The Healthiest City in Every State

September 18, 2019 by Sam Stebbins

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Any person can fall ill at any given time, and often without explanation. However, there are a multitude of behaviors and lifestyle choices that can increase the risk of getting sick, developing a chronic disease, or simply being in poor overall health — and they are no secret. 

Though there is no way to guarantee a long and healthy life, eating right, exercising, making regular doctor visits, and abstaining from bad habits like smoking, drug use, and excessive drinking can certainly improve the odds. While this should not come as news to anyone, there are parts of the country where such behaviors are far more common than in others — and these same places are proof positive that healthy behaviors are tied to positive outcomes. 

24/7 Wall St. created a weighted index of 35 measures of health outcomes and health factors, including behaviors and access to care, and ranked 382 U.S. metropolitan areas based on the index to identify the healthiest city in every state. Index measures include smoking rates, adult obesity rates, premature death rates, shares of adults who exercise regularly, and health insurance coverage. All health data came from County Health Rankings & Roadmaps, a joint program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Because the index is based largely on measures of behaviors and health outcomes, residents of the cities on this list tend to have healthy habits and a reduced likelihood of poor health. However, the cities on this list are also similar in some other, perhaps less obvious, ways. 

For one, the cities on this list tend to be relatively wealthy places — at least compared to other cities in their states. In the vast majority of the healthiest cities by state, the median household income is higher than what the typical household earns across the state as a whole. This is likely not a coincidence. Higher-income Americans tend to have better access to health care options and can afford more healthy options related to diet and lifestyle, and therefore, the wealthiest areas are also often the healthiest. Here is a list of the 25 richest cities in America

It is important to note that appearing on this list does not necessarily mean a particular city is healthy compared to the United States as a whole. Many states have relatively unhealthy populations and average life expectancies at birth that fall short of the 78.6 year national average by several years. Even in the healthiest cities in many of these states, adults are less likely to live long, healthy lives than the typical American. These are the states where people live the longest.

Click here to see the healthiest city in every state
Click here to see the least healthy city in every state
Click here to read our methodology

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1. Alabama: Daphne-Fairhope-Foley
> Premature death rate (per 100,000): 348.4 (state: 471.6)
> Adult obesity rate: 31.0% (state: 35.1%)
> Rate of uninsured people under 65: 10.7% (state: 10.8%)
> Median household income: $55,342 (state: $48,123)

While the Daphne metro area ranks as the healthiest city in Alabama, city residents are less healthy than the average American by several measures. Some 23.8% of adults in Daphne are physically inactive, for example, a lower inactivity rate than the 28.2% rate statewide yet more than the 22.2% rate nationwide. Similarly, 31.0% of adults in Daphne are obese, below the state obesity rate of 35.1% yet higher than the national rate of 28.5%.

Obesity is a risk factor for a number of potentially deadly diseases and conditions. In Daphne, 348 in every 100,000 residents die before the age of 75, the lowest premature death rate of any city in Alabama and far below the state premature death rate of 472 per 100,000. Nationwide, some 340 in every 100,000 Americans die before the age of 75 annually.

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2. Alaska: Fairbanks
> Premature death rate (per 100,000): 330.2 (state: 361.4)
> Adult obesity rate: 29.4% (state: 30.4%)
> Rate of uninsured people under 65: 13.6% (state: 15.5%)
> Median household income: $76,747 (state: $73,181)

Fairbanks is one of just two metro areas in Alaska, and while both compare favorably to the country as a whole in several key health outcome measures, Fairbanks tends to be the healthier of the two.

Fairbanks is one of just eight U.S. metro areas where adult residents report fewer than three days of poor mental health per month. The metro area also has one of the lower premature age-adjusted mortality rates and low birthweight rates among newborns of any U.S. metro area.

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3. Arizona: Prescott
> Premature death rate (per 100,000): 353.7 (state: 331.2)
> Adult obesity rate: 23.8% (state: 27.2%)
> Rate of uninsured people under 65: 12.8% (state: 11.9%)
> Median household income: $50,041 (state: $56,581)

Prescott ranks as the healthiest metro area in Arizona. Just 14.3% of metro area adults report being in fair or poor health, a smaller share than the 17.8% of adults across the state as a whole. Additionally, just 23.8% of metro area adults are obese, well below the 27.2% obesity rate across Arizona.

Prescott residents also benefit from relatively clean air. The concentration of harmful particulate matter in the air in Prescott is tied with Lake Havasu City for the lowest of any metro area in the state.

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4. Arkansas: Fayetteville-Springdale-Rogers
> Premature death rate (per 100,000): 364.5 (state: 462.1)
> Adult obesity rate: 31.5% (state: 35.2%)
> Rate of uninsured people under 65: 11.6% (state: 9.4%)
> Median household income: $56,038 (state: $45,869)

Based on a number of key health measures, all six metropolitan areas in Arkansas compare unfavorably to the nation as a whole. The Fayetteville metro area, however, compares favorably to the other five metro areas in several important measures of health considered in the index, and in a few it even compares favorably to the U.S. as a whole.

Notably, Fayetteville’s premature mortality rate of 365 deaths before age 75 per 100,000 residents is lower than every other metro area in the state and not much higher than the national rate of 340 per 100,000. In all the other Arkansas metro areas, premature mortality rates are in excess of 400 per 100,000.

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5. California: San Jose-Sunnyvale-Santa Clara
> Premature death rate (per 100,000): 194.8 (state: 272.3)
> Adult obesity rate: 19.9% (state: 22.7%)
> Rate of uninsured people under 65: 5.1% (state: 8.4%)
> Median household income: $117,474 (state: $71,805)

San Jose is the healthiest metro area in California and one of the healthiest nationwide. Just 19.9% of metro area adults are obese, well below the 28.5% national obesity rate. Additionally, the metro area is one of only eight nationwide where adults report an average of fewer than three mentally unhealthy days per month. Nationwide, adults report an average of nearly four mentally unhealthy days per month.

