As people become more health conscious, the question of which cities have the healthiest populations is gaining importance. Health is affected by many factors, including access to healthcare, rates of chronic diseases, rates of mental illness, obesity rates, activity levels, and more. When looking at cities, larger factors like pollution levels and community design also come into play. With so many variables, it can be challenging to definitively say which city has the overall healthiest population. However, by analyzing key health indicators, some cities stand out over others.
What factors make a city healthy?
Some of the key factors that contribute to a city having a healthy population include:
- Access to healthcare – Are quality medical facilities and doctors readily available and affordable?
- Chronic disease rates – How prevalent are conditions like heart disease, diabetes, cancer etc?
- Mental health – What are the rates of issues like depression, anxiety, addiction?
- Obesity rates – What percentage of the population is considered obese?
- Physical activity – How easy and common is it for residents to exercise regularly?
- Healthy behaviors – Do people follow recommended guidelines for sleep, nutrition, alcohol use, etc?
- Community design – Does the layout of the city encourage walking and recreation?
- Air quality – How much pollution is in the air from traffic, industry, etc?
When looking at all these factors holistically for major cities, a few stand out as having the healthiest populations overall.
Cities with the Healthiest Populations
Seattle, Washington
Seattle consistently ranks as one of the healthiest cities in America. Contributing factors include:
- Access to healthcare – Washington state has the second lowest rate of uninsured residents at just 5.5% as of 2015, compared to the national average of 8.6%.
- Chronic disease – Seattle has lower rates of heart disease, diabetes, cancer, and other common conditions compared to national averages.
- Mental health – Depression rates are on par with the national average, while excessive drinking rates are lower.
- Obesity – Only 21.7% of Seattle residents were considered obese in 2015, compared to the national average of 29.8%.
- Physical activity – About 56% of residents get adequate weekly exercise, aided by the city’s many parks and bike trails.
- Healthy behaviors – 82.5% of residents report getting adequate sleep. The city also has above average fruit/vegetable intake.
- Community design – Seattle was one of the first cities to focus on pedestrian-friendly infrastructure, which promotes activity.
- Air quality – Despite the traffic, Seattle still has reasonably good air quality compared to other major metros.
Seattle offers many health advantages, from plentiful healthcare options, lower disease rates, and a culture that values fitness and the outdoors.
San Francisco, California
San Francisco is considered California’s healthiest city and also ranks high nationally. Factors supporting the health of residents include:
- Healthcare access – 96.4% of residents have health insurance, thanks to Bay Area tech jobs providing benefits.
- Chronic disease – San Francisco has lower rates of heart disease, diabetes, and cancer compared to both state and national averages.
- Mental health – Depression rates are slightly lower than average, while excessive drinking is on par with national levels.
- Obesity – Only about 1 in 5 San Francisco residents were considered obese in 2021.
- Physical activity – About 69% of residents get the recommended weekly exercise.
- Healthy behaviors – Fruit/vegetable consumption is high, and over 86% of residents report getting adequate sleep.
- Community design – San Francisco is very walkable and bikeable, with neighborhoods designed to get people outside.
- Air quality – Despite issues like traffic congestion, air quality is reasonably good compared to other big cities.
Quality healthcare access combined with active lifestyles and community infrastructure make San Francisco one of the healthiest major cities.
Boston, Massachusetts
Boston, a leader in healthcare innovation, also has one of America’s healthiest populations:
- Healthcare access – 96% of Massachusetts residents have health insurance, thanks to mandated state coverage.
- Chronic disease – Boston has lower rates of heart disease, diabetes, cancer, and stroke compared to national levels.
- Mental health – Depression rates are average, while excessive drinking is slightly above average.
- Obesity – Approximately 1 in 4 Boston residents are considered obese, below the national rate.
- Physical activity – About 61% of the population gets adequate weekly exercise.
- Healthy behaviors – Residents have above average rates of fruit/vegetable consumption and sleep.
- Community design – Boston promotes walkability and recreation, with green initiatives.
- Air quality – Relatively low pollution levels despite the historic city’s traffic.
High quality healthcare access and a focus on community health initiatives help Boston continue to be one of America’s healthiest major cities.
Minneapolis, Minnesota
Minneapolis emerges as one of the healthiest Midwest cities:
- Healthcare access – Minnesota has the 5th lowest rate of uninsured at 4.9%, compared to 8.6% nationally.
- Chronic disease – Lower than average rates for conditions like heart disease and diabetes.
- Mental health – Depression rates are average, while excessive drinking is slightly above average.
- Obesity – Minneapolis has a lower obesity rate than the national average at about 1 in 4 residents.
- Physical activity – Around 61% meet weekly exercise recommendations.
- Healthy behaviors – Above average for fruit/vegetable intake and sleep habits.
- Community design – Numerous parks and bike trails make it easy to be active.
- Air quality – Decent air quality compared to other Midwest industrial cities.
Strong healthcare access, low chronic disease rates, and recreational infrastructure contribute to Minneapolis emerging as the healthiest city in the Midwest.
Honorable Mentions
While Seattle, San Francisco, Boston, and Minneapolis emerge as among the top tier of healthy major cities, some other cities also fare well on health indicators:
Portland, Oregon
Portland is known for its focus on eco-conscious lifestyles and has below average obesity and chronic disease rates. Over 60% of residents exercise regularly, aided by the city’s walkability and bike trails. It has also prioritized pedestrian safety and the urban tree canopy. While Portland fares well on many health markers, its excessive drinking rates are higher than average.
