In matters of health, some of us try our best to improve what we can control, but sometimes factors beyond our control can present challenges. People can strive to lead an active lifestyle and eat a balanced diet, but if they go for a walk and have to breathe polluted air, or if financial constraints prevent access to healthier foods, they may not benefit as much due to their available choices.
Several factors that influence health, particularly socioeconomic conditions, health care infrastructure, and environmental characteristics, are common among many U.S. cities. The variations in these factors contribute to disparities in health outcomes across different urban areas.
In identifying the 25 least healthy cities in the United States, 24/7 Tempo reviewed county-level data from the 2023 County Health Rankings & Roadmaps program, conducted by the University of Wisconsin Population Health Institute. Metropolitan areas were ranked based on an index consisting of eight health measures, including potential life lost, smoking rate, and the percentage reporting fair or poor health, all using data provide by the CHR. A total of 384 metro areas were considered.
The measures are: The years of potential life lost before age 75 per 100,000 residents from 2018 to 2020; the percentage of adults reporting fair or poor health in 2020; the average number of physically unhealthy days reported in the last 30 days in 2020; the percentage of live births with low birthweight from 2014 to 2020; the percentage of adults who are current smokers in 2020; the percentage of adults reporting a body mass index of 30 or greater in 2020; the number of preventable hospital stays for ambulatory-care sensitive conditions per 100,000 Medicare enrollees in 2020; and the number of deaths due to injury per 100,000 residents from 2016 to 2020.
The majority of the least healthy cities are in Southern states, with five in Louisiana, five in West Virginia, and three in Alabama. Additionally, two cities each are in Florida, Georgia, and South Carolina. Four cities from midwestern states are also included in the list, while no states from the Northeast or the West make the list.
One element of the index is the adult smoking rate, which exceeds the national rate of 16% in all 25 of the least healthy metropolitan areas. Beckly, West Virginia, the unhealthiest city on the list, has the second highest smoking rate nationwide at 25.8%. In fact, six of the 25 cities are among the top 10 with the highest smoking rates nationwide. Similarly, all 25 of the least healthy cities exceed the national average adult obesity rate of 32%, including 15 cities registering an adult obesity rate above 40%. (This is the most obese city in every state.)
Here is a list of America’s least healthy cities:
25. Tuscaloosa, Alabama
- Adults in fair or poor health: 19.1% (#37 of 384 MSAs)
- Adult smoking rate: 19.1% (#128 of 384 MSAs)
- Adult obesity rate: 42.2% (#9 of 384 MSAs)
- Median household income: $53,998 (#318 of 384 MSAs)
24. Houma-Thibodaux, Louisiana
- Adults in fair or poor health: 19.6% (#25 of 384 MSAs)
- Adult smoking rate: 22.3% (#24 of 384 MSAs)
- Adult obesity rate: 40.3% (#27 of 384 MSAs)
- Median household income: $61,478 (#207 of 384 MSAs)
23. Springfield, Ohio
- Adults in fair or poor health: 16.3% (#114 of 384 MSAs)
- Adult smoking rate: 23.9% (#7 of 384 MSAs)
- Adult obesity rate: 36.7% (#120 of 384 MSAs)
- Median household income: $59,431 (#244 of 384 MSAs)
22. Muncie, Indiana
- Adults in fair or poor health: 17.3% (#83 of 384 MSAs)
- Adult smoking rate: 22.5% (#22 of 384 MSAs)
- Adult obesity rate: 40.1% (#29 of 384 MSAs)
- Median household income: $50,497 (#347 of 384 MSAs)
21. Rocky Mount, North Carolina
- Adults in fair or poor health: 17.5% (#75 of 384 MSAs)
- Adult smoking rate: 20.9% (#56 of 384 MSAs)
- Adult obesity rate: 39.0% (#56 of 384 MSAs)
- Median household income: $51,769 (#337 of 384 MSAs)
20. Sebring-Avon Park, Florida
- Adults in fair or poor health: 19.2% (#29 of 384 MSAs)
- Adult smoking rate: 21.2% (#43 of 384 MSAs)
- Adult obesity rate: 39.1% (#47 of 384 MSAs)
- Median household income: $48,564 (#362 of 384 MSAs)
19. Flint, Michigan
- Adults in fair or poor health: 16.8% (#94 of 384 MSAs)
- Adult smoking rate: 22.2% (#28 of 384 MSAs)
