The Unhealthiest City in Each State

When choosing where to live, most people consider location first. However, your neighborhood impacts health as much as real estate. The local health care system, public policies, culture, environment, and economy can either boost or undermine residents’ wellbeing. While some cities enable healthy lifestyles, others contribute to higher disease rates. So beyond just transit or amenities, take a hard look at how area conditions influence health when deciding on a new place. Prioritizing these factors could vastly improve your quality of life in the long run.

24/7 Tempo calculated an index using eight health measures such as 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 to measure and rank the health of the population in cities in every state.

Urban populations tend to be healthier than rural areas nationwide, though intrastate disparities exist too. Cities also vary significantly in economic and health care access, driving urban-urban differences as well. (Here are American cities with the most private hospitals.)

The analysis found smoking and obesity as leading drivers of health outcomes. Adult smoking rates ranged from 9.3% in St. George, Utah (ranked 42nd healthiest city) to 25.8% in Beckley, West Virginia (ranked least healthy). Similarly, adult obesity spanned 23.9% in Kahului, Hawaii (12th healthiest) to 42.9% in Pine Bluff, Arkansas (3rd unhealthiest). (These are America’s least healthy cities.)

Here is the city that is the unhealthiest in each state:

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)