Health outcomes in the United States vary dramatically depending on where you live, and in some cities, residents face far greater health-related challenges than others. Factors such as access to healthcare, environment, income inequality, education levels, and lifestyle all play a role in influencing public health. When negative pressures combine, they can lead to higher rates of chronic disease, shorter life spans, and excess stress on local health systems.
The cities on this list are not defined by a single issue, but by a pattern of multiple and overlapping health risks that affect large portions of their populations. Understanding where and why these challenges exist helps bring to light deeper problems; it enables us to see the kinds of policy changes, investments, and efforts that could help.
To calculate the U.S. cities facing the worst health challenges, 24/7 Tempo used eight health measures like potential life lost, smoking rate, and percentage reporting fair or poor health, using data from the 2023 County Health Rankings & Roadmaps program of the University of Wisconsin Population Health Institute. Here’s a closer look at the U.S. cities facing the most serious health hurdles today.
Alabama: Mobile
- Adults in fair or poor health: 19.9% (state: 18.9%)
- Adult smoking rate: 20.5% (state: 19.5%)
- Adult obesity rate: 39.5% (state: 39.3%)
- Median household income: $49,691 (state: $53,913)
Alaska: Anchorage
- Adults in fair or poor health: 11.5% (state: 12.2%)
- Adult smoking rate: 16.4% (state: 18.0%)
- Adult obesity rate: 30.0% (state: 31.8%)
- Median household income: $84,476 (state: $77,845)
Arizona: Lake Havasu City-Kingman
- Adults in fair or poor health: 16.7% (state: 14.5%)
- Adult smoking rate: 21.0% (state: 13.7%)
- Adult obesity rate: 35.7% (state: 31.5%)
- Median household income: $46,616 (state: $69,056)
Arkansas: Pine Bluff
- Adults in fair or poor health: 22.8% (state: 19.4%)
- Adult smoking rate: 23.1% (state: 21.6%)
- Adult obesity rate: 42.9% (state: 37.2%)
- Median household income: $46,826 (state: $52,528)
California: Bakersfield
- Adults in fair or poor health: 21.2% (state: 14.4%)
- Adult smoking rate: 15.1% (state: 9.0%)
- Adult obesity rate: 35.0% (state: 30.2%)
- Median household income: $58,217 (state: $84,907)
Colorado: Pueblo
- Adults in fair or poor health: 15.5% (state: 10.2%)
- Adult smoking rate: 17.6% (state: 12.6%)
- Adult obesity rate: 29.6% (state: 24.2%)
- Median household income: $56,689 (state: $82,254)
Connecticut: New Haven-Milford
- Adults in fair or poor health: 11.6% (state: 11.0%)
- Adult smoking rate: 15.4% (state: 12.6%)
- Adult obesity rate: 33.3% (state: 29.5%)
- Median household income: $75,295 (state: $83,771)
Delaware: Dover
- Adults in fair or poor health: 14.6% (state: 12.8%)
- Adult smoking rate: 20.0% (state: 15.8%)
- Adult obesity rate: 39.1% (state: 36.2%)
- Median household income: $64,308 (state: $71,091)
Florida: Ocala
- Adults in fair or poor health: 17.8% (state: 13.3%)
- Adult smoking rate: 20.8% (state: 15.5%)
- Adult obesity rate: 38.2% (state: 28.3%)
- Median household income: $55,161 (state: $63,062)
Georgia: Albany
- Adults in fair or poor health: 20.0% (state: 15.1%)
- Adult smoking rate: 21.1% (state: 16.3%)
- Adult obesity rate: 41.4% (state: 34.3%)
- Median household income: $48,659 (state: $66,559)
Hawaii: Kahului-Wailuku-Lahaina
- Adults in fair or poor health: 11.0% (state: 10.3%)
- Adult smoking rate: 14.0% (state: 12.2%)
- Adult obesity rate: 23.9% (state: 25.0%)
- Median household income: $76,273 (state: $84,857)
Idaho: Pocatello
- Adults in fair or poor health: 13.6% (state: 11.8%)
- Adult smoking rate: 18.2% (state: 14.2%)
- Adult obesity rate: 36.3% (state: 31.3%)
- Median household income: $60,475 (state: $66,474)
Illinois: Danville
- Adults in fair or poor health: 16.7% (state: 12.3%)
- Adult smoking rate: 22.1% (state: 12.8%)
- Adult obesity rate: 38.2% (state: 32.5%)
- Median household income: $49,091 (state: $72,205)
Indiana: Muncie
- Adults in fair or poor health: 17.3% (state: 15.1%)