- Adult obesity rate: 42.1% (#10 of 384 MSAs)
- Median household income: $52,025 (#334 of 384 MSAs)
18. Weirton-Steubenville, West Virginia-Ohio
- Adults in fair or poor health: 17.5% (#74 of 384 MSAs)
- Adult smoking rate: 24.7% (#3 of 384 MSAs)
- Adult obesity rate: 39.3% (#37 of 384 MSAs)
- Median household income: $49,362 (#356 of 384 MSAs)
17. Sumter, South Carolina
- Adults in fair or poor health: 18.8% (#44 of 384 MSAs)
- Adult smoking rate: 21.4% (#41 of 384 MSAs)
- Adult obesity rate: 41.3% (#15 of 384 MSAs)
- Median household income: $43,210 (#382 of 384 MSAs)
16. Danville, Illinois
- Adults in fair or poor health: 16.7% (#98 of 384 MSAs)
- Adult smoking rate: 22.1% (#29 of 384 MSAs)
- Adult obesity rate: 38.2% (#78 of 384 MSAs)
- Median household income: $49,091 (#357 of 384 MSAs)
15. Gadsden, Alabama
- Adults in fair or poor health: 19.1% (#35 of 384 MSAs)
- Adult smoking rate: 20.6% (#71 of 384 MSAs)
- Adult obesity rate: 41.1% (#17 of 384 MSAs)
- Median household income: $45,298 (#376 of 384 MSAs)
14. Ocala, Florida
- Adults in fair or poor health: 17.8% (#63 of 384 MSAs)
- Adult smoking rate: 20.8% (#61 of 384 MSAs)
- Adult obesity rate: 38.2% (#78 of 384 MSAs)
- Median household income: $55,161 (#305 of 384 MSAs)
13. Macon-Bibb County, Georgia
- Adults in fair or poor health: 19.0% (#39 of 384 MSAs)
- Adult smoking rate: 20.3% (#83 of 384 MSAs)
- Adult obesity rate: 39.0% (#57 of 384 MSAs)
- Median household income: $53,397 (#324 of 384 MSAs)
12. Alexandria, Louisiana
- Adults in fair or poor health: 18.6% (#46 of 384 MSAs)
- Adult smoking rate: 21.5% (#38 of 384 MSAs)
- Adult obesity rate: 43.2% (#3 of 384 MSAs)
- Median household income: $47,032 (#371 of 384 MSAs)
11. Mobile, Alabama
- Adults in fair or poor health: 19.9% (#22 of 384 MSAs)
- Adult smoking rate: 20.5% (#77 of 384 MSAs)
- Adult obesity rate: 39.5% (#35 of 384 MSAs)
- Median household income: $49,691 (#354 of 384 MSAs)
10. Shreveport-Bossier City, Louisiana
- Adults in fair or poor health: 19.4% (#28 of 384 MSAs)
- Adult smoking rate: 20.9% (#58 of 384 MSAs)
- Adult obesity rate: 42.0% (#11 of 384 MSAs)
- Median household income: $48,164 (#363 of 384 MSAs)
9. Albany, Georgia
- Adults in fair or poor health: 20.0% (#20 of 384 MSAs)
- Adult smoking rate: 21.1% (#49 of 384 MSAs)
- Adult obesity rate: 41.4% (#14 of 384 MSAs)
- Median household income: $48,659 (#361 of 384 MSAs)
8. Hammond, Louisiana
- Adults in fair or poor health: 19.5% (#26 of 384 MSAs)
- Adult smoking rate: 21.8% (#34 of 384 MSAs)
- Adult obesity rate: 40.8% (#19 of 384 MSAs)
- Median household income: $52,872 (#326 of 384 MSAs)
7. Parkersburg-Vienna, West Virginia
- Adults in fair or poor health: 19.2% (#33 of 384 MSAs)
- Adult smoking rate: 23.5% (#10 of 384 MSAs)
- Adult obesity rate: 40.7% (#20 of 384 MSAs)
- Median household income: $54,284 (#315 of 384 MSAs)
6. Monroe, Louisiana
- Adults in fair or poor health: 20.8% (#14 of 384 MSAs)
- Adult smoking rate: 21.2% (#44 of 384 MSAs)
- Adult obesity rate: 42.5% (#8 of 384 MSAs)
- Median household income: $45,001 (#378 of 384 MSAs)
5. Florence, South Carolina
- Adults in fair or poor health: 18.4% (#51 of 384 MSAs)
- Adult smoking rate: 20.8% (#65 of 384 MSAs)
- Adult obesity rate: 41.7% (#13 of 384 MSAs)
- Median household income: $49,724 (#353 of 384 MSAs)
4. Huntington-Ashland, West Virginia-Kentucky-Ohio
- Adults in fair or poor health: 19.4% (#27 of 384 MSAs)
- Adult smoking rate: 24.0% (#6 of 384 MSAs)
- Adult obesity rate: 39.1% (#45 of 384 MSAs)
- Median household income: $50,456 (#348 of 384 MSAs)
3. Pine Bluff, Arkansas
- Adults in fair or poor health: 22.8% (#6 of 384 MSAs)
- Adult smoking rate: 23.1% (#15 of 384 MSAs)
- Adult obesity rate: 42.9% (#4 of 384 MSAs)
- Median household income: $46,826 (#372 of 384 MSAs)
2. Charleston, West Virginia
- Adults in fair or poor health: 19.8% (#23 of 384 MSAs)
- Adult smoking rate: 24.2% (#5 of 384 MSAs)
- Adult obesity rate: 39.0% (#54 of 384 MSAs)
- Median household income: $53,549 (#323 of 384 MSAs)
1. Beckley, West Virginia
- Adults in fair or poor health: 21.7% (#8 of 384 MSAs)
- Adult smoking rate: 25.8% (#2 of 384 MSAs)
- Adult obesity rate: 41.8% (#12 of 384 MSAs)
- Median household income: $38,737 (#384 of 384 MSAs)