Posted by: Richie Bernardo

Location matters when it comes to health. Some places promote wellness by expanding access to nutritious food and recreational facilities. Others strive to keep healthcare costs affordable for everyone or keep parks clean and well-maintained.

When a city doesn’t take care of these issues, it can be hard to keep up good health. After all, the cost of care in the U.S. is rising and life expectancy is declining. And there are so many sources of health advice online that it can be difficult for a person to figure out what is legitimate and what is just a fad.

To determine which areas prioritize residents’ well-being, WalletHub compared more than170 of the most populated U.S. cities across 40 key indicators of good health. Our data set ranges from cost of doctor visit to fruit and vegetable consumption to fitness clubs per capita. Read on for our findings, further insight from a panel of experts and a full description of our methodology.

1. Main Findings
2. Ask the Experts
3. Methodology

Main Findings

Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/31072/geochart.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2nTbRTo>  

Healthiest Cities in the U.S.

Overall Rank*	City	Total Score	‘Health Care’ Rank	‘Food’ Rank	‘Fitness’ Rank	‘Green Space’ Rank
1	San Francisco, CA	72.81	30	1	9	1
2	Seattle, WA	70.16	35	7	2	2
3	Portland, OR	66.14	65	4	8	5
4	San Diego, CA	64.29	54	6	5	7
5	Washington, DC	63.01	31	13	27	3
6	Burlington, VT	62.27	5	17	6	21
7	Scottsdale, AZ	61.36	10	39	1	25
8	Honolulu, HI	61.04	16	3	59	10
9	Irvine, CA	60.86	2	18	16	13
10	Denver, CO	60.34	48	14	4	19
11	Salt Lake City, UT	59.77	38	12	11	34
12	New York, NY	59.20	84	2	46	16
13	Huntington Beach, CA	58.99	13	22	23	33
14	Minneapolis, MN	58.53	8	34	36	9
15	Fremont, CA	58.47	14	15	22	32
16	Los Angeles, CA	57.86	81	5	19	39
17	Austin, TX	57.78	42	20	24	14
18	Chicago, IL	57.40	76	29	17	8
19	Santa Clarita, CA	56.78	9	46	70	4
20	San Jose, CA	56.42	27	10	30	53
21	Glendale, CA	56.38	40	30	64	6
22	Sacramento, CA	55.56	95	11	51	18
23	Lincoln, NE	55.16	11	72	20	23
24	Boston, MA	54.75	55	23	47	22
25	Oakland, CA	54.75	66	8	67	50
26	Atlanta, GA	54.16	85	52	3	44
27	Raleigh, NC	54.12	22	25	13	69
28	Boise, ID	54.07	56	82	21	12
29	Madison, WI	54.02	18	49	45	26
30	Overland Park, KS	53.96	1	92	35	117
31	Orlando, FL	53.78	68	19	18	59
32	Long Beach, CA	53.64	52	24	75	20
33	Tampa, FL	53.48	87	36	10	51
34	Portland, ME	53.24	20	26	83	38
35	Miami, FL	52.95	122	9	71	48
36	Santa Rosa, CA	52.93	62	45	48	27
37	Peoria, AZ	52.74	41	96	37	11
38	Virginia Beach, VA	52.46	4	77	58	35
39	Plano, TX	52.41	7	58	34	60
40	Rancho Cucamonga, CA	52.11	67	81	31	15
41	Missoula, MT	51.93	23	134	29	47
42	Tempe, AZ	51.59	51	48	41	61
43	Philadelphia, PA	51.35	136	21	65	30
44	Pittsburgh, PA	51.30	26	50	55	49
45	Fort Lauderdale, FL	51.24	57	35	81	37
46	Sioux Falls, SD	50.94	3	130	14	106
47	St. Paul, MN	50.81	25	71	54	40
48	Vancouver, WA	50.80	86	54	12	101
49	Garden Grove, CA	50.28	61	31	80	79
50	Anaheim, CA	50.08	58	28	63	74
51	Aurora, CO	50.03	44	56	38	65
52	Las Vegas, NV	49.95	157	37	7	73
53	Chesapeake, VA	49.86	12	111	98	28
54	Chandler, AZ	49.75	27	65	15	118
55	Oceanside, CA	49.60	77	67	26	115
56	Colorado Springs, CO	49.39	59	87	39	43
57	Pembroke Pines, FL	49.25	34	38	86	147
58	Durham, NC	48.92	29	55	50	89
59	St. Louis, MO	48.75	141	78	40	31
60	Phoenix, AZ	48.75	103	47	66	45
61	Reno, NV	48.60	142	40	44	52
62	Gilbert, AZ	48.45	17	80	33	112
63	Fargo, ND	48.40	19	109	52	99
64	Grand Rapids, MI	48.11	15	98	95	66
65	Richmond, VA	48.08	64	105	32	77
66	Cincinnati, OH	47.97	114	69	42	54
67	Tallahassee, FL	47.88	39	154	68	17
68	Albuquerque, NM	47.84	89	53	74	55
69	Charleston, SC	47.82	24	100	87	62
70	Charlotte, NC	47.76	37	112	25	95
71	Baltimore, MD	47.70	32	42	130	56
72	Spokane, WA	47.60	101	64	73	58
73	Yonkers, NY	47.33	50	27	145	68
74	Billings, MT	47.31	49	43	79	125
75	Wilmington, DE	47.02	33	89	138	29
76	Tacoma, WA	46.73	113	73	53	82
77	Cedar Rapids, IA	46.64	6	156	49	146
78	St. Petersburg, FL	46.63	78	75	57	75
79	Rochester, NY	46.46	69	41	142	46
80	Des Moines, IA	46.38	21	121	84	84
81	West Valley City, UT	45.79	126	33	93	149
82	Chula Vista, CA	45.65	79	84	28	128
83	Manchester, NH	45.40	72	129	72	80
84	Salem, OR	45.23	102	94	76	76
85	Henderson, NV	45.20	106	127	43	67
