The healthiest city in every state
The long debate over the Affordable Care Act (ACA) has, if nothing else, put the spotlight on the poor state of the country’s health and health care system. The United States ranks behind most developed nations in life expectancy despite spending more per capita on health care than any other country.
Across the country, health outcomes vary greatly. More than 30% of the adult population of Madera, California, reported being in poor health, while only 6.4% said the same in Ames, Iowa, the healthiest city in the country by our measure. This vast disparity is another issue the ACA is at least in part intended to address. Cities such as Ames — that have populations with extremely high physical and mental well-being — can teach us much about what is necessary to create healthier populations — be it income, healthy behavior, or access to care. 24/7 Wall St. created an index to identify the healthiest city in each state.
Each city was ranked based on overall health outcomes, including length and quality of life. Also considered in the index are the range of factors that influence these outcomes. These include healthy behaviors, clinical care, social and economic indicators, and physical environment.
MORE:See the list of the healthiest cities in every state
While the healthiest city in most states tends to be healthy relative to the country as a whole, this was not always the case. In states like Mississippi, Alabama, and West Virginia, the healthiest metro areas scores worse than the national rate in most key metrics. For the most part, however, these cities have excellent health outcomes. Urban dwelling has many positive impacts on the health of a population, including access to healthy food, places to exercise, and the presence of enough jobs to keep people employed and earning the money they need to afford healthy options and health care.
Not surprisingly, healthy behavior tends to correlate strongly with healthier populations. High rates of exercise, for example, were common in these cities compared to the national rates of exercise. Obesity correlates very strongly with many of the leading causes of death in this country, and the healthiest cities’ obesity rates were generally lower than the national rate. Smoking also appeared to be an important health indicator. Only seven of the healthiest cities in each state had above national average smoking rates.
All but a handful of the healthiest cities had high rates of health insurance coverage. There are several reasons for this, explained Bridget Catlin, co-director of the County Health Rankings and Roadmaps Program, While people without insurance can still access care, “those that do will find it easier to access it, and will have choice of care, resources available to them, whereas those that don’t have insurance will have to go to the places that will take them.”
Another important factor in these metro areas is education. Nearly every city with a healthier population has above average rates of adults who have completed at least some college. Better-educated populations are more likely to make better health decisions, but it also come into play in other ways.
“Education definitely contributes to decision-making, but it also contributes to income and then opportunity,” Catlin said. Better-educated people often work in better-paying jobs, which allows them easier access to healthy food and to exercise options — much more than people with lower incomes. “There are multiple pathways going on here, but education is at the crux of increasing people’s opportunity for leading a healthier life.”
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24/7 Wall St. created an index modelled after analysis conducted by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. To identify the healthiest city in each state, 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. All data used were from the most recent available year.
These are the healthiest cities in every state.
1. Auburn-Opelika, Alabama
> Pct. without health insurance: 11.5%
> Pct. food insecure: 11.4%
> Obesity rate: 30.0%
> 2014 unemployment rate: 5.6%
Auburn-Opelika is the healthiest city in Alabama, a state where people report relatively poor health outcomes compared to the nation. While more than 20% of adult state residents reported fair or poor health, for example, 17.5% of adults in Auburn-Opelika reported such poor health. Relatively strong insurance coverage rates likely help Auburn residents stay healthy. Uninsured people are less likely to have a primary care provider or receive preventive care. As a result, health conditions are more often diagnosed at a late stage or not diagnosed at all. Roughly 11.5% of Auburn-Opelika residents did not have health insurance, lower than both the state and the national uninsured rates of 13.6% and 14.5%.
2. Phoenix-Mesa-Scottsdale, Arizona
> Pct. without health insurance: 17.4%
> Pct. food insecure: 3.8%
> Obesity rate: 24.6%
> 2014 unemployment rate: 6.0%
While residents of Phoenix-Mesa-Scottsdale are only marginally healthier than statewide residents, they are still the healthiest in Arizona. Area residents are also only marginally healthier than the average American. For example, 15.3% of adults in Phoenix reported being in fair or poor health, compared to 15.6% for the state and 16% of adults across the nation. Still, about 20% of Phoenix-Mesa-Scottsdale residents did not participate in physical activity during their leisure time in the month preceding the survey, a significantly lower proportion than the corresponding nationwide figure of 27%. Physical activity among the area’s population may have contributed to the area’s lower obesity rate. The obesity rate among area adults was 24.6%, significantly less than the national rate of 28%.
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3. Fayetteville-Springdale-Rogers, Arkansas
> Pct. without health insurance: 15.2%
> Pct. food insecure: 7.0%
> Obesity rate: 28.3%
> 2014 unemployment rate: 4.6%
The Fayetteville metro area is the healthiest in Arkansas. Only 14.9% of adults in the metro area reported fair or poor health, a smaller share than the 19.4% of adults statewide. Physical activity is important to both physical and mental health. About 76% of Fayetteville residents have adequate access to locations for physical activity compared to less than 66% of Arkansas residents. It is not surprising therefore that a smaller share of Fayetteville residents are physically inactive compared to the percentage of the entire Arkansas population — 23.9% versus 30.5%, respectively.
4. San Luis Obispo-Paso Robles-Arroyo Grande, California
> Pct. without health insurance: 11.2%
> Pct. food insecure: 1.6%
> Obesity rate: 20.4%
> 2014 unemployment rate: 5.6%
The San Luis Obispo metro area is the healthiest in California, which itself is one of the healthier states in the nation. Healthy behaviors likely contributed to the strong health indicators. Just 10% of area residents reported a smoking habit, lower than the comparable statewide smoking rate of 12.9% and half the comparable national smoking rate. Supermarkets and medical care are also highly accessible to San Luis area residents. Even among low income households, just 1.6% reported low access to food. Nationwide, 5.7% of low income households were food insecure. And while 14.5% of Americans did not have health insurance, 11.2% of the metro area’s residents were uninsured, also lower than the state percentage.
5. Boulder, Colorado
> Pct. without health insurance: 10.4%
> Pct. food insecure: 2.8%
> Obesity rate: 15.0%
> 2014 unemployment rate: 4.1%
Boulder is the healthiest metro area in Colorado with 9.1% of adults reporting fair or poor health, a smaller share than the 12.8% of adults statewide. Physical activity is important to both physical and mental health, and in order to be physically active people need access to parks and open spaces. Roughly 97.8% of Boulder residents said they have adequate access to locations for physical activity compared to about 92.3% of people in Colorado. Perhaps as a result, just 9.8% of Boulder residents are physically inactive, even lower than the 15.2% of Colorado residents. Based on this measure, Colorado is the most physically active state in the nation.
MORE: Click her to see the rest of the healthiest cities in every state
24/7 Wall St. is a USA TODAY content partner offering financial news and commentary. Its content is produced independently of USA TODAY.