Remaining physically active can be critical to remaining healthy — both mentally and physically. In San Jose, only 16.3% of adults lead completely sedentary lives, a smaller share than the 17.4% state and 22.2% national physical inactivity rate

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6. Colorado: Boulder
> Premature death rate (per 100,000): 210.5 (state: 285.2)
> Adult obesity rate: 14.9% (state: 21.0%)
> Rate of uninsured people under 65: 7.2% (state: 8.6%)
> Median household income: $80,834 (state: $69,117)

Boulder ranks not just as one of the healthiest metro areas in Colorado, but also in the U.S. as a whole. Just 9.4% of adults in the metro area report being in fair or poor health, the lowest share of any metro area nationwide, and well below the U.S. share of 16.0%.

Boulder also has the second lowest obesity rate among U.S. metro areas, with just 14.9% of adults reporting a body mass index greater or equal to 30. Obesity is one of the most direct indicators of good health behavior and outcomes.

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7. Connecticut: Bridgeport-Stamford-Norwalk
> Premature death rate (per 100,000): 220.8 (state: 273.8)
> Adult obesity rate: 21.6% (state: 25.5%)
> Rate of uninsured people under 65: 7.9% (state: 5.8%)
> Median household income: $91,198 (state: $74,168)

Of the four metro areas in Connecticut, Bridgeport ranks as the healthiest. It is the only metro area in the state where adults report an average of fewer than three days when they are physically unwell per month. Adults in Bridgeport are also less likely to smoke or be obese and more likely to exercise regularly than those living in any other metro area in the state.

Those with higher income often have better access to health care and can afford a greater range of healthy options related to diet and lifestyle, and they often report higher health status as a result. In the Bridgeport-Stamford-Norwalk metro area, the typical household earns $91,198, well above the median household income of $74,168 across the state as a whole.

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8. Delaware: Dover
> Premature death rate (per 100,000): 393.0 (state: 357.3)
> Adult obesity rate: 33.8% (state: 30.6%)
> Rate of uninsured people under 65: 7.6% (state: 6.7%)
> Median household income: $57,608 (state: $62,852)

Dover is the only metro area in Delaware and ranks as the healthiest city by default. By several important measures, however, the capital city is less healthy than the state as a whole. For example, only about 70% of metro area adults exercise regularly compared to about 75% of adults across the state. Regular physical activity can help in maintaining a healhty weight, and in Dover, 33.8% of adults are obese, a larger share than the state obesity rate of 30.6%.

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9. Florida: Naples-Immokalee-Marco Island
> Premature death rate (per 100,000): 223.7 (state: 340.9)
> Adult obesity rate: 21.4% (state: 26.5%)
> Rate of uninsured people under 65: 21.6% (state: 15.4%)
> Median household income: $66,048 (state: $52,594)

Just 15.8% of adults in the Naples metro area report being in fair or poor health, a far smaller share than the 18.5% of adults across Florida as a whole. The better than average health outcome is likely due in part to healthier lifestyles. For example, just 15.0% of adults in Naples drink excessively compared to 17.5% of adults statewide. Similarly, adults in Naples are less likely to smoke and more likely to exercise than the typical adult in Florida.

Obesity is a risk factor for a number of serious and potentially fatal diseases and conditions, including diabetes, heart disease, and certain cancers. The obesity rate in Naples of 21.4% is below both the state obesity rate of 26.5%, and the national rate of 28.5%.

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10. Georgia: Atlanta-Sandy Springs-Roswell
> Premature death rate (per 100,000): 343.3 (state: 380.5)
> Adult obesity rate: 28.8% (state: 30.3%)
> Rate of uninsured people under 65: 14.4% (state: 14.9%)
> Median household income: $65,381 (state: $56,183)

Atlanta is not only the largest metro area in Georgia by far — it accounts for more than half of the state’s population — but it is also the healthiest. The metro area has the fewest average days of reported poor mental health per month among adults. It also is the only metro area in Georgia where the average reported number of days per month of poor physical health is below the national average. Atlanta’s premature age-adjusted mortality rate of 343 deaths before age 75 for every 100,000 people is lower than the state rate of 381 per 100,000.

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11. Hawaii: Urban Honolulu
> Premature death rate (per 100,000): 270.6 (state: 278.6)
> Adult obesity rate: 23.0% (state: 23.1%)
> Rate of uninsured people under 65: 3.8% (state: 4.2%)
> Median household income: $81,284 (state: $77,765)

Of the two metro areas in Hawaii — Kahului-Wailuku-Lahaina and Honolulu — Honolulu is the healthiest. Unlike the other metro area, adults in Honolulu report fewer than three mentally and fewer than three physically unhealthy days per month on average. Adults in Honolulu are also less likely to be obese and less likely to smoke than those in the Kahului-Wailuku-Lahaina metro area.

Americans with health insurance are more likely to make regular doctor visits for checkups and preventative care, and in Honolulu, only 3.8% of the population is uninsured, below both the state uninsured rate of 4.2% and the national rate of 10.0%.

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12. Idaho: Boise City
> Premature death rate (per 100,000): 282.1 (state: 307.4)
> Adult obesity rate: 28.1% (state: 28.3%)
> Rate of uninsured people under 65: 11.2% (state: 11.8%)
> Median household income: $55,324 (state: $52,225)

Boise City ranks as the healthiest of Idaho’s five metro areas. Metro area adults report the fewest days of poor physical health per month as well as the fewest average days per month of poor mental health in the state.