86	Rapid City, SD	45.13	43	120	89	116
87	Worcester, MA	45.02	63	101	97	93
88	Omaha, NE	44.99	46	91	91	85
89	Buffalo, NY	44.93	105	51	108	70
90	Anchorage, AK	44.89	129	76	122	36
91	Tucson, AZ	44.76	140	61	77	72
92	Houston, TX	44.69	135	62	60	96
93	Warwick, RI	44.67	36	88	126	140
94	Mesa, AZ	44.52	74	74	69	126
95	Nashua, NH	44.25	73	142	62	91
96	Riverside, CA	44.19	120	68	56	121
97	Dallas, TX	43.81	133	59	82	98
98	Glendale, AZ	43.73	94	85	133	57
99	Bridgeport, CT	43.66	90	123	100	81
100	Milwaukee, WI	43.48	91	70	139	63
101	Springfield, MO	43.32	99	147	61	83
102	Providence, RI	43.12	112	83	136	42
103	Santa Ana, CA	43.10	137	44	110	103
104	Modesto, CA	42.90	159	106	78	71
105	Columbia, SC	42.89	47	135	96	142
106	Oxnard, CA	42.79	138	63	116	94
107	Jersey City, NJ	42.68	70	32	160	100
108	New Orleans, LA	42.30	155	137	111	24
109	San Antonio, TX	42.18	123	99	99	87
110	Nashville, TN	42.13	88	115	106	86
111	Aurora, IL	42.01	60	118	135	105
112	Norfolk, VA	41.75	83	119	137	64
113	Newport News, VA	41.70	53	117	141	124
114	New Haven, CT	41.65	108	132	143	41
115	Columbus, OH	41.53	96	102	120	88
116	Jacksonville, FL	41.42	139	107	92	92
117	Greensboro, NC	41.28	80	136	90	102
118	Fontana, CA	40.96	149	90	115	122
119	Lexington-Fayette, KY	40.93	45	122	113	138
120	Ontario, CA	40.64	153	97	107	140
121	Fort Worth, TX	40.60	107	86	112	132
122	Kansas City, MO	40.31	93	116	127	111
123	Cheyenne, WY	40.24	75	124	105	173
124	Knoxville, TN	39.83	127	133	124	89
125	Fresno, CA	39.63	156	79	109	127
126	Port St. Lucie, FL	39.62	100	144	102	161
127	Irving, TX	39.44	130	113	147	104
128	Huntsville, AL	39.28	92	149	128	113
129	Akron, OH	39.27	118	110	153	109
130	Louisville, KY	39.15	117	114	117	136
131	Moreno Valley, CA	39.05	146	95	157	114
132	Stockton, CA	38.80	158	57	131	137
133	Arlington, TX	38.48	104	108	144	134
134	Winston-Salem, NC	38.40	71	161	88	143
135	Fort Wayne, IN	38.13	111	150	85	144
136	Little Rock, AR	38.10	109	165	94	107
137	Cleveland, OH	37.96	161	60	158	110
138	Grand Prairie, TX	37.81	124	103	169	123
139	Indianapolis, IN	37.72	128	128	129	133
140	Garland, TX	37.71	132	104	146	145
141	Charleston, WV	37.61	82	145	149	131
142	Bakersfield, CA	37.11	144	125	114	154
143	Fayetteville, NC	36.95	97	167	104	165
144	Hialeah, FL	36.93	150	16	173	156
145	Cape Coral, FL	36.59	119	152	148	152
146	Lubbock, TX	36.22	116	160	121	119
147	Oklahoma City, OK	36.20	98	141	151	130
148	Nampa, ID	36.10	169	126	119	164
149	Wichita, KS	35.98	110	159	101	155
150	Birmingham, AL	35.79	131	138	134	160
151	Tulsa, OK	35.63	121	151	125	150
152	San Bernardino, CA	35.60	173	93	162	97
153	Las Cruces, NM	34.89	115	173	103	169
154	El Paso, TX	34.81	154	139	150	139
155	Amarillo, TX	34.28	143	155	159	120
156	Newark, NJ	34.13	168	66	170	151
157	Montgomery, AL	34.07	148	164	132	162
158	Columbus, GA	33.72	163	162	155	108
159	Toledo, OH	33.62	125	140	154	163
160	Chattanooga, TN	33.30	150	169	140	153
161	Baton Rouge, LA	33.27	165	168	118	129
162	North Las Vegas, NV	33.22	171	143	168	78
163	Mobile, AL	32.65	162	163	123	172
164	Huntington, WV	32.47	152	131	172	148
165	Memphis, TN	31.19	170	153	152	158
166	Corpus Christi, TX	30.75	145	158	163	159
167	Jackson, MS	30.72	134	171	156	168
168	Detroit, MI	30.15	172	146	171	135
169	Fort Smith, AR	29.25	166	148	166	171
170	Gulfport, MS	29.02	164	157	165	170
171	Shreveport, LA	28.64	147	172	164	167
172	Augusta, GA	28.23	160	166	161	174
173	Laredo, TX	26.31	167	170	174	157
174	Brownsville, TX	24.74	174	174	167	166

*1=Healthiest

Ask the Experts

With health-care reform still a hot issue, we asked a panel of experts to weigh in on the current presidential administration’s policies and give advice on building good personal health. Click on the experts’ profiles below to read their bios and thoughts on the following key questions:

1. What impact would repealing the Affordable Care Act (ACA) — dubbed “Obamacare” — have on the health of U.S. cities, particularly those with a large low-income population?
2. What are the most important factors to consider in choosing a city that is good for your health?
3. Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?
4. What tips do you have for a person looking to live a healthier lifestyle while on a budget?
5. What measures can local authorities undertake in order to improve local health-care systems?

