Special Report

The Least Healthy City in Every State

1. Gadsden, Alabama
> Pct. without health insurance:
> Pct. food insecure: 8.6%
> Obesity rate: 33.8%
> 2014 unemployment rate: 7.0%

Alabama is one of the nation’s least healthy states. So Gadsden, the state’s least healthy metro area, is also one of the least healthy areas in the nation. Nearly 23% of Gadsden adults reported fair or poor health, higher than the comparable state rate of 20.5%, which itself was the fourth highest such level of poor health compared to other states. An estimated 9,508 years of life are lost annually per 100,000 people in Alabama, the third highest statewide level of premature death. In Gadsden, preventable deaths resulted in an estimated 11,057 years of life lost per 100,000 area residents.

2. Anchorage, Alaska
> Pct. without health insurance:
> Pct. food insecure: 4.9%
> Obesity rate: 27.9%
> 2014 unemployment rate: 5.8%

Anchorage and Fairbanks are the only two metro areas in Alaska, and Anchorage earns the distinction of least healthy. However, as is the case across the nation, residents living in more urban areas tend to be healthier than residents living in more rural areas. As a result, even though Anchorage is the least healthy urban area in Alaska, it still performs better than the rest of the state in several health measures. For example, the incidence of premature death in the area, measured at 6,889 years lost annually per 100,000 people, was lower than the state’s estimate. However, preventable death nationwide resulted in fewer years lost compared to Anchorage. Both Anchorage residents and Alaskans statewide reported above-average alcohol consumption. Close to one in five people in Anchorage reported binge or heavy drinking, in line with the state proportion, but higher than the national proportion.

3. Lake Havasu City-Kingman, Arizona
> Pct. without health insurance:
> Pct. food insecure: 17.3%
> Obesity rate: 26.6%
> 2014 unemployment rate: 8.8%

Lake Havasu is one of the widest points in the Colorado River, which separates Arizona from California. The city on the lake is about an hour drive from Kingman, which is also part of the metro area. While Arizona residents had relatively healthy habits, residents of the Lake Havasu-Kingman metro area were more likely to smoke and less likely to exercise than their peers across the state and nationwide. Less than 17% of Arizonans reported a smoking habit, while in the Lake Havasu area, 26.9% smoked. And while just over 20% of Arizona residents were physically inactive, 30.8% of the metro residents were, likely contributing to the higher obesity rate. Nearly 27% of area residents were obese, higher than the state’s obesity rate of 23.9%.

4. Pine Bluff, Arkansas
> Pct. without health insurance:
> Pct. food insecure: 9.0%
> Obesity rate: 37.8%
> 2014 unemployment rate: 8.6%

Arkansas is one of the nation’s least healthy states. Partially as a result, Pine Bluff is not just the state’s least healthy metro area, but also one of the least healthy cities in the country. Only 57.6% of residents had adequate access to locations for physical activity, lower than the state share of 65.8% of residents, which itself was the fourth lowest compared to other states. The poor access likely contributed to Pine Bluff’s obesity rate of 37.8%, one of the highest of any U.S. area.

While Pine Bluff residents were more likely to have health insurance than both their statewide peers and Americans nationwide, practitioners are relatively scarce in Pine Bluff. There is one dentist for every 4,154 area residents, for example, far worse than the state ratio of one dentist for every 2,338 people, the worst ratio of all states. Similarly, there are roughly 1,749 people for every doctor in Pine Bluff, a worse ratio even than the already relatively poor state ratio.

5. Visalia-Porterville, California
> Pct. without health insurance:
> Pct. food insecure: 8.1%
> Obesity rate: 28.3%
> 2014 unemployment rate: 13.2%

California residents had some of the nation’s healthiest behaviors as well as some of the best health outcomes, in contrast with the Visalia metro area — the state’s least healthy urban region. Nearly one in four area residents reported fair or poor health, versus the comparable state and national proportions of 18.4% and 16.0%, respectively. Lack of health insurance may have contributed to worse health outcomes in the area — health insurance is important not just because it reduces the economic burden on the sick, but also because it encourages people to get routine checkups. California had good health outcomes despite its relatively high uninsured rate of 17.2%, the eighth highest. The Visalia area had an even higher rate of 19.4%, significantly greater than the national uninsured rate of 14.5%.