The Least Healthy City in Every State

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21. Massachusetts: Springfield
> Premature death rate (per 100,000): 324.2 (state: 284.7)
> Adult obesity rate: 26.3% (state: 24.4%)
> Adult smoking rate: 17.1% (state: 13.6%)
> Median household income: $55,379 (state: $77,385)

Springfield is the least healthy of the five metro areas in Massachusetts. Some 16.4% of metro area adults in the city report being in fair or poor health, a larger share than every other metro area in the state and well above the 13.8% share of adults across Massachusetts as a whole.

The prevalence of low self-reported health status in Springfield is likely attributable in part to unhealthy lifestyles. Adults in Springfield more likely to lead sedentary lives and more likely to smoke than adults in every other metro area in the state.

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22. Michigan: Flint
> Premature death rate (per 100,000): 466.7 (state: 366.4)
> Adult obesity rate: 32.4% (state: 31.7%)
> Adult smoking rate: 20.8% (state: 20.4%)
> Median household income: $46,298 (state: $54,909)

Low birthweight can be indicative of unhealthy maternal lifestyles, limited access to health care, and other negative environmental factors. Flint is the only metro area in Michigan where over 10% of newborns weigh under what is considered a healthy weight, the largest share in the state. Flint also has the highest premature death rate among metro areas in the state, with 467 deaths before age 75 annually for every 100,000 people.

Those who are unemployed are more likely to have unhealthy behaviors and report worse health outcomes than those who are employed. In Flint, the unemployment rate stands at 4.9%, the highest of any metro area in the state.

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23. Minnesota: Duluth
> Premature death rate (per 100,000): 336.6 (state: 266.5)
> Adult obesity rate: 29.8% (state: 27.6%)
> Adult smoking rate: 17.6% (state: 15.2%)
> Median household income: $54,162 (state: $68,388)

Smoking — the leading cause of preventable death in the United States — is relatively common in Duluth, as 17.6% of adults are smokers, the highest smoking rate of any other metro area in Minnesota. Adults in Duluth are also less likely to exercise regularly than adults in any other metro area in the state. Regular physical activity can help in maintaining a healthy weight, and in Duluth, 29.8% of adults are obese, a larger share than the 27.6% state obesity rate.

Living in poverty can greatly reduce an individual’s ability to make healthy lifestyle choices, and as a result, poorer Americans often report worse health outcomes. In Duluth, 13.6% of residents live below the poverty line compared to 9.5% of the Minnesota population.

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24. Mississippi: Gulfport-Biloxi-Pascagoula
> Premature death rate (per 100,000): 469.1 (state: 499.1)
> Adult obesity rate: 34.0% (state: 36.5%)
> Adult smoking rate: 20.1% (state: 22.7%)
> Median household income: $47,099 (state: $43,529)

Though Gulfport-Biloxi-Pascagoula ranks as the least healthy metro area in Mississippi, by several measures, area residents are more likely to be healthy than those living in rural parts of the state. For example, adults in the metro area report an average of 4.0 physically unhealthy days per month, the most of any metro area in Mississippi but below the 4.4-day average for the state as a whole.

The same is true for some unhealthy habits. Though the 20.1% smoking rate in Gulfport is the highest of any metro area in the state, it is below the 22.7% statewide smoking rate.

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25. Missouri: St. Joseph
> Premature death rate (per 100,000): 414.4 (state: 395.9)
> Adult obesity rate: 35.7% (state: 32.2%)
> Adult smoking rate: 23.1% (state: 22.1%)
> Median household income: $47,309 (state: $53,578)

Some 35.7% of adults in the St. Joseph metro area are obese, the largest share of any metro area in Missouri. Additionally, 23.1% of adults smoke, also the largest share in the state. Unhealthy lifestyles can contribute to poor health outcomes, and more than one in every five adults in St. Joseph report being in fair or poor health — the largest share of any metro area in Missouri and well above both the 18.5% state and 16.0% national rates.

Adults in St. Joseph are also less likely to exercise than the typical adult in the state. The prevalence of sedentary lifestyles may be partially attributable to a lack of exercise opportunities in the metro area. Just 72.4% of the metro population has access to places for physical activity like parks and recreation centers — below the 76.3% share of state residents and 84.0% of Americans nationwide.