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• John Sardelis Associate Chair of Health Administration and Professor at St. Joseph's College New York
• Angela Mattie Professor and Chair of the Department of Healthcare Management & Organizational Leadership, and Professor of Medical Sciences in the Frank H. Netter Medical School at Quinnipiac University
• Brian Bossak Associate Professor in the Department of Health & Human Performance and Program Director of the Bachelor of Science in Public Health Program at the College of Charleston
• Craig Konnoth Associate Professor of Law at the University of Colorado Boulder
• Thomas Prohaska Professor in the Department of Global and Community Health at George Mason University
• Carl Milofsky Professor of Sociology at Bucknell University
• Joan Salge Blake Clinical Associate Professor of Nutrition in the College of Health & Rehabilitation Sciences at Boston University
• Rachel L. Levine Acting Secretary of the Pennsylvania Department of Health and Physician General
• Kelly Nagel Director of the Office of Public Health Systems and Performance at the North Dakota Department of Health
• Rebekah Gee Secretary of the Louisiana Department of Health
• Audrey J. Burnett Associate Professor in the Department of Health Sciences at James Madison University

John Sardelis Associate Chair of Health Administration and Professor at St. Joseph's College New York

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

The access to health care among low-income populations will be adversely affected with the repeal of the ACA, since the poor rely on an expanded Medicaid, and the working-poor get support to make insurance more affordable.

What are the most important factors to consider in choosing a city that is good for your health?

I would look for a city that has a good medical care system and a well-regarded educational system. A good medical care system with an academic medical center is a plus, since many advanced procedures and emerging technologies should be more readily available. Research has consistently shown a positive correlation between health status and years of education, so, indirectly, you would benefit from being part of a healthier population.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

Offering positive incentives for each segment of the population. For people who are well, I would recommend reducing premiums -- for those who maintain healthy habits, like exercise and weight control. Those who have a chronic condition -- a growing percentage as America ages -- I would suggest eliminating drug copays, and in some cases, paying patients to pick up their medications (diabetics), since adhering to their treatment regimen is a key factor to better outcomes.

Reaching a bit further, I would also ask employers to create a wellness fund that would be available to employees on retirement or some other event. Similar to a 401k, employees can see this fund grow based on their maintaining or improving their health status.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

Healthy habits may in fact be cheaper, starting with preparing meals at home and regular exercise, like walking.

What measures can local authorities undertake in order to improve local health care systems?

Local authorities should encourage health systems to address the social determinants of health (education, nutrition, housing, etc.), since so much of health is determined by these factors. Our medical system is wonderful, but we need to address the root causes that emanate from social factors.

Angela Mattie Professor and Chair of the Department of Healthcare Management & Organizational Leadership, and Professor of Medical Sciences in the Frank H. Netter Medical School at Quinnipiac University

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

Estimates indicate that 17-18 million people gain health insurance coverage under "Obamacare." Insurance coverage equates to health care access. Without insurance coverage, people present in a hospital's emergency department and induce inappropriate utilization, such as seeking emergency care for an ear infection. Faced without access to primary care -- what health care insurance coverage allows -- often the only place to seek care is in a costly fashion -- an emergency department. Patients also postpone care without health care insurance coverage; for example, a diabetic may not have access to medication and will defer treatment until his/her condition worsens and requires hospitalization. Bottom line -- without health insurance coverage, patients are forced to seek costly care in the emergency department and end up deferring preventive care until very sick.

What are the most important factors to consider in choosing a city that is good for your health?

We now know that zip code is a major determinant of health. We also know socio-economic status is a major factor in someone's health status. While access to healthy food in walkable cities increases the potential for a healthy lifestyle, other factors are required. We have to assure access to health care for preventive services, affordable medications, adequate housing, counseling, affordable healthy foods, and other public health measures to increase the health of our population.

What measures can local authorities undertake in order to improve local health care systems?

It is time for a paradigm shift in this country. We need to incentivize well-care. We reimburse sick care, and this is an ineffective method of increasing the health of our population. The hospitals’ walls should extend to the community. The reimbursement of care in this country needs to support public health interventions and not focus solely on acute care.

Brian Bossak Associate Professor in the Department of Health & Human Performance and Program Director of the Bachelor of Science in Public Health Program at the College of Charleston

What are the most important factors to consider in choosing a city that is good for your health?

In my opinion, numerous factors relate to a city that is good for your health, including environmental, social, economic, and spiritual parameters. From an environmental perspective, weather/climate (including hours of sunlight annually and seasonally), pollution or lack thereof, greenspace, recreational opportunities, and transportation options are all important. Additionally, local opportunities for special interest group socialization, support network development, and educational advancement provide options for support when needed, and growth when wanted. Economic opportunities in the form of diverse career choices, business expansion, a thriving start-up scene, and a reasonable cost-of-living are exciting from a financial perspective -- such opportunities may also be inversely associated with difficult societal issues, such as high crime rates or urban blight. Access to spiritual growth, whether religious or non-religious, provides options for those desiring such connections to feel inspired about life and living.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

I frequently tout the maxim that “Life is lived forward, but understood backward.” The problem, in my mind, is an issue of time. Life is lived in the now, but many people associate health issues with the future. I think we, as a society, can do more to motivate people to invest more in health today, but just promising a better future from healthier decisions today doesn’t seem to work well for most. I think that is why I still see so many people smoking, despite near universal knowledge that smoking is bad for your health and bad for your wealth.