- Adult smoking rate: 22.5% (state: 20.2%)
- Adult obesity rate: 40.1% (state: 37.2%)
- Median household income: $50,497 (state: $62,743)
Iowa: Davenport-Moline-Rock Island, Iowa/Illinois
- Adults in fair or poor health: 12.9% (state: 12.0%)
- Adult smoking rate: 16.8% (state: 16.8%)
- Adult obesity rate: 36.3% (state: 37.2%)
- Median household income: $61,166 (state: $65,600)
Kansas: Topeka
- Adults in fair or poor health: 13.1% (state: 12.8%)
- Adult smoking rate: 17.7% (state: 17.2%)
- Adult obesity rate: 37.5% (state: 35.8%)
- Median household income: $57,474 (state: $64,124)
Kentucky: Bowling Green
- Adults in fair or poor health: 18.9% (state: 19.5%)
- Adult smoking rate: 22.1% (state: 22.2%)
- Adult obesity rate: 37.6% (state: 37.0%)
- Median household income: $57,057 (state: $55,573)
Louisiana: Monroe
- Adults in fair or poor health: 20.8% (state: 19.0%)
- Adult smoking rate: 21.2% (state: 18.9%)
- Adult obesity rate: 42.5% (state: 38.3%)
- Median household income: $45,001 (state: $52,087)
Maine: Bangor
- Adults in fair or poor health: 12.6% (state: 11.1%)
- Adult smoking rate: 20.2% (state: 18.0%)
- Adult obesity rate: 34.3% (state: 31.3%)
- Median household income: $56,250 (state: $64,767)
Maryland: Hagerstown-Martinsburg, Maryland/West Virginia
- Adults in fair or poor health: 15.1% (state: 10.6%)
- Adult smoking rate: 20.4% (state: 11.1%)
- Adult obesity rate: 37.7% (state: 30.9%)
- Median household income: $67,372 (state: $90,203)
Massachusetts: Springfield
- Adults in fair or poor health: 12.9% (state: 10.8%)
- Adult smoking rate: 15.4% (state: 11.4%)
- Adult obesity rate: 29.2% (state: 24.5%)
- Median household income: $65,520 (state: $89,645)
Michigan: Flint
- Adults in fair or poor health: 16.8% (state: 14.7%)
- Adult smoking rate: 22.2% (state: 19.3%)
- Adult obesity rate: 42.1% (state: 35.3%)
- Median household income: $52,025 (state: $63,498)
Minnesota: Duluth, Minnesota/Wisconsin
- Adults in fair or poor health: 11.7% (state: 10.0%)
- Adult smoking rate: 20.5% (state: 14.3%)
- Adult obesity rate: 33.0% (state: 30.6%)
- Median household income: $64,960 (state: $77,720)
Mississippi: Hattiesburg
- Adults in fair or poor health: 18.6% (state: 18.7%)
- Adult smoking rate: 19.4% (state: 20.7%)
- Adult obesity rate: 39.1% (state: 39.9%)
- Median household income: $55,444 (state: $48,716)
Missouri: St. Joseph, Missouri/Kansas
- Adults in fair or poor health: 16.2% (state: 15.2%)
- Adult smoking rate: 22.2% (state: 18.6%)
- Adult obesity rate: 37.3% (state: 34.2%)
- Median household income: $54,702 (state: $61,847)
Montana: Great Falls
- Adults in fair or poor health: 12.9% (state: 12.1%)
- Adult smoking rate: 18.6% (state: 17.5%)
- Adult obesity rate: 35.0% (state: 28.9%)
- Median household income: $57,706 (state: $63,249)
Nebraska: Grand Island
- Adults in fair or poor health: 12.8% (state: 10.2%)
- Adult smoking rate: 17.3% (state: 14.5%)
- Adult obesity rate: 39.1% (state: 34.0%)
- Median household income: $61,749 (state: $66,817)
Nevada: Carson City
- Adults in fair or poor health: 16.3% (state: 16.7%)
- Adult smoking rate: 18.4% (state: 14.1%)
- Adult obesity rate: 34.4% (state: 28.1%)
- Median household income: $65,330 (state: $66,274)
New Hampshire: Manchester-Nashua
- Adults in fair or poor health: 10.9% (state: 10.8%)
- Adult smoking rate: 14.1% (state: 14.7%)
- Adult obesity rate: 29.2% (state: 30.5%)
- Median household income: $91,627 (state: $88,465)
New Jersey: Vineland-Bridgeton
- Adults in fair or poor health: 17.8% (state: 10.8%)
- Adult smoking rate: 19.1% (state: 11.1%)
- Adult obesity rate: 35.7% (state: 27.7%)
- Median household income: $58,389 (state: $89,296)
New Mexico: Farmington
- Adults in fair or poor health: 17.7% (state: 13.8%)
- Adult smoking rate: 22.6% (state: 16.9%)
- Adult obesity rate: 35.0% (state: 31.7%)
- Median household income: $47,819 (state: $53,992)
New York: Elmira
- Adults in fair or poor health: 12.5% (state: 11.8%)
- Adult smoking rate: 19.1% (state: 12.3%)
- Adult obesity rate: 33.0% (state: 26.5%)
