The Least Healthy City in Every State

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36. Oklahoma: Lawton
> Premature death rate (per 100,000): 469.0 (state: 458.3)
> Adult obesity rate: 32.8% (state: 33.3%)
> Adult smoking rate: 20.5% (state: 19.6%)
> Median household income: $50,702 (state: $50,051)

Some 16.2% of residents in the Lawton metro area live below the poverty line, the highest poverty rate of any city in Oklahoma and higher than the rate of 15.8% statewide. Income is one of the largest determinants of health, and areas with higher poverty rates tend to have worse health behaviors and outcomes.

In Lawton, 20.5% of adults smoke, the highest smoking rate of any Oklahoma metro area. Just 70.2% of adults regularly exercise, less than the 71.6% state activity rate and one of the smallest shares nationwide. Tobacco use and inactivity are two of the leading causes of premature death, and in Lawton, 469 in every 100,000 residents die before the age of 75 — the highest premature death rate in Oklahoma and among the highest of any city in the country.

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37. Oregon: Grants Pass
> Premature death rate (per 100,000): 426.9 (state: 309.0)
> Adult obesity rate: 29.5% (state: 28.3%)
> Adult smoking rate: 18.3% (state: 16.2%)
> Median household income: $44,426 (state: $60,212)

In Grants Pass, 17.1% of adults are in fair or poor health, the largest share of any metro area in the state. Adults in Grants Pass are also more likely to report being in poor mental or physical health than the average Oregon resident statewide.

Low-income households cannot afford as many healthy options related to diet and lifestyle as wealthier households, and often report worse health outcomes as a result. In Grants Pass, the typical household earns just $44,426 a year, well below the $60,212 state median.

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38. Pennsylvania: Johnstown
> Premature death rate (per 100,000): 462.5 (state: 359.2)
> Adult obesity rate: 29.3% (state: 29.9%)
> Adult smoking rate: 17.3% (state: 18.0%)
> Median household income: $46,598 (state: $59,195)

Johnstown is the only metro area in Pennsylvania where adults report an average of more than four physically unhealthy days per month. Johnstown also has the highest premature death rate of any of the 18 metro areas in Pennsylvania. There are 463 deaths before age 75 annually for every 100,000 metro area residents, well above the state premature death rate of 359 per 100,000.

Pennsylvania has been hit particularly hard by the opioid epidemic, and Johnstown is one of the hardest hit metro areas in the state. For every 100,000 Johnstown residents, there are 120 deaths from unintentional injury — the leading cause of which is drug overdose — far more than the state rate of 81 injury deaths per 100,000 Pennsylvania residents and the national rate of 67 injury deaths per 100,000 Americans.

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39. Rhode Island: Providence-Warwick
> Premature death rate (per 100,000): 322.8 (state: 307.3)
> Adult obesity rate: 27.6% (state: 27.0%)
> Adult smoking rate: 16.2% (state: 14.4%)
> Median household income: $65,226 (state: $63,870)

The Providence-Warwick metro area encompasses all five counties in Rhode Island as well as Bristol County in Massachusetts. As the only metro area in Rhode Island, Providence ranks as the least healthy city in the state by default, and matches the state as a whole in most measures of health behaviors and outcomes. For example, 27.6% of adults in Providence are obese, compared to 27.0% of adults across the state. Similarly, 14.5% of adults in Providence report being in fair or poor health, closely in line with the 14.8% of adults who do throughout Rhode Island.

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40. South Carolina: Florence
> Premature death rate (per 100,000): 518.4 (state: 414.2)
> Adult obesity rate: 36.6% (state: 32.4%)
> Adult smoking rate: 19.8% (state: 20.0%)
> Median household income: $40,562 (state: $50,570)

Only about 70% of adults in the Florence metro area get regular exercise, a smaller share than the 75% of adults across South Carolina who do. Remaining active can help in maintaining a healthy weight, and in Florence, 36.6% of adults are obese, compared to 32.4% of adults statewide.

Obesity is a risk factor for a number of potentially deadly diseases and conditions, including diabetes, heart disease, and certain cancers, and is a leading cause of premature death overall. In Florence, there are 518 deaths before age 75 for every 100,000 people annually, well above the state premature death rate of 414 per 100,000.