I do think “wants” motivate people -- people want more money so that they can buy more stuff or do more things. Cities that tout themselves as healthy places to live could spearhead financial incentives for healthy behaviors. Companies that want healthier employees (i.e., increased productivity and reduced benefit costs) could provide financial incentives, such as increased retirement contributions or matching in exchange for documented healthy behaviors. It just takes some creative thought, the ability to support “win-win” propositions, and effective communications to start the process of increasing the prevalence of healthy actions in society.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

Free, or nearly free actions are all around us, and can cost very little. There are only so many health-related that we can modify. Exercise, sleep, and diet are a few, but social connections, spirituality and disease prevention play a role in health as well. Take advantage of park and recreation opportunities -- tennis courts, rivers, lakes, and fields provide outdoor activity outlets. Dog parks, trails, and walking/bike paths provide ways to move without costing an arm and a leg. Get more sleep, cut cords and cables whenever possible, and don’t have a TV in a bedroom. You’ll potentially save in energy bills and entertainment costs, while increasing rest and relaxation for the day to follow. Not to mention the possibility of reading a book and increasing knowledge, or meditating and increasing mindfulness -- both of which pay may health dividends.

Start growing your own food -- begin with a single herb, tomato or pepper growing in a windowsill, or a small mushroom cluster from a kit. So many of us don’t know where our food comes from, how it was grown, what could be on or in it. Something like 2 percent of the U.S. population now produces food for a living, the rest of us produce nothing edible and buy everything we eat from someone and someplace else. One can always expand into urban or rural beekeeping, or have an urban chicken farm, or a small vegetable garden, which is both healthy from a nutrition standpoint, and healthy from an exercise/hobby standpoint.

The options are endless, but spending money on a gym or yoga facility membership is not necessary. Find a library giving away old books or selling them cheap, get some exercise-related books, and then get a group of friends together to exercise or be mindful together. If you are new to a city and don’t have a group of friends yet, find or create a meetup for free group activities (yoga, sports, tai chi, anything, really). Get vaccinated -- it’s far cheaper than having to get treated. A more healthy lifestyle begins with a single step. Make it a small one.

Craig Konnoth Associate Professor of Law at the University of Colorado Boulder

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

There have been a few proposals under the Trump Administration for repealing the ACA, most of them disastrous -- they would make the health care system worse than the system pre-ACA. But assuming we just have a clean repeal, the effects would still be serious. One way to think of the ACA is by looking at whom it regulated. It regulated insurers, requiring them to provide a basic level of coverage, prohibiting them from excluding preexisting conditions, and making sure that $0.85 of every $1 went to health care, instead of to, say, executive bonuses.

All of these had been major problems before the ACA. It regulated individuals, telling them that they had to have health insurance, and that, in most cases, if they couldn’t afford it, the government would subsidize them. This allowed us to have stable insurance markets, as opposed to unstable markets in which only the sickest people would try to buy insurance. It regulated states (sort of) by giving them the option of dramatically expanding Medicaid. Many states -- including many red states -- did so.

An ACA repeal would take away subsidies and end Medicaid expansion, gutting benefits to low-income individuals. These individuals will only be able to afford insurance plans that don’t cover much of anything. Repeal would hurt the sickest individuals (who are usually the poorest individuals) by taking away coverage for preexisting conditions. In short, a repeal would be fatal for low-income individuals, especially those who are poor, but not poor enough for pre-ACA Medicaid.

In cities, where people live close to each other, and lives are interlinked, harming the health of one group of individuals harms everyone’s health. For example, the ACA requires full coverage for preventative care like flu shots. Repealing the ACA would, in many states, allow insurance companies to charge a payment for shots; people may opt out of them, getting others sick as well. And even non-contagious conditions can be harmful. Someone who can’t get preventative or ongoing coverage for a heart attack will end up in an emergency room. Crisis care for that individual will divert more resources away from others in overburdened city hospitals who need it -- simply because the patient could not afford to get care in time.

What are the most important factors to consider in choosing a city that is good for your health?

We’re beginning to realize that our health is affected far more by our surroundings than by our genes. Our health requires simple things -- access to good grocery stores, to gyms and/or public parks where you can exercise for free, and which encourages a culture of good health. A city with good employment prospects is also important, given that in the United States, most working-age individuals are covered through an employer. Other considerations include access to emergency care, to pharmacies, public health centers that offer free screenings and the like. This is often affected by state funding -- cities in blue states can usually offer more than those in red states, because the state offers more funding, from Medicaid coverage to city run hospitals.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

The insurance mandate -- that the Trump tax plan repealed -- was a pretty good way to convince people to invest in their health. Failing to have insurance, after all, resulted in a fine. Education is also essential. Ensuring access to health care is a useful way to ensure that people are educated into a culture of good health.

Thomas Prohaska Professor in the Department of Global and Community Health at George Mason University

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

Multiple researchers in the field would have their own list of consequences of repealing the Patient Protection and Affordable Care Act. Without health insurance, a greater proportion of persons in lower socioeconomic status without insurance will delay or postpone seeking medical care. Health promotion and prevention services would likely be cut, resulting in a loss in participation in health promotion, leading to more costly health care for more serious health issues. This would be particularly difficult among lower SES populations, who may not afford out-of-pocket costs. Any increase in health care costs among lower-income persons could result in an inability to maintain proper diet and other needed necessities.

What are the most important factors to consider in choosing a city that is good for your health?

