Special Report

The Least Healthy City in Every State

41. Rapid City, South Dakota
> Pct. without health insurance:
> Pct. food insecure: 7.3%
> Obesity rate: 27.5%
> 2014 unemployment rate: 3.4%

South Dakota is one of the nation’s least populous states, and Rapid City is the state’s second largest city. Rapid City is situated next to the Black Hills mountain range, home to Mount Rushmore and numerous parks. Perhaps as a result, 94.9% of the area’s population reported access to locations for physical activity. Despite this, the metro area is the least healthy city in South Dakota. South Dakota is a relatively healthy state, so while Rapid City is its least healthy city, it is still nearly as healthy as the rest of the country. Rapid City reported smoking and obesity rates of 20.1% and 27.5% respectively, roughly in line with the rest of the nation. However, drunk driving deaths are more common in the area than across the country. More than 40% of all driving deaths in Rapid City are alcohol-related, higher than the state’s rate and nearly 10 percentage points higher than the national rate.

42. Morristown, Tennessee
> Pct. without health insurance:
> Pct. food insecure: 6.0%
> Obesity rate: 29.3%
> 2014 unemployment rate: 7.4%

Like Tennessee, Morristown residents report high rates of smoking and low rates of heavy drinking. Tennessee has the sixth highest smoking rate in the country, 22.6%, and Morristown’s was even higher at 24.6%. Conversely, with 9.3% of adults reporting heavy or binge drinking, Tennessee is the second driest state in the country, and Morristown is even more so with a heavy drinking rate of 4.8%, the second lowest of any metro area in the country. Physical activity is a major determinant of overall health, and 34% of Morristown’s population did not exercise in their spare time, 7 percentage points higher than the national rate. Unhealthy behaviors likely contributed to a higher incidence of premature death. An estimated 10,079 years are lost per 100,000 residents annually by those who died before the age of 75. The incidence of premature death was greater than 10,000 years in only 10 other metro areas.

43. Odessa, Texas
> Pct. without health insurance:
> Pct. food insecure: 8.4%
> Obesity rate: 31.5%
> 2014 unemployment rate: 3.4%

People with health insurance are more likely to seek preventive care, and higher coverage rates often lead to better health outcomes. Texas is the least insured state in the nation, and Odessa has an even lower uninsured rate. About one-fourth of Odessa’s residents are uninsured, and about one-fifth of its residents said they were in fair or poor health. This is about 5 percentage points higher than the proportion of Americans reporting such low levels of health. Education is also a strong determinant of health, as it provides access to the higher incomes that that can lead to healthier lifestyles. Also, more educated individuals are more likely to have the knowledge necessary to stay healthy. Odessa’s high school graduation rate is 70.2%, which lags behind the country’s by 9.8 percentage points. The proportion of Odessa residents who after graduating high school attained at least some college education is 47.2%, which is much lower than the national rate of 63.0%.

44. Salt Lake City, Utah
> Pct. without health insurance:
> Pct. food insecure: 3.3%
> Obesity rate: 24.3%
> 2014 unemployment rate: 3.7%

Utah is a relatively healthy state, and even Salt Lake City, the state’s unhealthiest city, is in good shape compared to the rest of the country. Utah boasts the lowest incidence of alcohol-related driving deaths, and less than one in 10 Utah adults smoked, the lowest proportion compared to states. While it is ranked as the least healthy city in Utah, Salt Lake City shares characteristics with Utah. Only about 12% of both Salt Lake City and Utah residents reported being in fair or poor health. And Salt Lake City and Utah each have an obesity rate of less than 25%, versus the national rate of 28.3%. High income inequality frequently leads to poor health outcomes in a community. Incomes in the top 80th percentile were less than four times greater than incomes in the bottom 20th percentile in Utah, the smallest such income gap compared to all states. Salt Lake City had a similarly low income gap.

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

Burlington-South Burlington is the only metropolitan area in Vermont. While this means that it is the least healthy metro area by default, residents were actually on the whole healthier than the rest of the state, which itself was one of the healthiest in the nation. Just over 9% of Burlington residents reported fair or poor health, a smaller share than the 10.6% of Vermonters and significantly less than the 16% of Americans who reported such poor health. Healthy behaviors help explain the area’s relatively good health. Only 13.1% of the Burlington area population identified as smokers, less than the 16.1% share of Vermonters and the 20% of Americans who said they smoked. Additionally, nearly 16.5% of Burlington residents were physically inactive in their spare time, a smaller share than the corresponding figure for both the state and the nation of 18.4% and 27%, respectively.