Those in the workforce who are steadily employed are less likely to deal with the stress associated with unemployment and are less likely to face poverty and financial uncertainty. Unemployed people are likely for a number of reasons to have worse health outcomes. Boise’s unemployment rate, however, is just 2.7%, one of the lowest rates among U.S. metro areas.

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13. Illinois: Bloomington
> Premature death rate (per 100,000): 295.5 (state: 326.4)
> Adult obesity rate: 30.3% (state: 28.7%)
> Rate of uninsured people under 65: 4.4% (state: 7.5%)
> Median household income: $65,936 (state: $62,992)

Just 14.4% of adults in Bloomington report being in fair or poor health, the smallest share of any metro area in Illinois. The better outcome is due in part to healthier behaviors. For instance, adults in Bloomington are less likely to smoke than adults across the state as a whole. Additionally, with a 4.4% uninsured rate — they lowest of any metro area in the state — Bloomington residents are also more likely to make regular visits to the doctor and receive preventive medical care.

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14. Indiana: Lafayette-West Lafayette
> Premature death rate (per 100,000): 341.8 (state: 398.3)
> Adult obesity rate: 30.1% (state: 32.8%)
> Rate of uninsured people under 65: 10.6% (state: 9.5%)
> Median household income: $52,224 (state: $54,181)

The greater Lafayette metro area ranks as the healthiest of Indiana’s 12 metropolitan statistical areas, but compared to the country as a whole, the city ranks as average to slightly worse than average.

There are some exceptions, however. The metro area has a below average rate of newborns with low birth weight, a common indicator of poor regional health. Additionally, the metro area’s premature death rate of 342 deaths before age 75 for every 100,000 people is below the state rate of 398 per 100,000 and in line with the national rate of 340 per 100,000.

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15. Iowa: Ames
> Premature death rate (per 100,000): 227.7 (state: 315.5)
> Adult obesity rate: 27.7% (state: 32.2%)
> Rate of uninsured people under 65: 4.7% (state: 5.0%)
> Median household income: $60,351 (state: $58,570)

Ames has the lowest premature death rate of any metro area in Iowa. This is likely due in part to healthier behaviors, as adults in Ames are less likely to smoke and more likely to exercise than adults across the state as a whole.

The healthy lifestyles in Ames are partially attributable to the presence of certain amenities in the city. For example, 92.1% of the metro area population has easy access to places for physical activity like parks and recreation centers, the largest share of any metro area in the state.

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16. Kansas: Manhattan
> Premature death rate (per 100,000): 268.6 (state: 348.7)
> Adult obesity rate: 26.4% (state: 33.2%)
> Rate of uninsured people under 65: 8.3% (state: 9.9%)
> Median household income: $50,698 (state: $56,422)

Manhattan ranks as the healthiest metro area in Kansas and one of the healthiest in the United States. Adults in the metro area tend to report relatively little time spent in a state of poor physical or mental health.

Children born with low birthweight — defined as under 2,500 grams, or about 5.5 pounds — are more likely to be exposed to immediate and future health issues. A high rate of low birthweight in a given area can also be an indicator of poor health among mothers in the area. Manhattan has the 11th lowest rate of low birthweight of the 382 metro areas measured. Low birthweight rates are a potential risk factor for premature mortality, and Manhattan has the lowest premature death rate of any metro area in the state.

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17. Kentucky: Lexington-Fayette
> Premature death rate (per 100,000): 400.5 (state: 471.7)
> Adult obesity rate: 30.0% (state: 34.2%)
> Rate of uninsured people under 65: 6.7% (state: 6.0%)
> Median household income: $58,069 (state: $48,375)

The obesity rate in the Lexington-Fayette metro area of 30.0% is higher than the national rate of 28.5% but the lowest of the five metro areas in Kentucky. Physically active lifestyles can help in maintaining a healthy weight, and in Lexington, just 23.2% of adults get no exercise beyond getting up and going to work, the lowest physical inactivity rate of any metro area in the state.

Adults with a college education tend to lead healthier lives. In Lexington, 37.5% of adults have a bachelor’s degree, well above the state bachelor’s attainment rate of 24.0% and the national rate of 32.0%.

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18. Louisiana: Baton Rouge
> Premature death rate (per 100,000): 437.5 (state: 452.5)
> Adult obesity rate: 33.2% (state: 35.3%)
> Rate of uninsured people under 65: 10.2% (state: 11.8%)
> Median household income: $57,401 (state: $46,145)

Louisiana’s nine metropolitan areas do not compare well to the U.S. as a whole in many key measures of health behavior or outcomes. But among these, Baton Rouge ranks as the best of the lot. While the capital city’s adult smoking rate of 18.1% is higher than the national rate of 17.0%, it is still the lowest in the state. The same goes for the city’s adult obesity rate of 33.2%, which, while higher than the national rate of 28.5% is still better than any other metro area in the state. Louisiana has five metro areas among the 10 with the highest obesity rates in the country.

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19. Maine: Portland-South Portland
> Premature death rate (per 100,000): 298.9 (state: 337.8)
> Adult obesity rate: 26.4% (state: 29.4%)
> Rate of uninsured people under 65: 8.4% (state: 10.1%)
> Median household income: $68,570 (state: $56,277)

Portland is the only metro area in Maine where adults report fewer than four mentally unhealthy days per month on average. This positive outcome in the area is partially due to a greater prevalence of healthy lifestyles. For example, just 26.4% of adults in the metro area are obese, the lowest obesity rate of Maine’s three metro areas and below the 29.4% statewide obesity rate. The coastal city also has the lowest smoking rate in the state and is home to a larger share of adults who exercise regularly than the state average.