Affordable, walkable neighborhoods, easy access to health care goods and services, safety, considerable opportunity for community engagement.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

The most effective method for promoting health is to make it a part of a lifestyle.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

Not all elements of a healthy lifestyle are dependent on economic resources. Social engagement, an active lifestyle and, to some degree, a healthy diet can be managed with a modest budget.

What measures can local authorities undertake in order to improve local health care systems?

Local authorities could easily form community health coalitions among key stakeholders and the public to identify barriers to health, health care services and health promotion. There is a large number of examples of coalitions for healthy people and healthy communities.

Carl Milofsky Professor of Sociology at Bucknell University

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

Repealing the Affordable Care Act would have a big impact on access by citizens to health care. This is most obvious for lower-income people. If Medicaid were kept intact, these would be people over 134 percent of the poverty line. The most vulnerable part of this population in my experience is people between 50 and 65, because when these people retire, they lose employee-based health care and they are without until they enter Medicare. People with serious, ongoing health problems are hard hit, because they must pay for health care out of pocket, and they already start with limited income. The impact of the ACA on when these people get insured is huge.

Less recognized is that people above 400 percent of the poverty line (e.g., over by about $90,000) are really hurt by the whole way the ACA has been implemented. Many of these people are self-employed or work for small businesses, and implementation of the ACA was never completed for this group, so they pay the full cost of health insurance. As long as people receive a subsidy (this applies to everyone under 400 percent of the poverty line), they are protected from insurance rate increases. But above that line, when insurance charges go up, people get the full impact of those increases. As government has refused to pay full ACA costs, insurance companies have had no choice but to raise their rates. This over 400 percent of Federal Poverty Level group are the ones who have seen health insurance rates double or triple.

Regardless of coverage availability, low-income people who are insured by ACA have found it very difficult to find a doctor who will give them care. Because the ACA increased health care utilization by millions of people, many providers have not had enough caregivers, so this has become a major problem.

Finally, and less obvious to outsiders, the ACA had a big impact on the way health care organizations provided care. The ACA created pressure and a values mandate for organizations to provide health care more efficiently. Before, they had provided care in a way that would maximize profits. With ACA, health care cost increases flattened out. This has direct impact on the cost of insurance coverage charged to everyone, including those who are employed and get coverage through their employer.

What are the most important factors to consider in choosing a city that is good for your health?

The magazine Men’s Fitness used to give a ranking of healthiest cities, and surprises were places like Milwaukee and Baltimore. It seems like those places had mayors and municipal administrations that made healthy citizens a priority. They had programs to make physical fitness centers cheaply available across their cities and this helped a lot.

Healthy food availability is important. Some of this involves helping to situate full-service supermarkets in low-income neighborhoods, the areas called food deserts. It is important for these stores to be clean and to stock fresh looking food. That matters a lot to low-income people. Free food distribution is important. Oddly, there seems to be a lot of free food available, but there are lots of problems with getting it distributed. Many of the distribution centers are small nonprofits that are inefficient for a variety of reasons, and where it is hard to track inventory.

Exposure to pollution has a big impact on the health of poor people, and there are important differences in the level of pollution in different cities. Traffic is a problem because poor neighborhoods are often near highways. But industrial pollution is also a big factor. Where old industrial plants have closed down or where older firms cannot update themselves, neighborhood residents live with a lot of pollution.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

Marketing and sales messages play an important role in what people buy and eat. I’ve thought that community messaging campaigns about healthy food and about the importance of eating well should happen more. A big problem is that processed foods are cheaper than fresh foods. Poor people eat what they can afford. I like food distribution centers that provide cooking lessons. However, it is important for these lessons to be culturally appropriate and sensitive.

Exercise is very important, but in many places, people are afraid to go out or to let their children go out. Helping people to feel safe in their neighborhoods should be a priority, as well as making attractive places available for working out nearby.

Communicating health-related knowledge is important, but it needs to be offered in contexts where people will feel comfortable accepting the knowledge. Community groups are the right venues, but they need to be supported by knowledgeable health professionals. The health knowledge would have to do with managing health problems like diabetes, but it would also have to do with how to get insurance and how to get access to medical care. Long-term monitoring of chronic health problems is important.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

Exercise is cheap and it’s mostly a matter of motivation. People can get good exercise close to home if they’re willing to do it and if they are regular about it. Local exercise support groups can be really helpful. They also help with weight control, which is important.

One can eat cheaply if you know nutrition values, know what foods are inexpensive, and know how to cook things so they are satisfying and taste good. Local food lessons would be important. This kind of cooking often takes time and it may involve labor in food preparation, so the busier people are, the harder it is for them to do this. But if time is available, it is worth it to put time into preparing inexpensive, healthy food.

What measures can local authorities undertake in order to improve local health care systems?

Local authorities can improve coordination, effective data collection, evidence-based programs, and they can have a willingness to combine programs across agencies to leverage resources so they help poor people. In my area, agencies are fragmented, they have poor knowledge of how to develop and use data (important for fund-raising, for example), and big institutions push around community-based organizations. Community-based organizations know the local communities and can be most effective, but big institutions, especially health care institutions, do not respect or collaborate with them. Really annoying.

Joan Salge Blake Clinical Associate Professor of Nutrition in the College of Health & Rehabilitation Sciences at Boston University

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

The health of a city is a reflection of the health of its residents. The Affordable Care Act requires health plans to cover preventive services, such as counseling by a registered dietitian nutritionist (RDN) for those who are overweight and/or have diet-related medical conditions. Obesity increases the risk of heart disease, stroke, certain cancers, and diabetes. These are four of the top leading causes of death among Americans, and prevention is key to fighting these diseases. By providing health insurance to everyone, regardless of income, all will have the opportunity for affordable care and nutrition counseling that can improve the quality of their lives. Healthy residents make for a healthy city.

