What are the least healthy cities in America? 

According to the Centers For Disease Control and Prevention (CDC), chronic health conditions such as heart disease, cancer and diabetes prevent six in 10 American adults from living life to the fullest.

Between 2020 and 2050, the number of adults aged 50 and older with at least one chronic disease is projected to nearly double, according to a study published in the National Library of Medicine.

In some cities, the rate of chronic disease tends to be higher due to unhealthy lifestyle habits, such as smoking, binge drinking and a lack of physical activity. Analyses suggest that income level, education and even commuting patterns may influence why some cities are healthier than others. 

For example, metro areas with higher incomes tend to have lower levels of people who smoke and have obesity; cities where people drive to work alone are more likely to have more people with obesity.

To determine which cities have the healthiest and least healthy populations, Forbes Advisor compared the 46 most populated cities with available data across eight key metrics.

The results found that Detroit, Michigan tops the list of cities with the least healthy populations, while San Jose, California has the healthiest residents.

Two Tennessee cities rank among the top 10 cities with the least healthy populations: Memphis and Nashville.

Five California cities rank among the top 15 cities with the healthiest residents: San Jose, San Diego, San Francisco, Oakland and Los Angeles.

Bakersfield, California has the highest number of heart disease deaths per 100,000 residents (373.1) and Milwaukee, Wisconsin has the highest number of opioid overdose deaths per 100,000 residents (59.2).

Top 5 Least Healthy Cities

1. Detroit, Michigan

Detroit’s score: 100 out of 100

Detroit has the least healthy population of any other city on the list due to its residents having the highest rates of diabetes, high blood pressure and obesity.

Detroit stands out as the city with the:

• Highest percentage of adults with diabetes (18.2%)
• Highest percentage of adults with high blood pressure (46.2%)
• Highest percentage of adults who report having obesity (45.5%)
• Highest percentage of adults who report smoking (28.5%)
• Highest percentage of adults who report being physically inactive (37.4%)
• Second-highest number of heart disease deaths per 100,000 residents (370.9)
• Second-highest number of opioid overdose deaths per 100,000 residents (58)

2. Milwaukee, Wisconsin

Milwaukee’s score: 94.02 out of 100

Milwaukee’s population is one of the unhealthiest due to the highest number of opioid overdoses and the rate of binge drinking among adults.

Milwaukee has the:

• Highest number of opioid overdose deaths per 100,000 residents (59.2)
• Highest percentage of adults who report binge drinking (22.6%)
• Fourth-highest percentage of adults who report having obesity (40.4%)
• Fourth-highest percentage of adults who report smoking (20.3%)
• Seventh-highest percentage of adults with high blood pressure (33.5%)
• Ninth-highest number of heart disease deaths per 100,000 residents (262.3)

3. Memphis, Tennessee

Memphis’ score: 92.58 out of 100

Memphis trails closely behind Milwaukee as having one of the unhealthiest populations among the cities they considered, with some of the highest rates of diabetes, high blood pressure and obesity.

Memphis stands out as the city with the:

• Second-highest percentage of adults with diabetes (15.9%)
• Second-highest percentage of adults with high blood pressure (41.1%)
• Second-highest percentage of adults who report having obesity (40.8%)
• Second-highest percentage of adults who report smoking (22.7%)
• Second-highest percentage of adults who report being physically inactive (32.9%)
• Sixth-highest number of heart disease deaths per 100,000 residents (314.7)
• Ninth-highest number of opioid overdose deaths per 100,000 residents (47.3)

4. Philadelphia, Pennsylvania

Philadelphia’s score: 83.77 out of 100

Philadelphia’s population ranked poorly when it comes to physical inactivity and opioid overdose deaths.

Philadelphia has the:

• Third-highest percentage of adults who report being physically inactive (30.8%)
• Fourth-highest number of opioid overdose deaths per 100,000 residents (55.2)
• Fifth-highest percentage of adults who report smoking (19.5%)
• Seventh-highest percentage of adults with diabetes (12.1%)

5. Tulsa, Oklahoma

Tulsa’s score: 76.40 out of 100

Tulsa is the second city in the South that ranks among the unhealthiest populations across the country. Its residents have an elevated incidence of high blood pressure and heart disease.

