The United States is often considered one of the least healthy affluent nations, due in part to its low life expectancy, expensive health care, and an ever-increasing adult obesity rate. Life expectancy at birth nationwide is 78.6 years, one of the lowest among OECD nations. Still, health varies significantly nationwide, and in many U.S. cities, Americans are less obese and generally live longer, healthier lives.
There are many factors that contribute to one’s ability to live a long, healthy life, ranging from certain behaviors to financial stability. 24/7 Wall St. reviewed 35 health factors and outcomes from the County Health Rankings and Roadmaps program, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, to identify the 25 healthiest metropolitan areas in the country.
One of the best ways to measure the health of a population is the premature death rate — the rate at which residents die before the age of 75. In our index, we weighted premature death more heavily than any other measure.
There appears to be a strong correlation between income and health. Among the 25 healthiest U.S. cities, all but six exceed the national median household income of $57,617. Places with a higher median household income typically report better health outcomes, likely because residents are better able to afford health care as well as nutritious foods, gym memberships, and other things that help facilitate a healthy lifestyle.
Having health insurance is another crucial component in maintaining good health as it ensures individuals are receiving proper medical and preventive care. Nationwide, 11.0% of people under the age of 65 are not covered by health insurance. Among the 25 healthiest cities, only one has a higher than average share of residents under 65 without insurance coverage.
Both health insurance and income are important. However, healthy behaviors and habits can also impact health. Certain behavioral factors and indicators, such as smoking and obesity, can increase the risk of a number of chronic diseases and health complications. Nationwide, 17% of adults identify as smokers, and 28% of adults are obese. The vast majority of the healthiest cities are home to a smaller share of adult who are obese or smoke than the country as a whole.
24/7 Wall St. created an index modeled after an analysis conducted by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. 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 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. Data on the prevalence of food insecurity in each metropolitan area came from the United States Department of Agriculture 2015 Food Access Research Atlas.
25. Washington-Arlington-Alexandria, DC-VA-MD-WV
> Premature death rate: 252.5 (per 100,000)
> Adult obesity rate: 25.6%
> Pct. under 65 without health insurance: 9.4%
> Median household income: $95,843
The Washington-Arlington-Alexandria metropolitan area is one of the wealthiest in the country with a median household income of $95,843 a year, far greater than the national median of $57,617. Cities with higher incomes usually report better health outcomes, as more affluent people tend to have access to better medical care and healthy food. Wealthier people also do not have to face the unhealthy stress levels associated with poverty. In the D.C. area, only 12.4% of adults are in fair or poor health, much less than the nationwide share of 16.0%.
Some 17.0% of American adults smoke, but only 12.2% of adults in this metropolitan area do, likely contributing to a lower premature death rate in the D.C. area. For every 100,000 metro area residents, about 252 die before age 75, far less than the national rate of 363 premature deaths per 100,000 people.
24. Santa Rosa, CA
> Premature death rate: 243.2 (per 100,000)
> Adult obesity rate: 20.3%
> Pct. under 65 without health insurance: 10.0%
> Median household income: $73,929
Adults in Santa Rosa, California, are among the healthiest in the nation. Leading an active lifestyle can contribute to a long, healthy life, and nearly 85% of adults in this city are physically active — one of the highest shares in the nation. The relatively high share of physically active adults likely explains the low obesity rate of just 20.3%, much less than the national rate of 28.0%. Maintaining a healthy body weight can help people avoid deadly health conditions such as cardiovascular disease and diabetes, and adults in Santa Rosa are less likely to die prematurely than most Americans. For every 100,000 residents some 243 die before the age of 75, far less than the national rate of 363 per 100,000 people.
23. Lincoln, NE
> Premature death rate: 274.5 (per 100,000)
> Adult obesity rate: 27.4%
> Pct. under 65 without health insurance: 9.0%
> Median household income: $59,344
Maintaining an active, healthy lifestyle can be dependent on opportunity. In Lincoln, Nebraska, 95.1% of residents have access to places for physical activity such as parks and recreation centers. For perspective, only 83% of Americans have access to such facilities. Adults in Lincoln appear to be taking advantage of these opportunities, with only 18.1% leading sedentary lifestyles, less than the national average of 23.0%.
Engaging in regular physical activity is important for maintaining good health, and only 11.1% of adults in Lincoln report being in fair or poor health, one of the lowest shares in any metropolitan area in America. Additionally, Lincoln adults report some of the fewest days of poor mental and physical health per month in the nation.
22. Ogden-Clearfield, UT
> Premature death rate: 289.7 (per 100,000)
> Adult obesity rate: 26.6%
> Pct. under 65 without health insurance: 9.5%
> Median household income: $70,227
According to the CDC, smoking is the leading cause of preventable death nationwide. While 17.7% of adults smoke nationwide, only 8.3% do in Odgen-Clearfield.
Other factors that can contribute to a long, healthy life, such as access to health care, nutritious food, and exercising options, can be costly. However, this may be less of an issue for residents of this Utah metro area. The typical household in Odgen-Clearfield earns $70,227 a year, considerably more the national median household income of $57,617. Additionally, only 11.4% of metro area children live in poverty, far less than the national average of 20%. Children who live in poverty are more susceptible to malnutrition and obesity, and are less likely to have access to quality medical care.
21. Fargo, ND-MN
> Premature death rate: 291.8 (per 100,000)
> Adult obesity rate: 29.3%
> Pct. under 65 without health insurance: 7.0%
> Median household income: $60,009
People with health insurance are far more likely to go to the doctor regularly and receive preventive care than those who do not have insurance. In Fargo, 93% of residents under the age of 65 have health insurance, one of the best coverage rates in the country. This widespread access to health care is likely contributing to a low premature death rate. Each year, 291 out of every 100,000 residents die before age 75, much less than the national rate of 363 premature deaths per 100,000 Americans.