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.
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.