Special Report

The Least Healthy City in Every State

Life expectancy is one of the most telling and often cited measures of the health of a given population — and in the United States, life expectancy is falling at a historic rate. After declining for three consecutive years, life expectancy at birth stands at 78.6 years. It is too early to tell what impact on life expectancy the COVID-19 pandemic will have, but according to one estimate published at Prevent Epidemics website, the pandemic could lower life expectancy by at least five years in New York City, one the earlier epicenters of the outbreak in the U.S.

In a 2017 report, the Centers for Disease Control and Prevention identified several factors contributing to the decline in life expectancy. These include climbing rates of several diseases and conditions such as stroke, diabetes, and chronic liver disease, as well as unintentional injuries, which notably include drug overdoses. These conditions are often connected to unhealthy lifestyles — and in some parts of the country, both unhealthy behaviors and poor health outcomes are more common than in others.

24/7 Tempo created a weighted index of 35 measures of health outcomes and health factors, including behaviors and access to care, and ranked the 381 U.S. metropolitan areas based on the index to identify the least healthy metropolitan area in every state. Index measures include smoking rates, adult obesity rates, premature death rates, shares of adults who exercise regularly, health insurance coverage, and unemployment rate.

Making the list as the least healthy city in a state does not necessarily mean a particular metro area is unhealthy compared to the United States as a whole. Some states have relatively healthy populations and average life expectancies that exceed the national average by several years — these are the states where people live the longest.

The cities on this list tend to share certain socioeconomic characteristics. For example, in 43 metro areas on this list, the median annual household income is lower than the median across the state as a whole. This is likely no coincidence, as lower-income Americans tend to have less access to health care as well as to healthy options related to diet and lifestyle, and therefore they often report worse health outcomes than wealthier Americans.

A high uninsured rate is also common among the counties on this list. Americans without health insurance are less likely to make regular doctor visits, receive treatments, and receive preventative care. Many of the 50 metro areas on this list have the highest share of adults without health insurance in their respective state.

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