When it comes to health, we can try our best to improve what we can control, but sometimes factors beyond our control are stacked against us. People can try to lead an active lifestyle and eat a balanced diet, but if they breathe polluted air while going for a walk or if their income is insufficient to buy healthier foods, they may not benefit as much from the choices they can make. (One key environmental factor of health, for example, is water quality, and these are American cities with the most contaminated water.)
Some factors that impact health – especially socioeconomic conditions, health care infrastructure, and environmental characteristics – are common to many U.S. cities, and variations in these factors contribute to disparities in health outcomes across different urban areas.
To determine the 25 least healthy cities in the United States, 24/7 Tempo reviewed county-level data from the 2023 County Health Rankings & Roadmaps program of the University of Wisconsin Population Health Institute. Metropolitan areas were ranked based on an index consisting of eight health measures, such as potential life lost, smoking rate, and percentage reporting fair or poor health, all using data from the CHR. In all, 384 metro areas were considered.
Nearly all of the least healthy cities are in states in the South, including five in Louisiana, five in West Virginia, and three in Alabama. Two each are in Florida, Georgia, and South Carolina. Four cities from Midwestern states also rank among the least healthy, while no states from the Northeast or the West make the list.
One component of the index is the adult smoking rate, which is higher than the national rate of 16% in all of the 25 least healthy metro areas. The least healthy city on the list, Beckley, West Virginia, has the second highest smoking rate nationwide at 25.8%. In fact, six of the 25 cities have among the 10 highest smoking rates nationwide. Similarly, all of the 25 least healthy cities have a higher adult obesity rate than the national average of 32%, including 15 cities with an adult obesity rate above 40%. (Here is a list of the most obese city in every state.)
While median household income is not an index component, all of the 25 least healthy cities have lower median household incomes than the national median of $69,717, including 13 cities with median annual household incomes below $50,000. The least healthy city, Beckley, has a median household income of $38,737 – the lowest of all 384 metros considered.
25. Tuscaloosa, Alabama
> Adults in fair or poor health: 19.1% (#37 of 384 MSAs)
> Adult smoking rate: 19.1% (#128 of 384 MSAs)
> Adult obesity rate: 42.2% (#9 of 384 MSAs)
> Median household income: $53,998 (#318 of 384 MSAs)
24. Houma-Thibodaux, Louisiana
> Adults in fair or poor health: 19.6% (#25 of 384 MSAs)
> Adult smoking rate: 22.3% (#24 of 384 MSAs)
> Adult obesity rate: 40.3% (#27 of 384 MSAs)
> Median household income: $61,478 (#207 of 384 MSAs)
23. Springfield, Ohio
> Adults in fair or poor health: 16.3% (#114 of 384 MSAs)
> Adult smoking rate: 23.9% (#7 of 384 MSAs)
> Adult obesity rate: 36.7% (#120 of 384 MSAs)
> Median household income: $59,431 (#244 of 384 MSAs)
22. Muncie, Indiana
> Adults in fair or poor health: 17.3% (#83 of 384 MSAs)
> Adult smoking rate: 22.5% (#22 of 384 MSAs)
> Adult obesity rate: 40.1% (#29 of 384 MSAs)
> Median household income: $50,497 (#347 of 384 MSAs)
21. Rocky Mount, North Carolina
> Adults in fair or poor health: 17.5% (#75 of 384 MSAs)
> Adult smoking rate: 20.9% (#56 of 384 MSAs)
> Adult obesity rate: 39.0% (#56 of 384 MSAs)
> Median household income: $51,769 (#337 of 384 MSAs)
20. Sebring-Avon Park, Florida
> Adults in fair or poor health: 19.2% (#29 of 384 MSAs)
> Adult smoking rate: 21.2% (#43 of 384 MSAs)
> Adult obesity rate: 39.1% (#47 of 384 MSAs)
> Median household income: $48,564 (#362 of 384 MSAs)
19. Flint, Michigan
> Adults in fair or poor health: 16.8% (#94 of 384 MSAs)
> Adult smoking rate: 22.2% (#28 of 384 MSAs)
> Adult obesity rate: 42.1% (#10 of 384 MSAs)
> Median household income: $52,025 (#334 of 384 MSAs)
18. Weirton-Steubenville, West Virginia-Ohio
> Adults in fair or poor health: 17.5% (#74 of 384 MSAs)
> Adult smoking rate: 24.7% (#3 of 384 MSAs)
> Adult obesity rate: 39.3% (#37 of 384 MSAs)
> Median household income: $49,362 (#356 of 384 MSAs)
17. Sumter, South Carolina
> Adults in fair or poor health: 18.8% (#44 of 384 MSAs)
> Adult smoking rate: 21.4% (#41 of 384 MSAs)
> Adult obesity rate: 41.3% (#15 of 384 MSAs)
> Median household income: $43,210 (#382 of 384 MSAs)
16. Danville, Illinois
> Adults in fair or poor health: 16.7% (#98 of 384 MSAs)
> Adult smoking rate: 22.1% (#29 of 384 MSAs)
> Adult obesity rate: 38.2% (#78 of 384 MSAs)
> Median household income: $49,091 (#357 of 384 MSAs)