- Median household income: $60,219 (state: $74,314)
North Carolina: Rocky Mount
- Adults in fair or poor health: 17.5% (state: 13.5%)
- Adult smoking rate: 20.9% (state: 17.0%)
- Adult obesity rate: 39.0% (state: 33.6%)
- Median household income: $51,769 (state: $61,972)
North Dakota: Grand Forks, North Dakota/Minnesota
- Adults in fair or poor health: 11.6% (state: 11.6%)
- Adult smoking rate: 17.8% (state: 17.9%)
- Adult obesity rate: 35.9% (state: 33.6%)
- Median household income: $62,568 (state: $66,519)
Ohio: Springfield
- Adults in fair or poor health: 16.3% (state: 14.5%)
- Adult smoking rate: 23.9% (state: 20.2%)
- Adult obesity rate: 36.7% (state: 35.8%)
- Median household income: $59,431 (state: $62,262)
Oklahoma: Lawton
- Adults in fair or poor health: 18.0% (state: 17.3%)
- Adult smoking rate: 20.7% (state: 19.6%)
- Adult obesity rate: 39.4% (state: 37.1%)
- Median household income: $49,422 (state: $55,826)
Oregon: Grants Pass
- Adults in fair or poor health: 15.8% (state: 12.7%)
- Adult smoking rate: 19.1% (state: 13.6%)
- Adult obesity rate: 30.4% (state: 28.3%)
- Median household income: $48,785 (state: $71,562)
Pennsylvania: Johnstown
- Adults in fair or poor health: 14.4% (state: 13.1%)
- Adult smoking rate: 20.8% (state: 16.7%)
- Adult obesity rate: 33.2% (state: 31.6%)
- Median household income: $52,995 (state: $68,957)
Rhode Island: Providence-Warwick, Rhode Island/Massachusetts
- Adults in fair or poor health: 12.5% (state: 11.8%)
- Adult smoking rate: 15.7% (state: 14.1%)
- Adult obesity rate: 29.6% (state: 30.6%)
- Median household income: $73,788 (state: $74,008)
South Carolina: Florence
- Adults in fair or poor health: 18.4% (state: 15.9%)
- Adult smoking rate: 20.8% (state: 19.1%)
- Adult obesity rate: 41.7% (state: 36.7%)
- Median household income: $49,724 (state: $59,318)
South Dakota: Rapid City
- Adults in fair or poor health: 10.8% (state: 10.4%)
- Adult smoking rate: 18.0% (state: 19.0%)
- Adult obesity rate: 32.8% (state: 33.4%)
- Median household income: $63,342 (state: $66,143)
Tennessee: Memphis, Tennessee/Mississippi/Arkansas
- Adults in fair or poor health: 17.9% (state: 15.7%)
- Adult smoking rate: 19.1% (state: 19.7%)
- Adult obesity rate: 38.8% (state: 35.8%)
- Median household income: $55,840 (state: $59,695)
Texas: Texarkana, Texas/Arkansas
- Adults in fair or poor health: 19.1% (state: 15.7%)
- Adult smoking rate: 21.1% (state: 13.3%)
- Adult obesity rate: 38.6% (state: 35.8%)
- Median household income: $50,070 (state: $66,963)
Utah: St. George
- Adults in fair or poor health: 12.0% (state: 10.9%)
- Adult smoking rate: 9.3% (state: 8.3%)
- Adult obesity rate: 30.8% (state: 29.3%)
- Median household income: $61,186 (state: $79,449)
Vermont: Burlington-South Burlington
- Adults in fair or poor health: 9.1% (state: 10.6%)
- Adult smoking rate: 13.0% (state: 14.4%)
- Adult obesity rate: 24.5% (state: 26.3%)
- Median household income: $81,852 (state: $72,431)
Virginia: Roanoke
- Adults in fair or poor health: 14.6% (state: 12.4%)
- Adult smoking rate: 18.6% (state: 13.9%)
- Adult obesity rate: 35.0% (state: 32.4%)
- Median household income: $59,630 (state: $80,963)
Washington: Yakima
- Adults in fair or poor health: 19.2% (state: 11.8%)
- Adult smoking rate: 17.5% (state: 11.6%)
- Adult obesity rate: 37.1% (state: 28.0%)
- Median household income: $61,012 (state: $84,247)
West Virginia: Beckley, WV
- Adults in fair or poor health: 21.7% (state: 20.0%)
- Adult smoking rate: 25.8% (state: 24.0%)
- Adult obesity rate: 41.8% (state: 39.6%)
- Median household income: $38,737 (state: $51,248)
Wisconsin: Janesville-Beloit
- Adults in fair or poor health: 12.1% (state: 12.4%)
- Adult smoking rate: 18.4% (state: 16.1%)
- Adult obesity rate: 35.1% (state: 32.7%)
- Median household income: $66,090 (state: $67,125)
Wyoming: Casper
- Adults in fair or poor health: 12.2% (state: 11.5%)
- Adult smoking rate: 20.3% (state: 19.4%)
- Adult obesity rate: 34.0% (state: 30.6%)
- Median household income: $63,605 (state: $65,204)
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