Special Report

The Least Healthy City in Every State

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6. Colorado: Pueblo
> Premature death rate (per 100,000): 430.3 (state: 285.2)
> Adult obesity rate: 28.0% (state: 21.0%)
> Adult smoking rate: 17.1% (state: 15.6%)
> Median household income: $43,148 (state: $69,117)

Pueblo is the only metro area in Colorado where adults report an average of more than four days of poor mental health in a month and more than four physically unhealthy days per month. Additionally, 22.1% of adults in the metro area report being in fair or poor health, by far the largest share in the state and one of the largest shares of any U.S. metro area. For context, 16.0% of American adults and 14.3% of adults in Colorado report being in fair or poor health.

Low-income Americans tend to have less access to quality health care options than those with higher incomes, and are less able to afford leading a healthy lifestyle. In Pueblo, the typical household earns just $43,148 a year. Meanwhile, the typical Colorado household earns nearly $70,000 annually.

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7. Connecticut: New Haven-Milford
> Premature death rate (per 100,000): 302.7 (state: 273.8)
> Adult obesity rate: 27.1% (state: 25.5%)
> Adult smoking rate: 13.6% (state: 13.3%)
> Median household income: $66,863 (state: $74,168)

Adults in New Haven are more likely to report being in poor mental and physical health than those in any other metro area in Connecticut. Regular exercise can improve overall well-being, and in New Haven adults are less likely to be physically active than the average adult in the state.

Smoking is the leading cause of preventable death in the United States, and New Haven’s smoking rate of 13.6% is the highest of any metro area in the state. It is, however, still lower than the 17.0% national smoking rate.

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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%)
> Adult smoking rate: 18.2% (state: 17.7%)
> Median household income: $57,608 (state: $62,852)

Dover is the only metro area in Delaware and ranks as the least healthy city by default. By several important measures, however, the capital city is less healthy than the state as a whole. For example, only 70.5% of metro area adults exercise regularly, compared to 74.6% of adults across the state. Regular physical activity can help in maintaining a healthy weight, and in Dover, 33.8% of adults are obese, a larger share than the 30.6% share of adults across the state.

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9. Florida: Ocala
> Premature death rate (per 100,000): 448.2 (state: 340.9)
> Adult obesity rate: 29.9% (state: 26.5%)
> Adult smoking rate: 17.8% (state: 15.5%)
> Median household income: $43,910 (state: $52,594)

The Ocala metro area ranks as the least healthy metro area in Florida and one of the least healthy nationwide. Just 68.9% of adults in Ocala exercise regularly, compared to 75.3% of adults statewide and 77.8% nationwide. Physical inactivity increases the risk of obesity compared to those who exercise regularly, and in Ocala 29.9% of adults are obese, more than the statewide rate of 26.5% and the nationwide rate of 28.5%.

Obesity is one of the leading causes of premature death. In Ocala, 448 in every 100,000 residents die before the age of 75, far more than the statewide premature death rate of 341 per 100,00 and the national rate of 340 per 100,000.

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10. Georgia: Albany
> Premature death rate (per 100,000): 505.0 (state: 380.5)
> Adult obesity rate: 33.5% (state: 30.3%)
> Adult smoking rate: 20.5% (state: 17.9%)
> Median household income: $43,614 (state: $56,183)

Smoking is the leading cause of preventable death in the United States, and in Albany, Georgia, 20.5% of adults are smokers, the largest share of any of the state’s 14 metro areas. Unhealthy habits like smoking likely contribute to Albany’s higher than average premature death rate. There are 505 deaths before age 75 for every 100,000 Albany residents annually, well above the state rate of 380 per 100,000.

Lower-income Americans have less access to quality health care than those with higher incomes, and often report worse health outcomes as a result. In Albany, the typical household earns just $43,614 a year, well below the median income of $56,183 across the state.

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