15. Gadsden, Alabama
> Adults in fair or poor health: 19.1% (#35 of 384 MSAs)
> Adult smoking rate: 20.6% (#71 of 384 MSAs)
> Adult obesity rate: 41.1% (#17 of 384 MSAs)
> Median household income: $45,298 (#376 of 384 MSAs)
14. Ocala, Florida
> Adults in fair or poor health: 17.8% (#63 of 384 MSAs)
> Adult smoking rate: 20.8% (#61 of 384 MSAs)
> Adult obesity rate: 38.2% (#78 of 384 MSAs)
> Median household income: $55,161 (#305 of 384 MSAs)
13. Macon-Bibb County, Georgia
> Adults in fair or poor health: 19.0% (#39 of 384 MSAs)
> Adult smoking rate: 20.3% (#83 of 384 MSAs)
> Adult obesity rate: 39.0% (#57 of 384 MSAs)
> Median household income: $53,397 (#324 of 384 MSAs)
12. Alexandria, Louisiana
> Adults in fair or poor health: 18.6% (#46 of 384 MSAs)
> Adult smoking rate: 21.5% (#38 of 384 MSAs)
> Adult obesity rate: 43.2% (#3 of 384 MSAs)
> Median household income: $47,032 (#371 of 384 MSAs)
11. Mobile, Alabama
> Adults in fair or poor health: 19.9% (#22 of 384 MSAs)
> Adult smoking rate: 20.5% (#77 of 384 MSAs)
> Adult obesity rate: 39.5% (#35 of 384 MSAs)
> Median household income: $49,691 (#354 of 384 MSAs)
10. Shreveport-Bossier City, Louisiana
> Adults in fair or poor health: 19.4% (#28 of 384 MSAs)
> Adult smoking rate: 20.9% (#58 of 384 MSAs)
> Adult obesity rate: 42.0% (#11 of 384 MSAs)
> Median household income: $48,164 (#363 of 384 MSAs)
9. Albany, Georgia
> Adults in fair or poor health: 20.0% (#20 of 384 MSAs)
> Adult smoking rate: 21.1% (#49 of 384 MSAs)
> Adult obesity rate: 41.4% (#14 of 384 MSAs)
> Median household income: $48,659 (#361 of 384 MSAs)
8. Hammond, Louisiana
> Adults in fair or poor health: 19.5% (#26 of 384 MSAs)
> Adult smoking rate: 21.8% (#34 of 384 MSAs)
> Adult obesity rate: 40.8% (#19 of 384 MSAs)
> Median household income: $52,872 (#326 of 384 MSAs)
7. Parkersburg-Vienna, West Virginia
> Adults in fair or poor health: 19.2% (#33 of 384 MSAs)
> Adult smoking rate: 23.5% (#10 of 384 MSAs)
> Adult obesity rate: 40.7% (#20 of 384 MSAs)
> Median household income: $54,284 (#315 of 384 MSAs)
6. Monroe, Louisiana
> Adults in fair or poor health: 20.8% (#14 of 384 MSAs)
> Adult smoking rate: 21.2% (#44 of 384 MSAs)
> Adult obesity rate: 42.5% (#8 of 384 MSAs)
> Median household income: $45,001 (#378 of 384 MSAs)
5. Florence, South Carolina
> Adults in fair or poor health: 18.4% (#51 of 384 MSAs)
> Adult smoking rate: 20.8% (#65 of 384 MSAs)
> Adult obesity rate: 41.7% (#13 of 384 MSAs)
> Median household income: $49,724 (#353 of 384 MSAs)
4. Huntington-Ashland, West Virginia-Kentucky-Ohio
> Adults in fair or poor health: 19.4% (#27 of 384 MSAs)
> Adult smoking rate: 24.0% (#6 of 384 MSAs)
> Adult obesity rate: 39.1% (#45 of 384 MSAs)
> Median household income: $50,456 (#348 of 384 MSAs)
3. Pine Bluff, Arkansas
> Adults in fair or poor health: 22.8% (#6 of 384 MSAs)
> Adult smoking rate: 23.1% (#15 of 384 MSAs)
> Adult obesity rate: 42.9% (#4 of 384 MSAs)
> Median household income: $46,826 (#372 of 384 MSAs)
2. Charleston, West Virginia
> Adults in fair or poor health: 19.8% (#23 of 384 MSAs)
> Adult smoking rate: 24.2% (#5 of 384 MSAs)
> Adult obesity rate: 39.0% (#54 of 384 MSAs)
> Median household income: $53,549 (#323 of 384 MSAs)
1. Beckley, West Virginia
> Adults in fair or poor health: 21.7% (#8 of 384 MSAs)
> Adult smoking rate: 25.8% (#2 of 384 MSAs)
> Adult obesity rate: 41.8% (#12 of 384 MSAs)
> Median household income: $38,737 (#384 of 384 MSAs)
Methodology
To determine the least healthy cities in the United States, 24/7 Tempo reviewed county-level data from the 2023 County Health Rankings & Roadmaps program of the University of Wisconsin Population Health Institute. Metropolitan statistical areas were ranked based on an index consisting of eight health measures, all using data from the CHR.
The measures are: The years of potential life lost before age 75 per 100,000 residents from 2018 to 2020; the percentage of adults reporting fair or poor health in 2020; the average number of physically unhealthy days reported in the last 30 days in 2020; the percentage of live births with low birthweight from 2014 to 2020; the percentage of adults who are current smokers in 2020; the percentage of adults reporting a body mass index of 30 or greater in 2020; the number of preventable hospital stays for ambulatory-care sensitive conditions per 100,000 Medicare enrollees in 2020; and the number of deaths due to injury per 100,000 residents from 2016 to 2020.
All data was aggregated from the county level to the metropolitan level using boundary definitions from the U.S. Census Bureau and was weighted by county population. Supplemental data on median household income is from the Census Bureau’s 2021 American Community Survey and are one-year estimates.