Special Report

The Least Healthy City in Every State

Source: DenisTangneyJr / Getty Images

Oklahoma: Lawton
> Adult obesity rate: 32.6% (state: 33.7%)
> Adult smoking rate: 19.5% (state: 20.1%)
> Pct. of adults who don’t exercise: 30.2% (state: 29.3%)
> Residents with no health insurance: 15.1% (state: 16.5%)
> Median household income: $51,332 (state: $54,449)

Some 17.8% of residents in the Lawton metro area live below the poverty line, the highest poverty rate of any city in Oklahoma and higher than the state poverty rate of 15.2%. Income is one of the largest determinants of health, and areas with higher poverty rates tend to have worse health behaviors and outcomes.

In Lawton, 19.5% of adults smoke, the highest smoking rate of any Oklahoma metro area. Just 69.8% of adults regularly exercise, less than the 70.7% state activity rate. Tobacco use and inactivity are two of the leading causes of premature death, and in Lawton, 465 in every 100,000 residents die before the age of 75 — the highest premature death rate in Oklahoma and among the highest of any city in the country.

Oregon: Grants Pass
> Adult obesity rate: 31.1% (state: 28.8%)
> Adult smoking rate: 17.0% (state: 16.1%)
> Pct. of adults who don’t exercise: 20.7% (state: 17.2%)
> Residents with no health insurance: 8.5% (state: 8.2%)
> Median household income: $47,573 (state: $67,058)

The premature death rate in Grants Pass is 431 per 100,000 people, significantly higher than the statewide premature death rate of 304 per 100,000 and the highest in all eight metro areas in Oregon. Adults in Grants Pass are more likely to report being in poor mental health than the average Oregon resident.

Low-income households cannot afford as many healthy options related to health care, diet, and lifestyle as wealthier households, and they often report worse health outcomes as a result. In Grants Pass, the typical household earns just $47,573 a year, well below the $67,058 state median.

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Pennsylvania: Scranton–Wilkes-Barre–Hazleton
> Adult obesity rate: 29.6% (state: 30.3%)
> Adult smoking rate: 19.6% (state: 18.7%)
> Pct. of adults who don’t exercise: 27.6% (state: 23.1%)
> Residents with no health insurance: 6.4% (state: 6.6%)
> Median household income: $54,304 (state: $63,463)

Scranton–Wilkes-Barre–Hazleton is among the least healthy metro areas not just in Pennsylvania but the entire country. About 27.6% of area adults live a sedentary lifestyle, the second highest share in the state and well above the state inactivity rate of 23.1%. The area’s adult smoking rate of 19.6% is also the second highest in the state.

Scranton–Wilkes-Barre–Hazleton has the second highest premature death rate of any of the 18 metro areas in Pennsylvania. There are 427 deaths before age 75 annually for every 100,000 metro area residents, well above the state premature death rate of 359 per 100,000.

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Rhode Island: Providence-Warwick
> Adult obesity rate: 28.5% (state: 28.1%)
> Adult smoking rate: 14.3% (state: 14.9%)
> Pct. of adults who don’t exercise: 25.2% (state: 24.4%)
> Residents with no health insurance: 4.8% (state: 5.4%)
> Median household income: $70,967 (state: $71,169)

The Providence-Warwick metro area encompasses nearly all of Rhode Island as well as Bristol County in Massachusetts. As the only metro area in Rhode Island, Providence ranks as the least healthy city in the state by default and matches the state as a whole in most measures of health behaviors and outcomes. For example, 28.5% of adults in Providence are obese, compared to 28.1% of adults across the state. Similarly, 14.3% of adults in Providence report smoking, closely in line with the 14.9% of adults who smoke throughout Rhode Island.

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South Carolina: Florence
> Adult obesity rate: 37.9% (state: 32.9%)
> Adult smoking rate: 18.3% (state: 18.8%)
> Pct. of adults who don’t exercise: 32.0% (state: 25.9%)
> Residents with no health insurance: 11.7% (state: 13.1%)
> Median household income: $48,547 (state: $56,227)

Florence is the least healthy metro area in South Carolina and among the least healthy in the U.S. Only 68.0% of adults in the Florence metro area get regular exercise, a smaller share than the 74.1% of adults across South Carolina. Remaining active can help in maintaining a healthy weight, and in Florence, 37.9% of adults are obese, compared to 32.9% of adults statewide.

Obesity is a risk factor for a number of potentially deadly diseases and conditions, including diabetes, heart disease, and certain cancers. In Florence, there are 534 deaths before age 75 for every 100,000 people annually, more than any of the eight metro areas in the state and well above the state premature death rate of 413 per 100,000.

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