There's no doubt that great strides have been made in Americans' health over the years. Americans smoke less, are more likely to be insured and live longer. However, significant health disparities remain across the nation, influenced by individual choices, the community and clinical care.
To determine the well-being of Americans, Gallup-Healthways surveyed hundreds of thousands of Americans in 189 metropolitan areas in the United States in 2012 and 2013. The survey recorded the physical and emotional health of the residents, as well as measuring job satisfaction and access to basic needs. The resulting Gallup-Healthways Well-Being Index allows for comparisons between places and over time.
Not surprisingly, the physical health of residents was influenced by their habits. While less than 20% of Americans surveyed were smokers, more than 34% of Charleston, W.Va., residents smoked, the most in the nation. Residents also reported among the highest rates of obesity in the country.
In America's healthier areas, on the other hand, smoking rates tended to be much lower. San Jose had the second lowest smoking rate, with just around 11% of respondents reporting a smoking habit. Obesity rates in the areas were among the lowest.
According to Dan Witters, research director for the Gallup-Healthways Well-Being Index, there is a clear relationship between poor physical health outcomes, such as obesity, and many of these habits. "When you're talking about obesity, the big three are healthy eating, exercise, and smoking."
Having access to basic needs, such as medical care, medicines, food and shelter, also appeared to play a major role in determining the physical well-being of residents. Witters explained that "providing people with a safe place to exercise" obviously plays a role in regional obesity rates. Additionally, having a personal doctor "increases the probability that they'll have a trusted professional advising them about their healthy habits."
In addition to having access to basic needs, a healthy state of mind made a difference in the physical health of many area-residents. In fact, half of the metro areas with the best physical health index scores were also among the least likely to report recent bouts of depression. Emotional states such as anger, stress and sadness became much less common in areas with high physical health scores as well.
Survey participants who were "clinically diagnosed with depression had a significantly elevated probability of carrying around obesity," Witters said, as well as a variety of other chronic conditions.
Poverty and financial instability can make it very difficult to stay healthy. All but one of the 10 healthiest metro areas had poverty rates considerably lower than the national rate in 2012. Seven of the least healthy metro areas, on the other hand, had poverty rates exceeding the national rate. While access to healthy food has an impact on good nutrition, Witters pointed out that poverty played a greater role.
Many components of staying healthy are learned. If people are poorly educated, they are less likely to know how best to care for themselves. Nine of the least healthy metro areas had college education attainment rates below the national rate. Residents of eight of the healthiest regions, conversely, were considerably more likely to have attained a bachelor's degree than Americans as a whole.
To identify the best and worst cities for physical health, 24/7 Wall St. reviewed the metropolitan areas with the best and worst scores on the Physical Health Index, part of the Gallup-Healthways Well-Being Index. The Gallup-Healthways Well-Being Index assessed 189 metropolitan statistical areas. The Physical Health Index is one of five subindices included in the groups' overall score. The index measures physical well-being for the United States, states, metropolitan areas and occupations, based on answers to a variety of questions. In addition to these figures, we also considered income, poverty and educational attainment data from the U.S. Census Bureau, all from 2012.
AMERICA'S LEAST HEALTHY CITIES:
10. Little Rock-North Little Rock-Conway, Ark.
> Physical Health Index: 72.2
> Obesity rate: 35.1% (5th highest)
> Blood pressure: 37.8% (5th highest)
> Poverty rate: 15.1% (134th lowest)
Unhealthy behaviors may help explain the poor physical health of Little Rock area's residents. Just 56.4% of respondents told Gallup they ate healthy all day the previous 24 hours, the worst rate nationwide. Additionally, more than one-quarter of survey respondents were smokers, compared with less than 20% of Americans nationwide. Although Little Rock residents were more likely than most Americans to exercise, more than 35% were classified as clinically obese in 2013, among the largest proportions in the country. A high obesity rate may have contributed to other health issues inflicting area residents. More than 37% of survey respondents had been told by a medical practitioner that they had high blood pressure, worse than all but four other metro
9. Spartanburg, S.C.
> Physical Health Index: 71.9
> Obesity rate: 30.0% (34th highest)
> Blood pressure: 36.3% (10th highest)
> Poverty rate: 20.0% (70th highest)
More than 30% of Spartanburg residents surveyed told Gallup they were unable to participate in age appropriate activities due to their health. This was one of the highest rates in the nation and one of a number of physical health problems that plagued residents. Even worse, 36.3% of respondents said they had high blood pressure, 13.7% said they had been diagnosed with diabetes and nearly 6% said they had previously suffered a heart attack — all among the worst rates in the nation. One contributing factor may be people's unhealthy behaviors. Less than 48% of respondents exercised regularly, among the lowest rates in the nation. Also, 27.5% of people stated they smoked, one of the highest rates in America.
8. Chattanooga, Tenn.-Ga.
> Physical Health Index: 71.7
> Obesity rate: 29.7% (40th highest)
> Blood pressure: 35.7% (14th highest)
> Poverty rate: 15.8% (164th lowest)
Less than 80% of respondents living in the Chattanooga metro area said they had enough energy to accomplish what they needed to the day before, worse than all but two other metro areas. Also, nearly 31% of respondents had health problems that hindered their ability to participate in age appropriate activities. Low incomes in the region may be contributing to the poor physical health of residents — median household income was just $43,475 in 2012, considerably lower than the national median of $51,371 that year. Low incomes may have limited Chattanooga-area residents' ability to access basic needs, such as health care, which in turn may have also contributed to poor physical health. While the percentage of area residents covered by health insurance was inline with the national rate, just three-quarters of respondents said they had enough money for health care and medicine, among the lowest rates nationwide.