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20. Maryland: California-Lexington Park
> Premature death rate (per 100,000): 322.8 (state: 335.8)
> Adult obesity rate: 35.5% (state: 30.3%)
> Rate of uninsured people under 65: 5.6% (state: 7.0%)
> Median household income: $81,495 (state: $80,776)

California-Lexington Park is the only metro area in Maryland where adults report fewer than three physically unhealthy days per month on average. Additionally, just 11.3% of metro area residents report being in fair or poor health, the smallest share of any of the state’s five metro areas and well below the 13.9% share of adults across Maryland as a whole.

Americans with higher incomes are often able to afford a greater range of healthy options related to diet and lifestyle as well as better access to health care. In the California-Lexington Park metro area, the typical household earns $81,495 a year, the most of any of the five metro areas in the state.

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21. Massachusetts: Barnstable Town
> Premature death rate (per 100,000): 305.9 (state: 284.7)
> Adult obesity rate: 20.4% (state: 24.4%)
> Rate of uninsured people under 65: 3.1% (state: 3.0%)
> Median household income: $71,235 (state: $77,385)

Barnstable Town is the healthiest city in one of the healthiest states. Just 15.2% of adults in Barnstable Town do not exercise, the smallest share of any city in Massachusetts and far less than the 22.2% national inactivity rate. Physical activity helps in maintaining healthy weight, and in Barnstable Town, just 20.4% of adults are obese — the smallest share in Massachusetts and nearly the smallest of any metro area nationwide.

In self-reported assessments of general health, individuals who exercise regularly and exhibit other healthy behaviors are more likely to rank their health as good or excellent. In Barnstable Town, just 10.4% of adults report being in fair or poor health, the smallest share in Massachusetts and the fourth smallest share of any U.S. metro area.

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22. Michigan: Ann Arbor
> Premature death rate (per 100,000): 248.8 (state: 366.4)
> Adult obesity rate: 23.8% (state: 31.7%)
> Rate of uninsured people under 65: 4.9% (state: 6.4%)
> Median household income: $70,286 (state: $54,909)

Only 11.5% of adults in Ann Arbor are in fair or poor health, the smallest share of any of the state’s 14 metro areas and below the 17.4% of adults across the state as a whole reporting similar health. Additionally, Ann Arbor’s 23.8% obesity rate is the lowest in the state and well below the 31.7% statewide rate.

Exercise can lead to a greater perception of one’s own well-being and help in maintaining a healthy weight. In Ann Arbor, about 85% of adults are regularly physically active, by far the largest share of the state’s metro areas and well above share of 78% among all adults across Michigan.

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23. Minnesota: Rochester
> Premature death rate (per 100,000): 230.6 (state: 266.5)
> Adult obesity rate: 27.3% (state: 27.6%)
> Rate of uninsured people under 65: 4.8% (state: 4.8%)
> Median household income: $71,985 (state: $68,388)

Adults in Rochester report an average of just 2.7 physically unhealthy days per month, the smallest share of any metro area in Minnesota and below the 3.0 day statewide average. Rochester residents are also less likely than those in some other parts of the state to engage in certain risky behaviors. For example, the rates of avoidable health outcomes like sexually transmitted infections and of driving deaths that involve alcohol are lower in Rochester than they are across the state as a whole.

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24. Mississippi: Jackson
> Premature death rate (per 100,000): 459.2 (state: 499.1)
> Adult obesity rate: 36.1% (state: 36.5%)
> Rate of uninsured people under 65: 12.2% (state: 14.0%)
> Median household income: $52,434 (state: $43,529)

While Jackson is the healthiest metro area in Mississippi, city residents are still less healthy than the average American by several metrics. Some 18.1% of adults in Jackson smoke, for example, the smallest share in Mississippi yet a higher share than the 17.0% national smoking rate. Similarly, while Jackson’s 36.1% obesity rate is slightly lower than the state rate of 36.5%, it is far higher than the national obesity rate of 28.5%.

Tobacco use and obesity are the two leading causes of preventable death. In Jackson, 459 in every 100,000 residents die before the age of 75 annually, the lowest premature death rate in Mississippi yet far more than the national rate of 340 per 100,000.

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25. Missouri: Columbia
> Premature death rate (per 100,000): 284.9 (state: 395.9)
> Adult obesity rate: 26.5% (state: 32.2%)
> Rate of uninsured people under 65: 9.2% (state: 10.6%)
> Median household income: $51,340 (state: $53,578)

People in Columbia, Missouri, are more likely to live long, healthy lives than those in any of the state’s seven other metro areas. The premature death rate of 285 deaths before age 75 for every 100,000 people in the metro area is well below the comparable statewide rate of 396 per 100,000. Additionally, just 16.8% of adults in Columbia report being in fair or poor health, below the 18.5% of adults statewide.

The positive health outcomes are attributable in part to healthy behaviors. For example, adults in Columbia are more likely to exercise and less likely to smoke than adults across the state as a whole.

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26. Montana: Missoula
> Premature death rate (per 100,000): 305.9 (state: 346.6)
> Adult obesity rate: 23.4% (state: 25.4%)
> Rate of uninsured people under 65: 9.5% (state: 10.0%)
> Median household income: $54,311 (state: $53,386)

In Missoula, just 23.4% of adults are obese, compared to the state obesity rate of 25.4% and a national obesity rate of 28.5%. One likely reason for the metro area’s relatively low obesity rate is the level of exercise the population reports. Less than 15% of Missoula residents report no leisure time physical activity, one of the lowest shares among all metro areas nationwide and well below the national share of 22%.

