Special Report

The Least Healthy City in Every State

26. Great Falls, Montana
> Pct. without health insurance:
> Pct. food insecure: 8.2%
> Obesity rate: 28.9%
> 2014 unemployment rate: 4.4%

The cities in Montana are all fairly similar in general measures of health. Great Falls is the least healthy city in Montana, but has average health outcomes for an American metropolitan area. Compared to the national obesity rate of 28.3% and the 27.0% of Americans who reported being inactive, Great Falls is roughly in line with a 28.9% obesity rate and 27.0% of adults reporting inactivity. The share of uninsured people in Great Falls — 14.2% — is similar to the national uninsured rate of 14.5%. Of all driving deaths in the state, 46.9% were alcohol related, the highest of all states. In Great Falls, the percentage was even higher, with 50% of all driving deaths caused by alcohol.

27. Omaha-Council Bluffs, Nebraska
> Pct. without health insurance:
> Pct. food insecure: 4.0%
> Obesity rate: 28.7%
> 2014 unemployment rate: 3.7%

Unhealthy habits among Omaha residents likely contributed to the area’s poor overall health. About 18.5% of people in Omaha identified as smokers, slightly more than the 17.6% smoking rate in Nebraska. Additionally, slightly more than 21% of area residents reported excessive drinking, higher than both the corresponding statewide and national figures of 19.5% and 15%, respectively. While across Nebraska, 35.4% of deaths behind the wheel were the result of alcohol impaired driving, in Omaha, alcohol was the cause of 42.3% of fatal car accidents. Unhealthy habits and avoidable driving deaths helped contribute to the nearly 6,000 years of life lost due to premature death per 100,000 Omaha residents.

28. Las Vegas-Henderson-Paradise, Nevada
> Pct. without health insurance:
> Pct. food insecure: 2.0%
> Obesity rate: 24.9%
> 2014 unemployment rate: 7.8%

Nevada is the second least insured state in the country after Texas and it had the second most people per primary care physician. In the Las Vegas metro area, 21.6% of residents were uninsured and there were 1,807 people per primary care physician, both worse than the state levels. Such poor insurance coverage and scarcity of doctors make it more difficult for residents to receive primary and preventive care. For example, Nevada had the fourth lowest rate — 77.4% — of diabetic Medicare patients aged 65-75 receiving regular HbA1c monitoring and the third lowest rate — 56.2% — of Medicare enrollees aged 67-69 receiving mammography screenings. In the Las Vegas area, 76.7% received HbA1c monitoring and 54.4% received mammography screenings.

29. Manchester-Nashua, New Hampshire
> Pct. without health insurance:
> Pct. food insecure: 3.4%
> Obesity rate: 27.2%
> 2014 unemployment rate: 4.2%

Manchester-Nashua is the only metropolitan area in New Hampshire, so it qualifies as both its healthiest and least healthy city. Compared to the rest of the country, the Manchester metro area is reasonably fit and fosters an environment conducive to healthy lifestyles. About 16% of area residents smoke, which was 4 percentage points lower than the national smoking rate. Impressively, at 95.9%, almost all of the metro area’s population had adequate access to locations for physical activity. Strong economic conditions in the Manchester area and across New Hampshire contributed to healthier lifestyles, particularly among younger residents. The child poverty rate of 10.9% is the lowest in the country, and in Manchester-Nashua, the child poverty rate is 11.0%. New Hampshire also had the lowest teen birth rate in the country, with only 16.6 teen births per 1,000 women aged 15-19. The rate was 19.6 teen births in Manchester-Nashua. still well below the national teen birth rate of 37 births per 1,000 teenage women.

30. Vineland-Bridgeton, New Jersey
> Pct. without health insurance:
> Pct. food insecure: 9.2%
> Obesity rate: 33.9%
> 2014 unemployment rate: 9.9%

New Jersey is a fairly healthy state and fares slightly better than the rest of the country in health measures such as smoking, obesity, and inactivity rates. However, the Vineland-Bridgeton metro area, the least healthy city in the state, does not fare as well. In a state where nearly all residents have access to locations for physical activity, at 95.6%, the Vineland metro area provides adequate access for just 77.5% of its residents. In a state that beats the country’s 20% smoking rate by 4.4 percentage points, the Vineland area’s smoking rate was 4.1 percentage points higher than the nation’s. Likewise, in a state that beats the national obesity rate of 28.3% by 3.9 percentage points, the Vineland-Bridgeton area’s obesity rate is much higher, at 33.9%.