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Which cities have the most outdoorsy, fit, healthy residents? NerdWallet sifted through the fifty largest metro areas to find the ones with the best indicators of health, including health scores for the residents, health insurance coverage and a high prevalence of doctors and clean air. NerdWallet assessed the health score according to the following factors:

How fit are the residents? We assessed fitness of residents through the American Fitness Index, a composite index that includes the CDC’s Selected Metropolitan/Micropolitan Area Risk Trends Behavioral Risk Factor Surveillance System, environmental factors from the Trust for Public Lands, rates of disease and other government data. Is healthcare accessible? We incorporated the percentage of residents who have health insurance as well as the number of physicians per 100,000 residents. Is the air quality good? Research shows that cleaner air adds an average of 4 months to a resident’s life expectancy. We included the number of high particle pollution days per year for each metro area.

Healthiest metro areas

1. Boston, Massachusetts

Boston is a city of runners, with the Boston Marathon bringing 20,000 registered participants and 50,000 spectators to Beantown each year. Health insurance coverage in the city is excellent, largely due to Romneycare, which requires that each resident obtain health insurance and provides free health insurance to low-income individuals. There are a whopping 591 physicians per 100,000 residents in the city, and programs like the federally-funded Boston Healthy Start Initiative and Northeastern University’s Healthy Kids, Healthy Futures program, which supports health-promoting environments for young children to prevent early childhood obesity, show the city’s commitment to health.

2. Seattle, Washington

With a high fitness index, comprehensive health insurance coverage and very clean air, it’s clear why The Emerald City made it on our list. Health-conscious residents can participate in the plethora of outdoor activities the area offers, doing everything from kayaking to biking to hiking. In addition, the city has shown a commitment to public health and fitness. The Seattle Parks and Recreation Department has started a Healthy Parks, Healthy You initiative to promote physical activity.

3. Portland, Oregon

Portland is known for its outdoor activities health-conscious residents. With extinct volcanoes, over 5,000 acres of land in Forest Park and Tryon Creek State Natural Area, Portland has an abundance of outdoor activities. The city has clean air (it’s often rated one of the greenest cities in the United States), fit residents and a high level of health insurance coverage. In fact, the state of Oregon has instituted Healthy Kids, a health coverage program for all uninsured Oregon children.

4. Minneapolis, Minnesota

Minneapolis has a very high fitness index as well as high health insurance coverage. Additionally, the one-of-a-kind Rainbow Health Initiative is working toward health equity for Minnesota’s LGBTQ community.

5. Hartford, Connecticut

The Hartford metro area is well-insured and contains plenty of physicians. Hartford residents tend to be fit and healthy, and the Connecticut Department of Public Health has launched their Healthy Homes Initiative, which aims to promote safe and healthy home environments.

6. San Francisco, California

San Francisco has tons of physicians per capita, fairly clean air and high health insurance coverage. It’s no wonder the residents tend to be fit, what with Muir Woods, Lake Tahoe, Yosemite National Park and Big Sur all within driving distance. San Francisco is paradise for health-conscious, outdoorsy people, and the weather’s always good enough to go for a run outside.

7. Washington, DC

DC residents have access to plenty of physicians, including those at Georgetown’s Hoya Clinic, which provides free healthcare to homeless, underserved and uninsured people. The city also has some incredible healthy initiatives, including the Healthy Corner Store Program, which runs a wholesale delivery service of fresh local produce to local corner stores.

8. Denver, Colorado

Denver has particularly clean air, and the city’s proximity to mountains for hiking and skiing attracts health-conscious residents while making it easy to plan an outdoorsy weekend getaway. Denver’s Healthy People initiative creates partnerships and works with area health organizations to promote holistic health.

9. San Jose, California

San Jose has physicians aplenty, relatively clean air and fit residents. Santa Clara County’s Children’s Health Initiative focuses on helping children and their families access healthcare.

10. Providence, Rhode Island

Providence residents benefit from the city’s clean air and widespread health insurance coverage. The state’s Healthy Communities Initiative has improved Rhode Island’s health systems, helping them give high-quality care.

11. Sacramento, California

Sacramento residents can enjoy clean air and access to doctors and health insurance. Additionally, health organizations abound in the city. Sacramento Covered works with local health systems to enroll uninsured families in health insurance and public benefits programs.

12. Baltimore, Maryland

Residents have access to the world-renowned Johns Hopkins Medical Center as well as 511 physicians per 100,000 residents. The Johns Hopkins Urban Health Institute has forged partnerships between the university and the community, and has collaborated with neighborhood educators and community leaders.

13. Virginia Beach, Virginia

Virginia Beach residents benefit from the city’s clean air and easy access to healthcare. In addition, organizations like the Virginia Business Coalition on Health encourage businesses to prioritize the health of their workers, thereby helping the overall health of the community.

14. Salt Lake City, Utah

Salt Lake City provides easy access to nature, and outdoorsy residents can explore nearby ski resorts, hiking trails and fishing spots. Residents tend to be insured and fit, and the clean air makes being outdoors enjoyable.

15. Buffalo, New York

Buffalo has very high insurance coverage—more than 92% of residents are insured. Plus, Buffalo’s Green and Healthy Homes Initiative is working to repair old homes, thereby reducing lead poisoning and mold exposure for Buffalo residents.

Healthiest metro areas

Rank Metro area Fitness index Health insurance coverage Physicians per 100,000 residents # High particle pollution days per year Overall health score 1 Boston, Massachusetts 70 95.2% 591 10.5 82.0 2 Seattle, Washington 67.8 87.3% 390 6.6 79.9 3 Portland, Oregon 67.9 91.0% 369 7.4 79.2 4 Minneapolis, Minnesota 76.4 91.0% 326 9.5 76.1 5 Hartford, Connecticut 68.5 92.2% 395 9 76.1 6 San Francisco, California 69 88.0% 476 10 72.9 7 Washington, DC 75.8 88.2% 453 11.2 72.7 8 Denver, Colorado 65.6 84.6% 344 7.9 69.9 9 San Jose, California 62.2 88.0% 415 10.2 65.1 10 Providence, Rhode Island 57.2 90.9% 338 9.4 63.6 11 Sacramento, California 68.4 87.3% 317 10.9 62.5 12 Baltimore, Maryland 56.8 90.3% 511 11.6 62.1 13 Virginia Beach, Virginia 63.2 88.1% 314 10.3 61.5 14 Salt Lake City, Utah 59.8 83.9% 360 9.7 59.7 15 Buffalo, New York 49 92.4% 373 9.7 59.4

Least healthy metro areas

Rank Metro area Fitness index Health insurance coverage Physicians per 100,000 residents # High particle pollution days per year Overall health score 1 Riverside, California 43.1 79.3% 171 16.2 14.5 2 Houston, Texas 36.4 75.3% 297 13 22.9 3 Los Angeles, California 41.2 78.4% 328 14.4 25.0 4 Dallas, Texas 35.1 77.4% 230 10.7 28.9 5 Detroit, Michigan 29.4 87.3% 313 12.3 30.5

Methodology:

The overall health score for each city was obtained from the following factors:

Fitness index from the American Fitness Index Health insurance coverage from the U.S. Census Physicians per 100,000 residents from the U.S. Census Number of high particle pollution days per year from the American Lung Association’s 2013 State of the Air report

The fifty biggest U.S. metro areas were included in this analysis.