The Least Healthy City in Every State

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31. New Mexico: Farmington
> Premature death rate (per 100,000): 456.5 (state: 392.8)
> Adult obesity rate: 32.8% (state: 25.6%)
> Adult smoking rate: 18.5% (state: 16.6%)
> Median household income: $45,942 (state: $46,744)

Farmington is the only metro area in New Mexico where adults report an average of over four mentally unhealthy days per month. With an obesity rate of 32.8%, the metro area also has far and away the largest share of adults who are dangerously overweight.

Such unhealthy outcomes are likely due in part to the prevalence of unhealthy lifestyles. Regular exercise can be good for mental health and help in maintaining a healthy weight. In Farmington, 22.5% of adults get no exercise beyond getting up and going to work, by far the largest share of any metro area in the state and well above the 18.2% of adults across the state who lead sedentary lives.

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32. New York: Elmira
> Premature death rate (per 100,000): 390.5 (state: 279.4)
> Adult obesity rate: 34.6% (state: 25.7%)
> Adult smoking rate: 20.6% (state: 14.2%)
> Median household income: $51,194 (state: $64,894)

Elmira is the only one of New York’s 12 metro areas where adults report an average of over four physically unhealthy days per month. It is also the only metro area in the state where more than one in every five adults smoke and more than one in every three adults are obese.

Low-income Americans have less access to quality health care options than those with higher incomes, and are less able to afford the components of a healthy lifestyle. In Elmira, the typical household earns just $51,194 a year, compared to the statewide median of $64,894.

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33. North Carolina: Rocky Mount
> Premature death rate (per 100,000): 487.3 (state: 372.2)
> Adult obesity rate: 36.7% (state: 30.2%)
> Adult smoking rate: 19.6% (state: 17.9%)
> Median household income: $42,784 (state: $52,752)

Rocky Mount’s premature death rate of 487 deaths before age 75 for every 100,000 people is by far the highest of any of the 15 metro areas in North Carolina. It is also far higher than the state premature death rate of 372 per 100,000.

The higher premature death rate in the metro area is likely due in part to the prevalence of some unhealthy behaviors and outcomes. For example, 36.7% of metro area adults are obese, the largest share of any metro area in the state. Obesity is a risk factor for a number of potentially deadly diseases and conditions, including diabetes, heart disease, and certain cancers.

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34. North Dakota: Bismarck
> Premature death rate (per 100,000): 366.4 (state: 318.8)
> Adult obesity rate: 31.0% (state: 32.2%)
> Adult smoking rate: 16.7% (state: 19.8%)
> Median household income: $66,087 (state: $61,843)

People living in urban areas tend to have healthier behaviors and better health outcomes than residents of rural areas. So while Bismarck ranks as the least healthy metro area in North Dakota, it performs better than the state as a whole in several measures.

For example, 16.7% of adults in Bismarck smoke, less than the 19.8% state smoking rate. Similarly, 31.0% of Bismarck adults are obese, slightly less than the 32.2% state obesity rate. Adults who do not smoke and are normal weight are less likely to self-report being in poor health, and in Bismarck, 12.4% of adults report being in fair or poor health, less than the 14.3% of adults who do statewide and the 16.0% who do nationwide.

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35. Ohio: Springfield
> Premature death rate (per 100,000): 533.7 (state: 403.9)
> Adult obesity rate: 35.7% (state: 31.8%)
> Adult smoking rate: 22.0% (state: 22.5%)
> Median household income: $46,665 (state: $54,021)

Springfield is the only metro are in Ohio where adults report an average of over four physically unhealthy days per month. Springfield residents are also more likely than those in any other Ohio metro area to die prematurely. There are 534 deaths before age 75 for every 100,000 metro area residents annually, compared to the statewide premature death rate of 404 per 100,000.

Poor health outcomes are partially attributable to unhealthy lifestyles. For example, adults in Springfield are less likely to exercise than adults across the state, and Springfield’s 35.7% obesity rate is the highest of the 11 metro areas in Ohio.