At 78.5 years, life expectancy in the United States, while trailing several dozen other countries, has continuously risen in the past century. Leading this upward trajectory are the 25 healthiest U.S. cities. These cities span 14 states and are located across multiple regions, from the Northeast to the Southwest — yet most share several common factors.
In order to determine the healthiest cities in the United States, 24/7 Wall St. examined more than two dozen measures of health factors and health outcomes from the County Health Rankings and Roadmaps program, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Based primarily on measures intended to capture quality and length of life, Rochester, Minnesota is the healthiest U.S. metropolitan area.
1. Rochester, Minn.
> Premature death rate: 229.7 (per 100,000 residents)
> Adult obesity rate: 25.1%
> Pct. adults without health insurance: 5.4%
> Median household income: $64,210
Home to one of the Mayo Clinic’s main locations, it is perhaps no coincidence that Rochester  is the healthiest city in the United States. Adults in Rochester report an average of only 2.4 physically unhealthy days a month, the fewest of any U.S. city. When area residents need medical attention, there is no shortage of medical professionals in the area. There are roughly 180 primary care physicians for every 100,000 area residents, more doctors per capita than in any other U.S. city.
Area residents are also less likely to smoke, more likely to be physically active, and less likely to be obese than the average American. Life expectancy in the Rochester metro area is a near-nation-leading 81.2 years.
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2. San Jose-Sunnyvale-Santa Clara
> Premature death rate: 200.6 (per 100,000 residents)
> Adult obesity rate: 19.6%
> Pct. adults without health insurance: 7.1%
> Median household income: $92,960
Life expectancy in the San Jose-Sunnyvale-Santa Clara metro area is 82.7 years, the highest in the country. Healthy behavior plays a role in the residents’ long life expectancy. More than 98% of the population has access to places for physical activity such as recreation centers and parks. As a result, area residents are more likely to lead active lifestyles than most Americans. Furthermore, only 9.1% of area adults smoke, the fourth smallest share of any U.S. city.
Residents’ health is also partially attributable to favorable economic conditions in the area. The typical metro area household earns $92,960 a year, the highest median household income of any U.S. metro area. Financial stability makes it easier to consistently afford healthy food, and only 9.8% of area residents struggle to put food on the table, less than half the national food insecurity rate.
3. Ames, Iowa
> Premature death rate: 214.3 (per 100,000 residents)
> Adult obesity rate: 25.6%
> Pct. adults without health insurance: 5.9%
> Median household income: $51,270
Those who are employed are more likely to have health insurance coverage, and those with insurance are more likely to receive regular medical care and preventative screening. In Ames, only 2.4% of the workforce is out of a job, tied with Fargo, North Dakota, for the lowest 2015 unemployment rate of any U.S. metropolitan area. Partially as a result, only 5.9% of the population too young for Medicare does not have insurance, a considerably smaller share than the national 11.7% uninsured rate. Life expectancy is about two years longer in Ames than it is across the country.
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4. Boulder, Colo.
> Premature death rate: 209.0 (per 100,000 residents)
> Adult obesity rate: 13.3%
> Pct. adults without health insurance: 7.3%
> Median household income: $69,407
By many measures, Boulder is one of the healthiest cities in the country. More than 90% of area adults lead physically active lives, the largest share of any U.S. metro area. Regular physical activity can help individuals maintain a healthy weight and have longer lives. Only 13.3% of adults in Boulder are obese, the lowest obesity rate of any U.S. city and well below the 27.0% national rate. In addition, there are 209 deaths before age 75 for every 100,000 area residents, the second lowest premature death rate in the country and less than half the national premature death rate.
5. Iowa City
> Premature death rate: 249.2 (per 100,000 residents)
> Adult obesity rate: 23.7%
> Pct. adults without health insurance: 5.8%
> Median household income: $55,030
Employment can be important for personal health in a number of ways. Those who are employed have regular income and often health insurance through work. Only 2.7% of the Iowa City workforce is out of a job, the sixth lowest 2015 unemployment rate of any city in the country. Low unemployment likely contributes to a low uninsured rate. Only 5.8% of those ineligible for Medicare do not have health insurance, less than half the national 11.8% uninsured rate. With less joblessness, a relatively small share of area children live in poverty. Children are more susceptible to the negative health outcomes associated with malnutrition. Only 8.0% of children in Iowa city live below the poverty line, the fourth smallest share in the country.
See the rest of the 25 healthiest cities in America:
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More on America's healthiest cities
Premature death is the most important measure in determining the health of a city. In each of the 25 healthiest U.S. cities, residents are far less likely to die before the age of 75 than the typical American. Though healthy behaviors and social and economic conditions vary among the healthiest cities, in every case, there are multiple identifiable causes for residents’ good health.
In an interview with 24/7 Wall St., Amanda Jovaag, data lead at County Health Rankings, explained that, in general, “as income and wealth increase … so does health.” People and families that are financially secure are more likely to be able to afford necessary medical treatment and healthy food on a regular basis. Median household incomes exceed the national median in a majority of the healthiest cities in the country. In the San Jose, California metro area, one of the healthiest in the country, the typical household earns $92,960 a year, more than in any other U.S. city.
In addition to sufficient income, health insurance coverage is a crucial component in ensuring individuals get necessary medical treatment and preventative screening. “The uninsured are much less likely to have primary care providers and a source for regular care than the insured,” Jovaag said. Ultimately, “those without insurance are often diagnosed at later, less treatable disease stages than those with insurance and, overall, have worse health outcomes, lower quality of life, and higher mortality rates.” Nationwide, 11.7% of people ineligible for Medicare are uninsured. Uninsured rates in the healthiest U.S. cities are all lower than the national rate, ranging from 3.9% inMankato, Minnesota, to 10.8% in the Provo-Orem, Utah metro area.
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While insurance coverage and income are important, so too are healthy behaviors. Certain behavioral factors and indicators, such as smoking and obesity, can increase the risk of a number of severe conditions and diseases and can significantly detract from quality of life. As a result, obesity and smoking rates were heavily weighted in the ranking of cities by health. Nationwide, 17% of adults identify as smokers, and 27% of adults are obese. The vast majority of the healthiest cities are home to a smaller share of obese residents and smokers than the country as a whole.
24/7 Wall St. created an index modeled after analysis conducted by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. To identify the 25 healthiest cities, 24/7 Wall St. reviewed all U.S. metropolitan statistical areas. The index rankings are based on overall health outcomes, a weighted composite of length of life, quality of life, and overall health factors. The health factors component is itself a weighted composite of healthy behaviors, clinical care, social and economic factors, and physical environment measures. Data on life expectancy came from the Institute for Health Metrics and Evaluation, a global health research center affiliated with the University of Washington.
24/7 Wall St. is a USA TODAY content partner offering financial news and commentary. Its content is produced independently of USA TODAY.