The Healthiest and Unhealthiest American Cities in 2018

In the United States, health varies among communities and regions. People living in urban areas have different health issues than those living in rural areas based on cultures that either promote healthy lifestyles or limit access to healthcare.

WalletHub has compared more than 170 of the most populated American cities in more than 40 key indicators of good health, including cost of doctor visits, fruit and vegetable consumption, and the amount of fitness clubs per capita. The metrics fell into 4 broad categories: healthcare, food, fitness, and green space.

Healthcare included measures such as premature-death rate, mental health, physical health, cost of medical visit, and quality of public health system. Food included measures such as farmer's markets per capita, share of obese residents (full weight), limited access to healthy foods, and dietitians and nutritionists. Fitness included measures such as fitness clubs per capita, average cost of fitness club membership, and weight loss centers per capita. Green space included measures such as parkland acres per capita, hiking/walking/running trails per capita, bike score, and city greeness, which is based on WalletHub's Greenest Cities in America ranking.

These are the healthiest and unhealthiest cities in the United States in 2018.

Healthiest

5. Washington, DC

Total Score: 63.01

While the nation’s capital has the highest average monthly cost of fitness club memberships, which may deter people from exercising, the District of Columbia still has the most running and walking trails out of all the cities in the United States that people take advantage of.

Washington, DC, also ranks third out of all the surveyed cities for the most green space, or the quality of parks and access to recreation for city dwellers.

4. San Diego, California

Total Score: 64.29

San Diego is ranked sixth for the healthiest food options, encompassing fruit and vegetable consumption, the number of dieticians and nutritionists per capita, and the low share of obese residents.

The sunny city is also ranked fifth for fitness which measures the share of adults who engage in physical activity, the average cost of fitness club memberships, and the amount of fitness trainers per capita.

3. Portland, Oregon

Total Score: 66.14

Portland was ranked fourth for food and fifth for green space, giving residents access to healthy food and large parks to enjoy nature and work out.

However, Portland was ranked 65th for healthcare which measures the number of dentists and family doctors per capita, the percentage of adults and children with health insurance, and the quality of the public hospital system.

2. Seattle, Washington

Total Score: 70.16

Ranked second for fitness and green space, residents of Seattle have a variety of opportunities to improve their health by either going to the gym or running in the many parks the city offers. Seattle was also ranked fourth for the highest number of healthy restaurants per capita.

1. San Francisco, California

Total Score: 72.81

San Francisco was ranked the healthiest city in the United States for 2018. The city ranked first in the food and green space categories and had the fifth most healthy restaurants per capita. San Francisco was tied for third for the lowest percentage of adults not eating enough servings of fruits and vegetables.

While San Francisco has one of the highest average monthly cost of fitness club memberships in the country, the state has the most and the most running/walking trails per capita.

Unhealthiest

5. Gulfport, Mississippi

Total Score: 29.02

Gulfport was ranked 170 out of the 174 surveyed cities for green space and has one of the highest percentages of adults who do not eat enough fruits and vegetables per day in the United States.

The city is ranked second in the country for the lowest average monthly cost of fitness club memberships, yet it has the second lowest percentage of physically active adults.

4. Shreveport, Louisiana

Total Score: 28.64

Shreveport was ranked 172nd in food, 167th in green space, 164th in fitness, and 147th in the healthcare categories. A lack of opportunities to exercise in the gym or outdoors and a culture of unhealthy eats makes Shreveport one of the unhealthiest cities in the United States.

3. Augusta, Georgia

Total Score: 28.23

Augusta is ranked 173rd for the highest premature-death rate and is among the states with the fewest healthy restaurants per capita. The city is also ranked last in the green space category, offering little options for residents to enjoy the great outdoors.

2. Laredo, Texas

Total Score: 26.31

Ranked 167th in healthcare, Laredo is among the states with the fewest mental-health counselors per capita. Laredo also has the lowest cost of medical visits in the United States and is ranked 166th for the fewest health restaurants per capita.

Laredo was also ranked last out of all the cities in fitness.

1. Brownsville, Texas

Total Score: 24.74

Brownsville takes last place, making it the unhealthiest city in the United States. Ranked 174th in healthcare and food categories, 167th in fitness, and 166th in green space, access to health services and daily exercise is limited for Brownsville residents.