The United States spends more per capita on health care than any other country, yet health outcomes lag behind many other developed nations. Not all Americans have the same access to quality care, and disadvantaged citizens are often the ones left behinds. The disparity in health care could partly explain why life expectancy varies by nearly 10 years across U.S. metropolitan areas.
Even among metropolitan areas within the same state, health outcomes can differ dramatically. In California’s healthiest metropolitan area, San Jose-Sunnyvale-Santa Clara, the life expectancy at birth is 82.7 years. However, there are four California cities with a life expectancy more than five years shorter.
To determine the healthiest city in every state, 24/7 Wall St. reviewed several factors such as healthy behavior, clinical care, social and economic conditions, and the physical environment of residents in all U.S. metro areas. We constructed an index out of these factors that can capture the health of a city’s residents.
One of the most important measures of a city’s health is the rate at which members of the population die prematurely. This rate is a common method used to quantify the amount of preventable deaths in an area by measuring the number of deaths among residents younger than 75 years old. The premature death rate in all 50 cities on this list is lower than the national rate. The San Jose-Sunnyvale-Santa Clara metro area has the lowest rate in the nation at 200 preventable deaths per 100,000 residents, which is well less than half of the preventable deaths of the nation as a whole.
While the healthiest city in every state tends to have better health outcomes than the nation overall, occasionally one of these cities ranks exceptionally low nationwide. For example, Mississippi as a whole has some of the worst health outcomes in the country, including the highest rate of preventable deaths of any state. While Gulfport-Biloxi-Pascagoula is the healthiest metro area in Mississippi, it is still among the least healthy cities in the nation.
Many behavioral factors affect a population’s health, with smoking and obesity rates among the most significant. Higher rates of both increase the risk of many preventable diseases and ultimately cause an increase in premature deaths. Because the healthiest metros tend to have lower smoking and obesity rates, it is unsurprising to find their residents tend to live longer than their statewide peers.
In addition to healthy behaviors, social and economic conditions in an area affect how healthy residents tend to be. Adequate health care may be too expensive for low-income or unemployed residents. Quality care can still be more expensive still. Consequently, most healthy cities also tend to be wealthier. Unemployment rates are lower than the country in all but 12 of the 50 cities on this list. Also, in the majority of these cities, median household incomes are higher than the national median income.
To identify the healthiest city in every state, 24/7 Wall St. created an index modelled after an analysis conducted by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. 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 are for the most recent available year. The index was used to compare all U.S. metropolitan statistical areas as defined by the U.S. Census Bureau. Four states — Delaware, New Hampshire, Rhode Island, Vermont — have only one metropolitan statistical area. In these states, the sole metro area is listed by default.