with Fargo, North Dakota, for the lowest 2015 unemployment rate of any U.S. metropolitan area. Partially as a result, only 5.9% of the population too young for Medicare does not have insurance, a considerably smaller share than the national 11.7% uninsured rate. Life expectancy is about two years longer in Ames than it is across the country.

2. San Jose-Sunnyvale-Santa Clara, CA
> Premature death rate: 200.6 (per 100,000 residents)
> Adult obesity rate: 19.6%
> Pct. adults without health insurance: 7.1%
> Median household income: $92,960

Life expectancy in the San Jose-Sunnyvale-Santa Clara metro area is 82.7 years, the highest in the country. Healthy behavior plays a role in the residents’ long life expectancy. More than 98% of the population has access to places for physical activity such as recreation centers and parks. As a result, area residents are more likely to lead active lifestyles than most Americans. Furthermore, only 9.1% of area adults smoke, the fourth smallest share of any U.S. city.

Residents’ health is also partially attributable to favorable economic conditions in the area. The typical metro area household earns $92,960 a year, the highest median household income of any U.S. metro area. Financial stability makes it easier to consistently afford healthy food, and only 9.8% of area residents struggle to put food on the table, less than half the national food insecurity rate.

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1. Rochester, MN
> Premature death rate: 229.7 (per 100,000 residents)
> Adult obesity rate: 25.1%
> Pct. adults without health insurance: 5.4%
> Median household income: $64,210

Home to one of the Mayo Clinic’s main locations, it is perhaps no coincidence that Rochester, Minnesota is the healthiest city in the United States. Adults in Rochester report an average of only 2.4 physically unhealthy days a month, the fewest of any U.S. city. When area residents need medical attention, there is no shortage of medical professionals in the area. There are roughly 180 primary care physicians for every 100,000 area residents, more doctors per capita than in any other U.S. city.

Area residents are also less likely to smoke, more likely to be physically active, and less likely to be obese than the average American. Life expectancy in the Rochester metro area is a near-nation-leading 81.2 years.

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