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 in the United States stands at 78.6 years. The last time life expectancy fell three years in a row in the U.S. was over a century ago, when the country was fighting in World War I and was stricken by the Spanish Flu epidemic.
In a recent report, the Centers for Disease Control and Prevention identified several factors contributing to the decrease in life expectancy. These include climbing rates of several diseases and conditions like 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 Wall St. created a weighted index of 35 measures of health outcomes and health factors, including behaviors and access to care, and ranked 382 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, and health insurance coverage.
It is important to note that appearing on this list does not necessarily mean a particular metro area is unhealthy compared to the United States as a whole. Many states have relatively healthy populations and average life expectancies that exceed the national average by several years. Even in the least healthy cities in some of these states, adults are more likely to live long, healthy lives than the typical American. These are the states where people live the longest.
Even though the cities on this list span the country, they tend to share certain socio-economic characteristics. For example, in the vast majority of the 50 metro areas on this list, the median annual household income is lower than the median income across the state as a whole. This is likely no coincidence, as lower-income Americans tend to have less access to health care options and can afford fewer healthy options related to diet and lifestyle, and therefore often report worse health outcomes.
Serious financial hardship can cause a great deal of stress and have other intangible negative effects on health. In many of the cities on this list, poverty is far more common than it is nationwide. Here is a full list of the cities hit hardest by extreme poverty in each state.