What are the most important factors to consider in choosing a city that is good for your health?

A city should make it easy for its citizens to be healthy. There should be a safe and an affordable mass transit system, and sidewalks that allow people to move through the city by foot. Folks need to leave their cars at home and use their feet to maneuver their daily routines. Daily physical activity can help you maintain a healthy weight, heart, and blood pressure. Walking is one of the best ways to affordably incorporate movement throughout your day and meet the recommended physical activity guidelines daily. There also should be farmers’ markets, supermarkets, and eateries that make it easy and affordable for people to make healthy food choices.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

You need to think of your health as you do of your long-term investments, such as your 401K retirement account. The more you invest now, the healthier and more robust you will be in your later years. Starting in your early years, a healthy lifestyle, a nutritious diet coupled with a daily physical activity routine, will allow you to reap huge benefits as you age. You will not only feel better daily, but you will also increase your chances of living a longer, higher-quality life in your later years. Invest early and reap these health benefits all through your life, especially in your later years.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

It is a myth that maintaining a healthy lifestyle is expensive. It isn’t. When it comes to a healthy diet, look to a diet that contains adequate amounts of fruits, vegetables, whole grains, lean protein and dairy, and some healthy oils. You can do this affordably by buying what is on sale at your local supermarket, and turn to staples such as frozen fruits and vegetables, brown rice and whole wheat bread, beans and nuts, as backup. Plan your meals for the week and freeze leftovers, or have them for lunch the next day. Preparing your meals, rather than buying take-out or eating out regularly, will save you big bucks and allow you to better control the quality of your diet. Also, walk everywhere. It's cheap and your save money by not buying gasoline for your car. Your healthy diet is your fuel for your body.

Rachel L. Levine Acting Secretary of the Pennsylvania Department of Health and Physician General

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

Repealing the Affordable Care Act could result in almost 850,000 people in Pennsylvania losing access to health care. We cannot allow that to happen. Access to health care helps ensure that people can visit a doctor for checkups, for flu shots and to work to remain healthy before a serious health issue arises.

By 2019, a repeal of the Affordable Care Act could lead to an estimated 1,700,000 people who would be uninsured. In addition, a repeal would hurt the state budget for Pennsylvania, as well as many other states. 22 percent of the state’s population relies on Medicaid, including 1.2 million children, nearly 250,000 seniors, over 500,000 people with a disability, over 560,000 individuals who receive mental health services and 215,000 individuals receiving substance use disorder treatment. Currently, 5.4 million Pennsylvanians cannot be denied coverage due to a pre-existing condition such as cancer, diabetes or heart disease.

As Pennsylvania and the entire country works to address the opioid epidemic, repealing the Affordable Care Act would have devastating consequences on that work, leaving many people without access to medication-assisted treatment and other forms of treatment and recovery.

What are the most important factors to consider in choosing a city that is good for your health?

Where you live is one of the most important factors when determining your health. Research now indicates that your zip code is a better predictor of your health than your genetics. Social determinants show that access to healthy food, transportation, employment, safe neighborhoods and education will influence health outcomes.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

An individual’s health truly is a long-term investment, and that starts with seeing a doctor regularly. Having a doctor will allow them to know your medical history, to understand your health and to work with you to determine where improvements may be needed. By seeing a doctor on a regular basis, you will be able to stay current on recommended screenings; such as mammograms and colonoscopies. Your doctor will ensure you are up-to-date on needed vaccinations, and can have a conversation with you about a diet and exercise plan that will fit your life.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

There are small steps people can take to be healthier, no matter the amount of money they have available. One of those steps is to make sure they see a doctor regularly. Another is to exercise. Even just walking for 15 minutes a day can help improve one’s health. Additionally, making healthy lifestyle choices such as eating healthy can also help someone become healthier.

What measures can local authorities undertake in order to improve local health care systems?

Each locality has to look at its own strengths and weaknesses to determine how it can best assist its residents in living a healthy life. Examples of action that can be taken include: eliminating food deserts, ensuring fresh produce is available, providing access to places of exercise such as parks and bike trails, and ensuring sidewalks are well-maintained.

Other key steps go back to some of those social determinants, such as reducing crime, investing in education, ensuring there is safe housing and encouraging healthcare professionals to work in the local area.

Kelly Nagel Director of the Office of Public Health Systems and Performance at the North Dakota Department of Health

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

North Dakota’s governor, Doug Burgum suggests within the Main Street Initiative that the key factors for a “Healthy, Vibrant Community” are fiscal and physical health. Supporting factors include:

• Renovation of historic buildings -- unique differentiation that creates a sense of place, history and culture;
• Mixed-use buildings (e.g., retail on first floor, upper floors for apartments or offices create economic efficiency around existing infrastructure);
• Vibrant main streets as a center point, where the community can come together;
• Walkable neighborhoods help lessen the burden of health care costs on taxpayers.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

Increasing an individual’s readiness to change risky behaviors should start with awareness and education strategies. Individuals need to make informed decisions. For this to happen, we need to inform individuals of the risk factors and the data, then provide people with tools and resources for action.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

Explore healthy community options. Walking/biking paths, parks, recreation waters, art and community health centers, community gardens, and farmers markets.

What measures can local authorities undertake in order to improve local health care systems?

Governor Burgum’s Main Street Initiative has integrated health into the Healthy, Vibrant Communities pillar. Measures are currently being identified and will be included in community dashboards. The dashboard is being modeled after the Michigan’s Health and Wellness dashboard. Measuring the health of a community will include indicators for economic strength (employment including health care provider availability, health care costs, etc.), education attainment, public safety, quality of life and length of life.