Obesity is one of the most direct indicators of poor health, and the condition is associated with many of the most common life-threatening conditions, including heart disease, cancer, diabetes, and hypertension. And the metro area’s low obesity rate may partially explain why its premature death rate is also lower than the state average.

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27. Nebraska: Lincoln
> Premature death rate (per 100,000): 274.7 (state: 307.4)
> Adult obesity rate: 27.7% (state: 31.2%)
> Rate of uninsured people under 65: 9.0% (state: 9.7%)
> Median household income: $60,057 (state: $59,970)

Lincoln is the only metro area in Nebraska where adults report fewer than three physically unhealthy days per month on average. Additionally, just 11.1% of adults in Lincoln report being in fair or poor health, the smallest share of any metro area in the state and well below the 14.2% share of adults statewide.

Adults with a college education typically have a greater sense of control over their lives and are better equipped to make healthier lifestyle choices. In Lincoln, 38.1% of adults have a bachelor’s degree, well above the state bachelor’s degree attainment rate of 31.7% and the national rate of 32.0%.

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28. Nevada: Reno
> Premature death rate (per 100,000): 356.4 (state: 364.4)
> Adult obesity rate: 22.9% (state: 26.5%)
> Rate of uninsured people under 65: 11.7% (state: 13.1%)
> Median household income: $61,360 (state: $58,003)

Among Nevada’s three metro areas — Reno, Las Vegas, and Carson City — none are perfect models of good health behaviors or outcomes. Adults in all three, for example, report more days of poor mental health a month than the average nationwide. However, Reno compares favorably to the other two in several important indicators.

Notably, Reno has by far the lowest adult obesity rate, at just 22.9%, compared to a national obesity rate of 28.5%. Reno’s adults are also the least likely in the state to have sedentary lifestyles. Just 17.0% of the city’s adults report no leisure time physical activity, compared to 21.0% and 22.5% in Carson City and Las Vegas, respectively.

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29. New Hampshire: Manchester-Nashua
> Premature death rate (per 100,000): 315.4 (state: 307.6)
> Adult obesity rate: 28.2% (state: 28.0%)
> Rate of uninsured people under 65: 7.3% (state: 7.2%)
> Median household income: $78,769 (state: $73,381)

Manchester is the only metro area in New Hampshire and therefore ranks as the healthiest city by default. In fact, Manchester is slightly less healthy than the state as a whole in some measures of health outcomes. For example, Manchester’s premature death rate of 315 deaths before age 75 per 100,000 people is slightly higher than the comparable state rate of 308 per 100,000.

Despite the poorer health outcome, Manchester residents are more likely to exhibit certain healthier habits than the typical New Hampshire resident. Just 15.2% of metro area adults smoke and 19.7% drink excessively, compared to 18.0% and 20.1% of adults statewide, respectively.

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30. New Jersey: Trenton
> Premature death rate (per 100,000): 296.0 (state: 288.1)
> Adult obesity rate: 25.2% (state: 26.2%)
> Rate of uninsured people under 65: 8.9% (state: 9.2%)
> Median household income: $79,173 (state: $80,088)

Those who have health insurance are more likely to receive adequate and timely medical care than those without it. In Trenton, just 8.9% of residents under age 65 do not have health insurance coverage, the second lowest uninsured rate among New Jersey’s metro areas, and well below the national share of 10.0%.

The biggest sign of Trenton’s good health is the premature mortality rate. There are 296 deaths before age 75 out of every 100,000 metro area residents. Of the three remaining metro areas in the state, the next lowest premature mortality rate is Ocean City, which has a rate of 389 per 100,000.

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31. New Mexico: Santa Fe
> Premature death rate (per 100,000): 297.0 (state: 392.8)
> Adult obesity rate: 14.3% (state: 25.6%)
> Rate of uninsured people under 65: 13.0% (state: 11.2%)
> Median household income: $58,821 (state: $46,744)

Sante Fe is the only metro area in New Mexico where adults report fewer than four physically unhealthy days per month. Sante Fe’s obesity rate of just 14.3% is also the lowest in both the state and the entire country. Across New Mexico, 25.6% of adults are obese, and nationwide, 28.5% of Americans are.

Wealthier individuals tend to have better access to health care and can better afford a greater range of healthy options related to diet and lifestyle. In Santa Fe, incomes tend to be higher than the average statewide. The typical metro area household earns $58,821 a year, about $12,000 more than the median income of $46,744 across New Mexico.

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32. New York: Ithaca
> Premature death rate (per 100,000): 278.5 (state: 279.4)
> Adult obesity rate: 24.5% (state: 25.7%)
> Rate of uninsured people under 65: 5.6% (state: 7.1%)
> Median household income: $56,672 (state: $64,894)

A high rate of low birthweight among newborns is often indicative of relatively poor health and nutrition of the mothers in that community. In Ithaca, just 6.4% of newborns are born under 2,500 grams (about 5.5 pounds), the lowest share of low birthweight of New York’s 12 metro areas.

In Ithaca, which is home to Ithaca College and Cornell University, 52% of adults have a bachelor’s degree, the highest share in the state and the fifth highest share among U.S. metro areas. Adults with higher educational attainment are more likely to lead healthier lives.

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33. North Carolina: Raleigh
> Premature death rate (per 100,000): 278.6 (state: 372.2)
> Adult obesity rate: 25.8% (state: 30.2%)
> Rate of uninsured people under 65: 9.9% (state: 12.2%)
> Median household income: $72,576 (state: $52,752)

Wealthier Americans tend to report better health outcomes, as they often have better access to health care and can better afford a greater range of healthy diet and lifestyle options. In Raleigh, the typical household earns $72,576 a year, by far the most of any of North Carolina’s 15 metro areas and well above the statewide median income of $52,752.

