For its 2021 Healthiest and Unhealthiest Cities in America report, the personal finance website WalletHub evaluated 182 U.S. cities according to dozens of metrics pertaining to healthcare, food, fitness, and green spaces. The data collected ranged from the cost of a medical visit and access to healthcare providers to premature death rates and COVID-19 cases. “Other important factors include inadequate fruit and vegetable consumption and the share of adults who engage in physical activity,” says WalletHub’s analyst and communications director Jill Gonzalez. “The report aims to determine which cities prioritize their residents’ well-being.” The methodology was established by WalletHub analysts in conjunction with academic experts. The metrics were chosen for relevance, as well as availability of data, Gonzalez says.
- San Francisco, California
- Seattle, Washington
- Portland, Oregon
- San Diego, California
- Honolulu, Hawaii
- Washington, DC
- Austin, Texas
- Irvine, California
- Portland, Maine
- Denver, Colorado The 10 cities that landed on the bottom of the list:
- Lubbock, Texas
- Huntington, West Virginia
- Jackson, Mississippi
- Fort Smith, Arizona
- Montgomery, Alabama
- Memphis, Tennessee
- Shreveport, Louisiana
- Gulfport, Mississippi
- Laredo, Texas
- Brownsville, Texas Megan Irby, PhD, a senior research associate at the Maya Angelou Center for Health Equity at the Wake Forest School of Medicine in Winston-Salem, North Carolina, says that a city’s health appears to be closely tied to its wealth. “Income is the strongest predictor of health in our country,” she says. Seven of the top 10 cities — Portland, San Diego, San Francisco, Seattle, Honolulu, Washington, DC, and Irvine — also topped Kiplinger’s 2020 ranking of the 20 most expensive U.S. cities. According to Data USA, the median household income in San Francisco is $112,376 dollars a year, compared with an annual median household income of $36,499 dollars in Brownsville. “Among the top ‘healthiest’ cities described in the WalletHub article, all have very high median incomes and are very expensive places to live, which indicates to me that health follows wealth,” says Dr. Irby. “But that likely is true only in the aggregate and applies only to those who are disproportionately more privileged.”
Inequities in Access to Health Resources
Fatima Cody Stanford, MD, MPH, an assistant professor of medicine at Harvard Medical School in Boston, points out that many of the cities at the bottom of the list are areas of lower income or communities where there are more people of color. “Does a list like this take into account the health inequities that exist in these cities? That would mean not only do these cities have quality healthcare, greenspaces, and healthy foods, but does everyone have access to them?” asks Dr. Stanford. “We can’t just look at those places and say that those are unhealthy places to live,” she says. “And if there are things about that city that make it a less healthy place to live, what are we doing to create equity within those communities?”
The Pandemic May Increase the Wellness Gap
The impact of COVID-19 on U.S. cities was another key factor in the survey results. “How well each city has been handling the COVID-19 pandemic has had a huge impact on the physical and mental wellness of residents,” says WalletHub’s Gonzalez. The pandemic has not only resulted in job losses nationwide, but it’s also transformed the way that many Americans work. According to data from Statista, a market research company, 44 percent of U.S. employees now work from home five or more days per week compared with 17 percent before the pandemic. What will it mean if a segment of the population can work remotely from any city they choose? “I think it will continue to widen the disparities that already exist,” says Irby. “There are many communities where people don’t have the privilege of working from home.” Irby uses her state, North Carolina, as a prime example. “Some of the highest rates of COVID-19 in our state were occurring in the Hispanic population where our chicken processing plants are located. These people didn’t have the option to work from home,” she says. Jobs and income have been lost because of day care and school closings due to COVID-19, Irby says. “The more wealth and more access to privileges like working from home you have, the more you are able to protect yourself from the virus.”