Rebekah Gee Secretary of the Louisiana Department of Health

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

The Affordable Care Act, and specifically its Medicaid Expansion, has been particularly effective at expanding access to health care in Louisiana. We've seen our uninsured rate fall by nearly 22 percent in Louisiana since 2013. More than 460k Louisianians have gained coverage and 75 percent of those have had a doctor's visit during the year. In some of our largest parishes, like Orleans and East Baton Rouge, we've seen 50k and 40k, respectively, get access to care through the expansion -- representing almost 15 percent of the total population in each case. More than just getting access, we've seen preventative health care infrastructure expand in urban centers to serve this newly insured population across the state, including dozens of new FQHCs and urgent care clinics. Access can be game-changing for working families in and out of our urban cores -- it creates a healthier, more productive workforce; fuels the economy; and saves state taxpayers money by moving resources toward preventive care.

What are the most important factors to consider in choosing a city that is good for your health?

Cities -- if designed and developed thoughtfully -- can be excellent venues for good health, because they encourage all of us to cast off a sedentary lifestyle and hit the streets. Walkability is key for me. While riding in a car can be a convenient mode of transportation, we can be mindful of our health by making time to walk wherever we're going. Walking is great physically, but also economically and socially. We're more likely to visit a local store as we walk by or stop and talk to a neighbor. Health isn't just physical, but it also must encompass general well-being -- we can help keep this up by spending time with our friends, our neighbors, and our family.

I think Louisiana has some of the most beautiful and interesting cities to walk through -- large and small. Nothing beats a morning walk through New Orleans' Vieux Carre, or a stroll down one of our historic main streets in Ponchatoula or St. Francisville. Of course, in New Orleans, we get plenty of walking during Carnival time and throughout the year in our second lines.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

I always tell my patients -- if you want to chase your grandchildren around, make sure you invest in your health today. Health care costs pile up at the end of people lives, often because of issues that could have been mitigated by cheap preventative care earlier in life. The smallest investment today yields huge dividends later in life -- just like saving for retirement. If you want a strong quality of life later on, you need to take care of yourself today. Don't put it off.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

Walk. Plan your meals ahead or cook at home. Home-cooked meals are generally healthier, but also encourage positive family time that builds stronger relationships. Get a preventive check-up, your vaccines, and age-appropriate health screenings (like for HBP, breast/colon exams, etc.)

What measures can local authorities undertake in order to improve local health care systems?

We need to build infrastructure with an eye on the health care of tomorrow -- not the concerns of yesterday. That means a system that is far more focused on outpatient care, not inpatient beds. A system that contemplates and prepares for widespread use of telemedicine, and other technological advances to help connect patients with their providers. A system that heavily rewards quality outcomes and penalizes excessive quantity. And a system that helps allow all of our allied health professionals practice to the top of their training, in order to lower overall costs and expand access -- especially around primary care.

Audrey J. Burnett Associate Professor in the Department of Health Sciences at James Madison University

What impact would repealing the Affordable Care Act (“Obamacare”) have on the health of U.S. cities, particularly those with a high low-income population?

As with any health care reform, low-income individuals are the ones who typically suffer the most. Repealing the Affordable Care Act would essentially leave those residents of low-income areas -- who already experience a deficit in terms of health status -- without accessibility to, and reliable coverage for, necessary health care services.

What are the most important factors to consider in choosing a city that is good for your health?

The most important factors to consider include public transportation to allow for easy access to necessary health care services, accessibility to safe parks and walkways to maintain physical activity, availability (and affordability) of healthy foods, and a sense of community capacity in which all residents foster a sense of responsibility to improve the overall health of the city.

Since health and wealth are both long-term investments, what are some effective strategies for convincing people to invest more in their health today?

I think that stressing preventive health measures, such as vaccination, regular checkups/exams, daily physical activity, and healthy diets, are the best strategies for improving one’s health, both short- and long-term. Of course, accessing these opportunities via free vaccination programs and lower-cost gym memberships, for instance, also play a pivotal role in convincing people to invest in such personal health measures.

What tips do you have for a person looking to embrace a more healthy lifestyle while on a budget?

Health efforts, such as regular physical activity, does not require expensive gym memberships or hours spent in a gym setting. Physical activity may include taking a nature hike through the woods, walking along a sidewalk or at a local school’s track. I also believe healthy foods -- while unnecessarily expensive in many cases -- can be accessed via programs such as WIC and local food co-ops/food banks.

What measures can local authorities undertake in order to improve local health care systems?

Perhaps conducting yearly health needs assessments of communities/health districts can better inform public policy at the local level, as long as the data is carefully taken into consideration and acted upon, when/where appropriate. I also believe that working with local businesses that provide necessary health care services (e.g., free clinics) will foster collaboration and accountability among local authorities, better tailor services to meet the needs of local community members, and mobilize the community as a whole to achieve improved health outcomes.

Methodology

In order to identify the overall healthiest cities in the U.S., WalletHub compared 174 cities — including the 150 most populated U.S. cities, plus at least two of the most populated cities in each state — across four key dimensions: 1) Health Care, 2) Food, 3) Fitness and 4) Green Space. Due to data limitations the following cities were not included in the analysis: Dover, Delaware, Lewiston, Maine, Bismarck, North Dakota, South Burlington, Vermont, Juneau, Alaska, Pearl City, Hawaii, Columbia, Maryland and Casper, Wyoming. Our sample considers only the city proper in each case and excludes cities in the surrounding metro area.