Denver, Colorado
Denver tends to have very active residents, with over 60% exercising regularly due to the accessible mountain recreation. Obesity rates are lower than average and healthy behaviors like sleep are a priority. While healthcare access is decent, Colorado lacks the MinnesotaCare program that helps Minneapolis. Denver also has slightly higher excessive drinking rates.
Austin, Texas
Austin emerges as the healthiest city in Texas due to high rates of physical activity and low obesity. Healthcare access lags behind other states though due to Texas rejecting the Affordable Care Act Medicaid expansion. Austin also has above average excessive drinking rates.
Cities with the Least Healthy Populations
While examining the healthiest cities is useful, looking at cities with the unhealthiest populations can further highlight why certain areas emerge poorly:
Jackson, Mississippi
Jackson has among the lowest health rankings in the U.S. Factors include:
- Healthcare access – Mississippi did not expand Medicaid, leaving many uninsured. Preventative care rates are low.
- Chronic disease – Jackson has very high rates of heart disease, diabetes, cancer, and stroke.
- Mental health – Depression rates are higher than average.
- Obesity – Jackson’s obesity rate of 39% is one of the highest of major cities.
- Physical activity – Only around 41% get weekly recommended exercise.
- Healthy behaviors – Jackson has lower than average rates for fruit/vegetable intake and sleep.
- Air quality – Air pollution from surrounding factories impacts air quality.
Lack of healthcare access paired with high poverty contributes to Jackson having one of the unhealthiest populations nationally.
Detroit, Michigan
Detroit contends with many health challenges as well:
- Healthcare access – Lack of services and insurance affect outcomes, with only 91% insured.
- Chronic disease – Very high heart disease, diabetes, cancer, and stroke rates.
- Mental health – Depression is higher than average, as is drug abuse.
- Obesity – Detroit’s obesity rate is 34%, well above the national figure.
- Physical activity – Just over 40% meet exercise recommendations.
- Healthy behaviors – Detroit has below average rates for sleep and nutrition.
- Air quality – Manufacturing impacts air pollution levels.
An unhealthy built city environment and lack of healthcare access contribute to Detroit’s poor population health outcomes.
Memphis, Tennessee
Memphis faces health challenges including:
- Healthcare access – Lack of insurance and preventative care, with only 92% covered.
- Chronic disease – Very high heart disease and cancer rates.
- Mental health – Memphis has above average depression rates.
- Obesity – Memphis has an adult obesity rate of about 35%.
- Physical activity – Just under 45% get adequate weekly exercise.
- Healthy behaviors – Memphis has below average fruit/vegetable intake and sleep.
- Air quality – Memphis has had issues with ozone pollution.
Like Jackson and Detroit, insufficient healthcare access and preventative care contribute to Memphis having unhealthy outcomes.
Key Factors that Impact City Health
Analyzing the healthiest and least healthy cities points to some key factors that make a major difference in public health outcomes.
Healthcare Access
Access to affordable insurance and preventative care has one of the biggest impacts on health. Cities in states that expanded Medicaid under the Affordable Care Act fare better than those in non-expansion states. Income disparities also affect access.
| City | Uninsured Rate | Medicaid Expansion State? |
|---|---|---|
| Seattle | 5.5% | Yes |
| San Francisco | 3.6% | Yes |
| Boston | 4.0% | Yes |
| Minneapolis | 4.9% | Yes |
| Jackson | 12.4% | No |
| Detroit | 9.0% | Yes |
| Memphis | 8.0% | No |
Chronic Disease Rates
Chronic conditions like obesity, heart disease, diabetes, and cancer are lower in healthy cities and higher in unhealthy ones. Access to preventative care and healthy lifestyles influences outcomes.
| City | Adult Obesity Rate | Heart Disease Mortality Rate Per 100K |
|---|---|---|
| Seattle | 21.7% | 155.2 |
| San Francisco | 20.0% | 161.2 |
| Boston | 25.0% | 198.4 |
| Minneapolis | 25.1% | 171.2 |
| Jackson | 39.0% | 347.3 |
| Detroit | 34.2% | 225.1 |
| Memphis | 36.5% | 303.8 |
Mental Health
Mental health issues like depression, anxiety, and substance abuse are affected by access to behavioral healthcare. They tend to be lower in healthier cities with prevention resources.
Health Behaviors
Healthy cities have cultures that encourage behaviors like exercise, nutrition, sleep, and moderation of alcohol. Transportation design and access to recreation opportunities also influence activity levels.
Air Quality
Breathing polluted air can contribute to problems like asthma and lung disease. Cities with poor environmental health often contend with higher levels of manufacturing. Transit design also impacts tailpipe emissions.
Conclusion
While no city is perfect, Seattle, San Francisco, Boston, and Minneapolis emerge among the healthiest major cities according to key population health indicators. Strong healthcare systems, preventative care, active lifestyles, community infrastructure, and low chronic disease and mental illness rates contribute to their high rankings. In contrast, cities like Jackson, Detroit, and Memphis face challenges such as lack of healthcare access, high poverty, insufficient insurance, and chronic disease. Addressing factors that determine health at the city and state levels could help improve outcomes in poorer performing areas.