Only 17.6% of adults in Raleigh get no exercise beyond getting up and going to work, the lowest inactivity rate in the state and well below the rate of 23.0% across North Carolina. Regular physical activity can help in maintaining a healthy weight, and in Raleigh, 25.8% of adults are obese, well below the state obesity rate of 30.2%.

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34. North Dakota: Fargo
> Premature death rate (per 100,000): 295.6 (state: 318.8)
> Adult obesity rate: 30.7% (state: 32.2%)
> Rate of uninsured people under 65: 5.6% (state: 7.6%)
> Median household income: $63,353 (state: $61,843)

Based on several major measures of health outcomes, the residents of North Dakota’s three metropolitan areas — Fargo, Bismarck, and Grand Fork — are among the healthiest in the country. Fargo, however, ranks the healthiest of the three. Adults in the metro area report the second lowest average number of poor mental health days and poor physical health days per month of any U.S. metro area.

Unemployed Americans are more likely to have unhealthy lifestyles and poor health outcomes. In Fargo, the 2.4% annual unemployment rate is the lowest in the state and well below the 3.9% national rate.

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35. Ohio: Columbus
> Premature death rate (per 100,000): 375.5 (state: 403.9)
> Adult obesity rate: 30.0% (state: 31.8%)
> Rate of uninsured people under 65: 7.0% (state: 6.7%)
> Median household income: $63,764 (state: $54,021)

In Columbus, just 15.1% of adults report being in fair or poor health, the smallest share of any of Ohio ‘s 11 metro areas and well below the 17.0% share of adults reporting subpar health across the state as a whole.

Ohio is one of the states hit hardest by the opioid epidemic, and some metro areas in the state report among the highest drug overdose death rates in the country. In Columbus, however, there are 68 accidental deaths — which include drug overdoses — for every 100,000 people per year, nearly the lowest of any metro area in the state and well below the rate of 82 per 100,000 across Ohio.

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36. Oklahoma: Oklahoma City
> Premature death rate (per 100,000): 419.1 (state: 458.3)
> Adult obesity rate: 32.1% (state: 33.3%)
> Rate of uninsured people under 65: 14.4% (state: 16.0%)
> Median household income: $56,260 (state: $50,051)

All four of Oklahoma’s metropolitan areas have premature age-adjusted mortality rates — one of the clearest indicators of the overall health of a population — higher than the majority of U.S. metro areas. But of them, Oklahoma City has the lowest, with 419 deaths before the age of 75 per 100,000 people.

Smoking is the leading cause of preventable death in the United States, and among Oklahoma’s four metro areas, the capital has the lowest adult smoking rate, at 15.9%, compared to a national smoking rate of 17.0%.

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37. Oregon: Corvallis
> Premature death rate (per 100,000): 213.6 (state: 309.0)
> Adult obesity rate: 26.5% (state: 28.3%)
> Rate of uninsured people under 65: 6.6% (state: 7.4%)
> Median household income: $60,260 (state: $60,212)

Corvallis is the healthiest metro area in Oregon and one of the healthiest in the United States. While no part of the country has been spared from the opioid epidemic, there are 52 injury deaths — which include drug overdoses — in Corvallis for every 100,000 people annually, the lowest rate of any metro area in the state and well below the rate of 72 per 100,000 across Oregon as a whole.

Adults in Corvallis are also more likely to exercise regularly than those in nearly every other metro area in the country. Just 11.5% of adults in the city lead completely sedentary lives, well below the physical inactivity rates of 15.2% statewide and 22.2% nationwide.

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38. Pennsylvania: State College
> Premature death rate (per 100,000): 214.6 (state: 359.2)
> Adult obesity rate: 26.9% (state: 29.9%)
> Rate of uninsured people under 65: 7.2% (state: 6.8%)
> Median household income: $55,895 (state: $59,195)

Residents of State College, Pennsylvania, are more likely to live long, healthy lives that those in any other metro area in the state. The premature death rate of 215 deaths before age 75 for every 100,000 people is lower than in every other metro area in Pennsylvania and lower than the statewide rate of 359 per 100,000.

Longevity in the area is due in part to healthier lifestyles. For example, about 83% of metro area adults get regular exercise, the largest share of the 18 metro areas in the state and well above the 78% of adults statewide. Regular exercise can help in maintaining a healthy weight, and in State College, just 26.9% of adults are obese, the smallest share in the state and well below the 29.9% obesity rate across Pennsylvania.

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39. Rhode Island: Providence-Warwick
> Premature death rate (per 100,000): 322.8 (state: 307.3)
> Adult obesity rate: 27.6% (state: 27.0%)
> Rate of uninsured people under 65: 4.5% (state: 5.1%)
> Median household income: $65,226 (state: $63,870)

The Providence-Warwick metro area encompasses all five counties in Rhode Island as well as Bristol County in Massachusetts. As the only metro area in Rhode Island, Providence ranks as the healthiest metro area in the state by default, and matches the state as a whole in most measures of health behaviors and outcomes.

For example, 27.6% of adults in Providence are obese compared to 27.0% of adults across the state as a whole. Similarly, 14.5% of adults in Providence report being in fair or poor health, closely in line with the 14.8% of adults across all of Rhode Island who do.

