Special Report

The Healthiest City in Each State

Grant Suneson

Detailed findings & methodology:

Cheyenne and Casper are the only two metropolitan areas in the state of Wyoming. Cheyenne leads Caper in a number of key health factors and outcomes. The area’s adults had an average of 3.5 days of poor mental health and 3.5 days of poor physical health in the last month. Casper’s averages fell in line with the U.S. rates, which are 3.8 mentally unhealthy days and 3.7 physically unhealthy days.

While not commonly associated with negative health impacts, people who drive to work for a long time each day are more likely to be obese and less likely to exercise. Cheyenne leads Wyoming, and the entire country, in the percentage of commuters who drive alone to work for 30 or more minutes. Just 7.3% of Cheyenne area residents have a solo commute longer than a half hour.

To determine the healthiest city in each state, 24/7 Wall St. made an index, ranking each of America’s 382 metropolitan areas based on health outcomes, such as the premature mortality rate, the number of physically and mentally unhealthy days in the last month, and the percentage of adults who feel they are in fair or poor health. The index also accounted for health factors, such as the rate of adults who got no exercise, the obesity rate, and the percentage of people under 65 that are uninsured in a given area.

Over the last two years, the premature mortality rate increased noticeably from 333 premature deaths per 100,000 residents to 363 premature deaths per 100,000 residents. County Health Rankings & Roadmaps noted that drug overdose deaths and other injuries “heavily influenced the rise in premature death.” The U.S. is struggling with an opioid epidemic, which may be one reason why the premature death rate increased the most among people aged 15-44. However, it is difficult to determine how many deaths are linked to overdoses from drugs like opioids, largely because overdose deaths are often listed as accidental deaths and not specifically noted as overdoses.

In 11 states, there are no metropolitan areas that are healthier than the average American metro area. Six of those states — Mississippi, Louisiana, Kentucky, Tennessee, Arkansas, and Alabama — are located in the Southeastern U.S. The other five — Oklahoma, West Virginia, Delaware, Ohio, and Nevada — are scattered across the country.

Another indicator of health outcomes in a given area is diversity. When speaking with 24/7 Wall St., County Health Rankings & Roadmaps associate researcher and community coach Justin Rivas said that “there is a connection to poorer health outcomes and segregated communities in urban areas.” He added that cities in the Midwest, South, and East Coast are more segregated than they are on the West Coast.

Hattiesburg, Mississippi was the least healthy place that ranked as the healthiest in its state. Out of 382 U.S. metro areas, it ranked 345th, with a high premature mortality rate of 470 early deaths per 100,000 residents. The San Jose-Sunnyvale-Santa Clara, California area is the healthiest in the state and the country. It has the lowest premature mortality rate of 196 premature deaths per 100,000 residents.

For the most part, the healthiest city in each state changes very little year over year. Just five states had different healthiest cities in 2017 and 2018 — Indiana, Louisiana, Mississippi, South Dakota, and Utah.

Many of the healthiest places in each state are also home to large colleges and universities. Metro areas like Columbia, Missouri, Lincoln, Nebraska, and Boulder, Colorado all have flagship state universities. These places have an influx of younger adults who are more likely to have high levels of educational attainment and higher salaries — both indicators of healthier populations as a whole.

To identify the 25 healthiest cities, 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 data came from County Health Rankings & Roadmaps, a collaboration between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The health factors component is itself a weighted composite of healthy behaviors, clinical care, social and economic factors, and physical environment measures. Median household income figures and poverty rates came from the Census Bureau’s 2016 American Community Survey.