We evaluated the four dimensions using 40 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the most favorable conditions for a healthy lifestyle. Data for metrics marked with an asterisk (*) were available at the state level only and therefore half-weighted. For metrics marked with an asterisks (**), we calculated the population size using the square root of the population in order to avoid overcompensating for minor differences across cities.

We then calculated determined each city’s weighted average across all metrics to calculate its total score and used the resulting scores to rank-order our sample.

Health Care – Total Points: 25

• Premature-Death Rate: Triple Weight (~4.17 Points)Note: “Premature Death” refers to years of potential life lost.
• Mental Health: Full Weight (~1.39 Points)Note: This metric measures the percentage of adults reporting 14 or more mentally unhealthy days in the past month.
• Mental-Health Counselors per Capita: Full Weight (~1.39 Points)
• Physical Health: Full Weight (~1.39 Points)Note: This metric measures the percentage of adults reporting 14 or more physically unhealthy days in the past month.
• Family Doctors per Capita: Full Weight (~1.39 Points)
• Dentists per Capita: Full Weight (~1.39 Points)
• Cost of Medical Visit: Full Weight (~1.39 Points)
• Cost of Dental Visit: Full Weight (~1.39 Points)
• Quality of Public Hospital System: Full* Weight (~1.39 Points)Note: This metric is based on the Centers for Medicare & Medicaid Services’ ranking of public hospital systems.
• Hospital Beds per Capita: Full Weight (~1.39 Points)
• Adult Health-Insurance Coverage: Full Weight (~1.39 Points)Note: This metric measures the percentage of adults aged 18 to 64 with health insurance coverage.
• Youth Health-Insurance Coverage: Full Weight (~1.39 Points)Note: This metric measures the percentage of youths aged 17 and younger with health insurance coverage.
• Share of Adults Who Visited a Doctor or a Dentist in the Past Year: Full Weight (~1.39 Points)
• Share of Adults Who Checked their Cholesterol in the Past 5 years: Full Weight (~1.39 Points)
• Mammography Screenings Among Women Aged 50–74 years: Full Weight (~1.39 Points)
• Share of Women & Men Aged 65 and Older Who Received Core Preventive Services: Full Weight (~1.39 Points)Note: This metric measures the percentage of women aged 65 and older who report having received all of the following: an influenza vaccination in the past year; a pneumococcal vaccination (PPV) ever; either a fecal occult blood test (FOBT) within the past year, a sigmoidoscopy within the past 5 years and a FOBT within the past 3 years, or a colonoscopy within the previous 10 years; and a mammogram in the past 2 years and men aged 65 and older who report having received all of the following: an influenza vaccination in the past year; a PPV ever; and either a fecal occult blood test (FOBT) within the past year, a sigmoidoscopy within the past 5 years and a FOBT within the past 3 years, or a colonoscopy within the past 10 years.

Food – Total Points: 25

• Fruit & Vegetable Consumption: Double Weight (~5.56 Points)Note: This metric measures the percentage of adults consuming fewer than one serving of fruits or vegetables per day.
• Farmer's Markets per Capita**: Full Weight (~2.78 Points)
• Gourmet Specialty-Food Stores per Capita**: Full Weight (~2.78 Points)
• Healthy Restaurants per Capita**: Full Weight (~2.78 Points)Note: “Healthy Restaurants” refers to vegetarian, vegan and gluten-free establishments.
• Dietitians & Nutritionists per Capita: Full Weight (~2.78 Points)
• Share of Residents Who Say They Eat Healthy: Full Weight (~2.78 Points)Note: This metric is based on Gallup and Sharecare's 2016 Community Rankings for Healthy Eating report which examines healthy eating across the nation.
• Share of Obese Residents: Full Weight (~2.78 Points)
• Limited Access to Healthy Foods: Full Weight (~2.78 Points)Note: This metric measures the percentage of the population who earn a low income and do not live within a reasonable distance to a grocery store.

Fitness – Total Points: 25

• Share of Adults Who Engage in Any Physical Activity: Double Weight (~7.14 Points)
• Fitness Clubs per Capita**: Full Weight (~3.57 Points)
• Average Cost of Fitness-Club Membership: Full Weight (~3.57 Points)
• Recreational Leagues per Capita**: Full Weight (~3.57 Points)
• Weight-Loss Centers per Capita**: Full Weight (~3.57 Points)
• Fitness Trainers & Aerobics Instructors per Capita: Full Weight (~3.57 Points)

Green Space – Total Points: 25

• Parkland Acres per Capita**: Full Weight (~2.50 Points)
• Quality of Parks: Full Weight (~2.50 Points)Note: This metric measures “parks spending per capita,” as a proxy for “parks quality.”
• Hiking Trails per Capita**: Full Weight (~2.50 Points)
• Running Trails per Capita**: Full Weight (~2.50 Points)
• Walking Trails per Capita**: Full Weight (~2.50 Points)
• Walk Score: Full Weight (~2.50 Points)
• Bike Score: Full Weight (~2.50 Points)
• Physical-Activity Access: Full Weight (~2.50 Points)Note: This metric measures the percentage of the population with adequate access to locations for engaging in physical activity.
• City “Greenness”: Full Weight (~2.50 Points)Note: This metric is based on WalletHub’s Greenest Cities in America ranking that encompasses environmental metrics like air quality or “green” transportation.
• Recreation Access: Full Weight (~2.50 Points)Note: This metric is based on WalletHub’s Best & Worst Cities for Recreation ranking.

 

Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Council for Community and Economic Research, U.S. Bureau of Labor Statistics, County Health Rankings, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, Yelp, Numbeo, IMLeagues, Gallup-Sharecare, The Trust for Public Land, Under Armour, Walk Score and WalletHub research.

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