7. Clarksville, Tenn.-Ky.
> Physical Health Index: 71.6
> Obesity rate: 33.8% (8th highest)
> Blood pressure: 29.3% (92nd highest)
> Poverty rate: 19.3% (93rd highest)
Clarksville-area residents were among the nation's most likely to be obese, with 33.8% considered obese based on their height and weight. Residents were also exceptionally likely to report recurring pains, with more than 37% stating they suffered from neck or back pain and more than 35% stating they suffered from leg or knee pain, both among the highest rates in the country. Residents' poor health was not just limited to physical ailments. People in the Clarksville area were more likely than Americans in most metro areas to have felt angry and among the least likely to have felt happy within the previous day. Both measures are important components of emotional health, for which Clarksville was among the worst rated metro areas in the nation.
6. Fort Smith, Ark.-Okla.
> Physical Health Index: 71.4
> Obesity rate: 29.8% (38th highest)
> Blood pressure: 35.4% (16th highest)
> Poverty rate: 22.6% (32nd highest)
Like most metro areas with poor physical health scores, health issues prevented many Fort Smith residents from participating in age-appropriate activities. Nearly 35% of survey respondents said health problems prevented them from performing activities people their age normally perform, worst among all areas surveyed. Chronic pain was likely an obstacle to usual activities for many residents. Nearly 40% of respondents reported recurring neck or back pains, second worst nationwide. In addition to poor health, residents suffered from poor economic conditions. Median household income was just $36,061 in 2012, among the lowest in the nation. Further, more than 22% were living in poverty that year, also among the worst rates in the United States.
5. Redding, Calif.
> Physical Health Index: 71.4
> Obesity rate: 27.6% (82nd highest)
> Blood pressure: 30.1% (78th highest)
> Poverty rate: 16.6% (166th highest)
Nearly a third of Redding area respondents said health problems prevented them from participating in age-appropriate activities, and 36.9% said their health kept them from their usual routines. Both rates were among the highest in the nation. Recurring pain was a common problem for many respondents, but even worse, 10.7% of those surveyed said they had previously been diagnosed with cancer, one of the highest rates in the nation. Drug use has also been a major health issue in the area. Shasta County, which makes up the Redding metro area, is considered part of the Central Valley High Intensity Drug Trafficking Area, and use of hard drugs such as methamphetamine has been cited as a problem in the county.
4. Columbus, Ga.-Ala.
> Physical Health Index: 70.7
> Obesity rate: 32.5% (13th highest)
> Blood pressure: 32.8% (36th highest)
> Poverty rate: 18.7% (102nd highest)
Individuals in the Columbus metro area were among the nation's most likely to suffer from recurring pain and a lack of energy. Only 68.2% said their health allowed them to take part in age-appropriate activities, one of the lowest rates in the nation. Columbus residents were among the least likely to eat healthy on a daily basis. Less than 60% of survey respondents said they ate healthy all day the previous day, worse than all but two metro areas reviewed. Financial constraints explain poor eating habits more than any other factor. More than 20% of residents were on food stamps in 2012, and just 67.1% of residents told Gallup they were able to afford food at all times the year before — among the worst rate in the nation. By comparison, 80.9% of Americans reported sufficient resources for food.
3. Kingsport-Bristol-Bristol, Tenn.-Va.
> Physical Health Index: 70.5
> Obesity rate: 30.9% (25th highest)
> Blood pressure: 40.6% (3rd highest)
> Poverty rate: 16.4% (176th highest)
Kingsport area residents suffered from a variety of health issues the past few years, including chronic pain and heart problems. More than 31% of respondents reported recurring knee and leg pain, and 40.6% complained of high blood pressure, both among the nation's worst rates. The region's health concerns may be tied to low rates of educational attainment and low incomes. Less than 20% of Kingsport area adults had at least a bachelor's degree in 2012, a considerably lower rate than the nearly 30% of Americans with at least a bachelor's degree. The area was also not particularly wealthy. A typical family in the Kingsport metro area earned just $37,769 in 2012, among the lowest median incomes nationwide.
2. Charleston, W.Va.
> Physical Health Index: 69.0
> Obesity rate: 34.6% (6th highest)
> Blood pressure: 45.4% (2nd highest)
> Poverty rate: 15.0% (130th lowest)
Fewer survey respondents from Charleston said they were well-rested and had enough energy to go about their day during the previous day than those in all but one other metro area. Just two-thirds of respondents said health problems did not prevent them from participating in age-appropriate activities, second worst among all areas reviewed. Poor behaviors may have played a role in respondents' poor physical health. Area residents had the highest smoking rate in the country, with more than one-third reporting a smoking habit. Poor emotional health can often be associated with poor physical health as well, and people in Charleston did not fare well on emotional health measures either. For example, only 52.1% of respondents said they learned something new or interesting in the previous 24 hours, less than any other metro area reviewed.
1. Huntington-Ashland, W.Va.-Ky.-Ohio
> Physical Health Index: 66.2
> Obesity rate: 39.5% (the highest)
> Blood pressure: 46.9% (the highest)|
> Poverty rate: 18.3% (111th highest)
No metro area rated worse than Huntington for physical health. Nearly 40% of area residents were considered obese, the most of any metro area reviewed. Additionally, nearly 47% of residents had high blood pressure and 34.4% had been diagnosed as having high cholesterol, the highest rates of any metro area. Residents also were among the most likely Americans to suffer serious health consequences. Nearly 10% had previously suffered a heart attack, again worse than any metro area. Additionally, 12.5% of the population had been diagnosed with cancer, third most in the nation. Poor healthy behaviors, such as high smoking rates and limited exercise, may have been contributing factors to residents' poor health. Additionally, limited access to basic needs, such as health care and medicine, may have also played a role.
24/7 Wall St. is a USA TODAY content partner offering financial news and commentary. Its content is produced independently of USA TODAY.