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40. South Carolina: Hilton Head Island-Bluffton-Beaufort
> Premature death rate (per 100,000): 276.8 (state: 414.2)
> Adult obesity rate: 24.7% (state: 32.4%)
> Rate of uninsured people under 65: 14.6% (state: 12.1%)
> Median household income: $55,430 (state: $50,570)

While South Carolina is one of the least healthy states, the Hilton Head Island metro area is one of the healthiest cities nationwide. Just 13.3% of adults in Hilton Head smoke, the lowest smoking rate of any city in South Carolina and far lower than both the 20.0% state and 17.0% national smoking rates. Additionally, just 24.7% of adults are obese, compared to the obesity rate of 32.4% statewide and 28.5% nationwide.

Tobacco use and obesity are the two leading causes of preventable death in the United States. In the Hilton Head Island metro area, 277 in every 100,000 residents die before the age of 75 — far less than the state premature death rate of 414 per 100,000 and the least of any city in South Carolina.

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41. South Dakota: Sioux Falls
> Premature death rate (per 100,000): 302.3 (state: 339.7)
> Adult obesity rate: 31.3% (state: 31.1%)
> Rate of uninsured people under 65: 8.7% (state: 10.4%)
> Median household income: $64,882 (state: $56,521)

Of the two metro areas in South Dakota — Sioux Falls and Rapid City — Sioux Falls is the healthiest. Unlike in Rapid City, adults in Sioux City report fewer than three physically unhealthy days and fewer than three mentally unhealthy days per month on average.

Americans with health insurance are more likely to make regular doctor visits, and in Sioux Falls, 8.7% of the population lacks health insurance compared to 10.4% of Rapid City residents.

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42. Tennessee: Nashville-Davidson–Murfreesboro–Franklin
> Premature death rate (per 100,000): 397.6 (state: 445.6)
> Adult obesity rate: 31.7% (state: 33.0%)
> Rate of uninsured people under 65: 10.0% (state: 10.6%)
> Median household income: $63,939 (state: $51,340)

The typical household in the Nashville metro area earns $63,939 a year, approximately $13,000 more than the median household income across Tennessee as a whole and the most of any city in the state. People with higher incomes tend to have greater access to quality health care and better health outcomes overall.

In Nashville, 16.4% of adults report being in fair or poor health, the smallest share in Tennessee and far below the 19.1% state rate. Some 398 in every 100,000 residents in Nashville die before the age of 75 annually, far less than the state premature death rate of 446 per 100,000 and the least of any city in the state.

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43. Texas: Austin-Round Rock
> Premature death rate (per 100,000): 258.0 (state: 339.5)
> Adult obesity rate: 25.2% (state: 29.0%)
> Rate of uninsured people under 65: 14.5% (state: 18.6%)
> Median household income: $73,800 (state: $59,206)

Of the 25 metro areas in Texas, Austin is by far the healthiest. Only about 25% of adults in the metro area are obese, the smallest share of any city in the state and well below the 29.0% obesity rate across Texas as a whole. Regular physical activity can help in maintaining a healthy weight, and in Austin, only 16.8% of adults do not exercise, well below the 22.8% inactivity rate across the state as a whole.

Wealthier individuals tend to have better access to health care and can better afford a greater range of healthy options related to diet and lifestyle, and incomes tend to be higher than average in Austin. The typical metro area household earns $73,800 a year, well above the median income of $59,206 across Texas.

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44. Utah: Provo-Orem
> Premature death rate (per 100,000): 258.7 (state: 291.5)
> Adult obesity rate: 25.4% (state: 25.9%)
> Rate of uninsured people under 65: 7.9% (state: 9.7%)
> Median household income: $70,196 (state: $68,358)

Provo-Orem has one of the lowest premature death rates in the United States. There are 259 deaths before age 75 for every 100,000 people annually in the metro area. Across the state, there are 292 premature deaths for every 100,000 people and 340 per 100,000 nationwide.

The low premature death rate is partially attributable to health habits. For example, Provo is the only metro area in the United States where fewer than one in every 10 adults drink excessively. Additionally, just 6.8% of area adults smoke, the lowest smoking rate in the country and well below the 8.8% rate statewide, and 17.0% rate nationwide.

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45. Vermont: Burlington-South Burlington
> Premature death rate (per 100,000): 283.6 (state: 300.0)
> Adult obesity rate: 22.6% (state: 25.5%)
> Rate of uninsured people under 65: 4.2% (state: 4.7%)
> Median household income: $63,160 (state: $57,513)

Burlington is the only metro area in Vermont, and as a result, it ranks as the healthiest city in the state by default. Still, by several measures, city residents are more likely to lead healthier lifestyles and have better health outcomes than the average Vermont resident. For example, just 13.0% of adults in Burlington smoke, compared to the 17.0% state smoking rate. Adults in Burlington are also more likely to regularly exercise and are less likely to be obese than the typical adult in the state.

Healthy behaviors can lead to healthy outcomes, and in Burlington, adult residents report an average of just 3.6 mentally unhealthy days per month, compared to an average of about four days across the state.

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46. Virginia: Charlottesville
> Premature death rate (per 100,000): 298.7 (state: 318.9)
> Adult obesity rate: 25.6% (state: 28.8%)
> Rate of uninsured people under 65: 11.4% (state: 9.9%)
> Median household income: $66,853 (state: $71,535)

Charlottesville ranks as the healthiest of Virginia’s nine metro areas, largely due to the prevalence of healthy behaviors among the city’s residents. For example, 80% of adults in Charlottesville exercise regularly, the largest share of metro areas in the state and more than the roughly 78% of adults across Virginia as a whole who are physically active. Additionally, just 15.2% of metro area adults smoke, and 25.6% are obese, each the smallest share of any metro area in the state.

