The Healthiest City in Every State

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26. Montana: Missoula
> Premature death rate (per 100,000): 305.9 (state: 346.6)
> Adult obesity rate: 23.4% (state: 25.4%)
> Rate of uninsured people under 65: 9.5% (state: 10.0%)
> Median household income: $54,311 (state: $53,386)

In Missoula, just 23.4% of adults are obese, compared to the state obesity rate of 25.4% and a national obesity rate of 28.5%. One likely reason for the metro area’s relatively low obesity rate is the level of exercise the population reports. Less than 15% of Missoula residents report no leisure time physical activity, one of the lowest shares among all metro areas nationwide and well below the national share of 22%.

Obesity is one of the most direct indicators of poor health, and the condition is associated with many of the most common life-threatening conditions, including heart disease, cancer, diabetes, and hypertension. And the metro area’s low obesity rate may partially explain why its premature death rate is also lower than the state average.

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27. Nebraska: Lincoln
> Premature death rate (per 100,000): 274.7 (state: 307.4)
> Adult obesity rate: 27.7% (state: 31.2%)
> Rate of uninsured people under 65: 9.0% (state: 9.7%)
> Median household income: $60,057 (state: $59,970)

Lincoln is the only metro area in Nebraska where adults report fewer than three physically unhealthy days per month on average. Additionally, just 11.1% of adults in Lincoln report being in fair or poor health, the smallest share of any metro area in the state and well below the 14.2% share of adults statewide.

Adults with a college education typically have a greater sense of control over their lives and are better equipped to make healthier lifestyle choices. In Lincoln, 38.1% of adults have a bachelor’s degree, well above the state bachelor’s degree attainment rate of 31.7% and the national rate of 32.0%.

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28. Nevada: Reno
> Premature death rate (per 100,000): 356.4 (state: 364.4)
> Adult obesity rate: 22.9% (state: 26.5%)
> Rate of uninsured people under 65: 11.7% (state: 13.1%)
> Median household income: $61,360 (state: $58,003)

Among Nevada’s three metro areas — Reno, Las Vegas, and Carson City — none are perfect models of good health behaviors or outcomes. Adults in all three, for example, report more days of poor mental health a month than the average nationwide. However, Reno compares favorably to the other two in several important indicators.

Notably, Reno has by far the lowest adult obesity rate, at just 22.9%, compared to a national obesity rate of 28.5%. Reno’s adults are also the least likely in the state to have sedentary lifestyles. Just 17.0% of the city’s adults report no leisure time physical activity, compared to 21.0% and 22.5% in Carson City and Las Vegas, respectively.

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29. New Hampshire: Manchester-Nashua
> Premature death rate (per 100,000): 315.4 (state: 307.6)
> Adult obesity rate: 28.2% (state: 28.0%)
> Rate of uninsured people under 65: 7.3% (state: 7.2%)
> Median household income: $78,769 (state: $73,381)

Manchester is the only metro area in New Hampshire and therefore ranks as the healthiest city by default. In fact, Manchester is slightly less healthy than the state as a whole in some measures of health outcomes. For example, Manchester’s premature death rate of 315 deaths before age 75 per 100,000 people is slightly higher than the comparable state rate of 308 per 100,000.

Despite the poorer health outcome, Manchester residents are more likely to exhibit certain healthier habits than the typical New Hampshire resident. Just 15.2% of metro area adults smoke and 19.7% drink excessively, compared to 18.0% and 20.1% of adults statewide, respectively.

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30. New Jersey: Trenton
> Premature death rate (per 100,000): 296.0 (state: 288.1)
> Adult obesity rate: 25.2% (state: 26.2%)
> Rate of uninsured people under 65: 8.9% (state: 9.2%)
> Median household income: $79,173 (state: $80,088)

Those who have health insurance are more likely to receive adequate and timely medical care than those without it. In Trenton, just 8.9% of residents under age 65 do not have health insurance coverage, the second lowest uninsured rate among New Jersey’s metro areas, and well below the national share of 10.0%.

The biggest sign of Trenton’s good health is the premature mortality rate. There are 296 deaths before age 75 out of every 100,000 metro area residents. Of the three remaining metro areas in the state, the next lowest premature mortality rate is Ocean City, which has a rate of 389 per 100,000.