Tulsa stands out as the city with the:

• Third-highest percentage of adults with high blood pressure (35.9%)
• Fourth-highest number of heart disease deaths per 100,000 residents (338)
• Fourth-highest percentage of adults who report being physically inactive (30.1%)
• Sixth-highest percentage of adults with diabetes (12.2%)
• Eighth-highest percentage of adults who report having obesity (37.6%)
• Ninth-highest percentage of adults who report smoking (18.2%)

Top 5 Most Healthy Cities

1. San Jose, California

San Jose’s score: 0 out of 100

San Jose has the healthiest population among the cities they considered, with low rates of opioid overdoses and obesity.

It stands out as the city with the:

• Second-lowest number of opioid overdose deaths per 100,000 residents (8.3)
• Second-lowest percentage of adults who report having obesity (20.9%)
• Second-lowest percentage of adults who report smoking (8.9%)
• Fifth-lowest number of heart disease deaths per 100,000 residents (152.3)
• Fifth-lowest percentage of adults with high blood pressure (23%)
• Sixth-lowest percentage of adults who report binge drinking (14.2%)
• Ninth-lowest percentage of adults who report being physically inactive (18.4%)

2. Austin, Texas

Austin’s score: 8.54 out of 100

Austin has one of the healthiest populations in the nation, thanks to the lowest rate of high blood pressure among its adults.

Austin has the:

• Lowest percentage of adults with high blood pressure (22.5%)
• Fourth-lowest percentage of adults with diabetes (7.4%)
• Fifth-lowest percentage of adults who report smoking (11.3%)
• Eighth-lowest number of heart disease deaths per 100,000 residents (175.5)
• Eighth-lowest number of opioid overdose deaths per 100,000 residents (9.6)
• 10th-lowest percentage of adults who report having obesity (28.2%)
• 10th-lowest percentage of adults who report being physically inactive (18.5%)

3. Seattle, Washington

Seattle’s score: 11.49 out of 100

With the lowest rates of diabetes, smokers and physical inactivity, Seattle is among the healthiest cities in the U.S.

Seattle stands out as the city with the:

• Lowest percentage of adults with diabetes (6.2%)
• Lowest percentage of adults who report smoking (8.7%)
• Lowest percentage of adults who report being physically inactive (13.2%)
• Second-lowest percentage of adults with high blood pressure (22.6%)
• Fourth-lowest number of heart disease deaths per 100,000 residents (150.4)
• Fifth-lowest percentage of adults who report having obesity (23.6%)

4. San Diego, California

San Diego’s score: 17.08 out of 100

The second California city to rank in the top five cities with the healthiest populations, San Diego has low rates of high blood pressure and obesity.

San Diego has the:

• Third-lowest percentage of adults with high blood pressure (22.7%)
• Fourth-lowest percentage of adults who report having obesity (22.7%)
• Fourth-lowest percentage of adults who report smoking (10.3%)
• Fifth-lowest percentage of adults who report being physically inactive (16.9%)
• Ninth-lowest number of heart disease deaths per 100,000 residents (175.7)
• 10th-lowest percentage of adults with diabetes (8.9%)

5. Denver, Colorado

Denver’s score: 19.45 out of 100

The capitol of Colorado, Denver has one of the lowest rates of adults with diabetes, making it one of the healthiest populations in the U.S.

Denver stands out as the city with the:

• Second-lowest percentage of adults with diabetes (6.9%)
• Third-lowest percentage of adults with high blood pressure (22.7%)
• Third-lowest percentage of adults who report having obesity (22.1%)
• Sixth-lowest number of heart disease deaths per 100,000 residents (162.2)
• Sixth-lowest percentage of adults who report being physically inactive (17.4%)

Methodology

To determine which cities have the healthiest and least healthy populations, Forbes Advisor compared the 50 most populated cities (46 of which had available data) across the following eight metrics:

• Number of heart disease deaths per 100,000 residents: 23% of score.
• Number of opioid overdose deaths per 100,000 residents: 23% of score.
• Percentage of adults with diabetes: 15% of score.
• Percentage of adults with high blood pressure: 15% of score.
• Percentage of adults who report binge drinking: 7% of score.
• Percentage of adults who report having obesity: 7% of score. This metric reflects the percentage of adults who report a BMI of 30 or higher.
• Percentage of adults who report smoking: 7% of score.
• Percentage of adults who report physical inactivity: 3% of score. This metric reflects the percentage of adults who report being physically inactive in the past 30 days.

Data for all metrics comes from The City Health Dashboard, 2021.

City population data comes from the U.S. Census Bureau, 2023.