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47. Washington: Seattle-Tacoma-Bellevue
> Premature death rate (per 100,000): 273.0 (state: 288.7)
> Adult obesity rate: 25.6% (state: 27.6%)
> Rate of uninsured people under 65: 6.0% (state: 6.9%)
> Median household income: $82,133 (state: $70,979)

Of the 11 metro areas in Washington state, Seattle is the healthiest. Just 11.6% of adults in the metro area report being in fair or poor health, below both the 13.9% state and 16.0% national shares. Adults in Seattle are also more likely to exercise and less likely to smoke or be obese than adults across the state as a whole.

Adults with a college education tend to have higher incomes and are better equipped to make healthy lifestyle choices than those without a college degree. In Seattle, 41.9% of adults have a bachelor’s degree, well above the state bachelor’s degree attainment rate of 35.5% and the national rate of 32.0%.

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48. West Virginia: Morgantown
> Premature death rate (per 100,000): 355.5 (state: 492.7)
> Adult obesity rate: 31.3% (state: 36.3%)
> Rate of uninsured people under 65: 6.8% (state: 6.5%)
> Median household income: $49,475 (state: $43,469)

While Morgantown is the healthiest city in West Virginia, residents in the metro area are less healthy than the average American by several measures. Some 20.3% of adults in Morgantown smoke, for example, the smallest share of any city in the state yet higher than the 17.0% national smoking rate. Similarly, some 31.3% of adults in Morgantown are obese, the smallest share of any metro area in the state yet far above the 28.5% national obesity rate.

Tobacco use and obesity can increase the risk of certain serious diseases and conditions and raise the likelihood of premature death overall. In Morgantown, 356 in every 100,000 residents die before the age of 75 annually, less than the state rate of 493 per 100,000 yet greater than the national rate of 340 premature deaths per 100,000 Americans.

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49. Wisconsin: Appleton
> Premature death rate (per 100,000): 267.0 (state: 308.5)
> Adult obesity rate: 29.3% (state: 31.1%)
> Rate of uninsured people under 65: 5.3% (state: 6.3%)
> Median household income: $65,990 (state: $59,305)

Just 14.7% of adults in Appleton smoke and just 29.3% are obese, each less than the corresponding state rates of 17.1% and 31.1%. Tobacco use and obesity are two of the leading causes of preventable death. In Appleton, 267 in every 100,000 residents die before age 75 annually — less than the state rate of 309 per 100,000 and one of the lowest premature death rates of any city nationwide.

Income is one of the primary determinants of health, and areas with lower poverty rates tend to have better health outcomes. In Appleton, just 6.9% of residents live in poverty, far less than the state’s 11.3% poverty rate and the smallest rate of any metro area in the state.

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50. Wyoming: Cheyenne
> Premature death rate (per 100,000): 358.1 (state: 348.5)
> Adult obesity rate: 30.5% (state: 28.5%)
> Rate of uninsured people under 65: 10.7% (state: 13.4%)
> Median household income: $61,961 (state: $60,434)

Of the two metro areas in Wyoming — Cheyenne and Casper — Cheyenne ranks as the healthiest. Some 22.9% of adults in Cheyenne do not exercise regularly, a lower inactivity rate than the 24.5% in Casper and the 23.1% across Wyoming as a whole. Similarly, 30.5% of adults in Cheyenne are obese, less than the obesity rate of 31.5% in Casper, yet higher than the 28.5% obesity rate statewide.

Obesity and sedentary lifestyles can increase the risk of premature death. In Cheyenne, 358 in every 100,000 residents die before the age of 75, less than the premature death rate in Casper of 387 deaths per 100,000 residents.

Methodology

To determine the healthiest city in every state, 24/7 Wall St. created an index composed of 35 health outcomes and health factors with data from the 2019 County Health Rankings & Roadmaps, a joint program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. We calculated composite scores for outcomes and factors separately, then combined the two scores to form a single score that determines the metropolitan statistical area’s rank. 

All data used in the index came from the CHR, with the exception of the MSA 2018 annual unemployment rate, the most recent annual figures available from the Bureau of Labor Statistics’ Local Area Unemployment Statistics program. County-level data was aggregated to the MSA level using 2017 five-year population estimates from the U.S. Census Bureau’s American Community Survey. 

We also considered measures from the ACS including median household income, poverty, and educational attainment. These measures were not included in the index. 

Values selected for the index are standardized into Z-Scores, which assumes a mean of 0 and a standard deviation of 1. Z-scores are calculated for each index measure by MSA within each city’s respective state. If an MSA spans multiple states, then the city is indexed according to its primary state, as designated by the Census Bureau. Note that four states — Rhode Island, New Hampshire, Vermont, and Delaware — only have one MSA.

Health outcomes with the heaviest weights in the index include the age-adjusted premature mortality rate, the percentage of births with low birthweight, the percentage of adults reporting fair or poor health, and the age-adjusted average number of mentally and physically unhealthy days per month. The premature mortality rate is defined as the number of deaths under the age of 75 per 100,000 people. Unhealthy days are determined by the average number of days out of the month the adult population (18+) self-identifies as being unwell. This is used as an indicator of how chronic disabilities or illnesses (physical and mental) affect the members of a particular geography.

Health factors with the heaviest weights in the index include the smoking rate, the 2018 annual unemployment rate, injury mortality, and the child poverty rate. Injury mortality measures the rate at which the total population is killed due to injury, whether intentional (for example suicide), or unintentional (drug overdose, car accidents, accidental suffocation, etc). Air quality is also considered in the health factors category and is determined by measuring the average daily density of particulate matter at 2.5 micrograms (or PM2.5 for short). 

The remaining measures included in the index, as well as an explanation as to why they were used, can be found at County Health Rankings & Roadmaps.