Is Chattanooga one of the least healthy cities in the U.S.?

Worse than Knoxville? Columbus, Ga.? Akron, Ohio?

That is the conclusion of a new survey by the Web site WalletHub that ranked each of the 150 largest cities in the U.S. based on health care, food, fitness, and green space.

Chattanooga ranked 132nd, behind Nashville and Knoxville in Tennessee, although well ahead of Memphis, which ranked third from the bottom — a dishonor awarded to Detroit.

As with any such survey, the results depended on the criteria used for the ranking. The "health care" category, for example, was based on the cost of a medical or dental visit; the number of family doctors, dentists, hospital beds, and mental health counselors per capita; health insurance coverage; and premature death rates, among others. Chattanooga ranked a dismal 144th.

But the city did even worse in the food category, at 147th, ahead of only Mobile, Ala., Shreveport, La., and Brownsville, Texas.

That ranking was based on fruit and vegetable consumption; the number of dietitians and nutritionists, farmer's markets, gourmet specialty-food stores, and "healthy" restaurants per capita, with "healthy" defined as vegetarian, vegan, and gluten-free; the share of obese residents; and access to healthy foods.

Chattanooga did a little better in the fitness category, ranking 79th, and in the green spaces category, coming in at 102nd.

"This doesn't tell us a lot of what we didn't already know," said Dr. Melinda Buntin, chair of the department of health policy at Vanderbilt University School of Medicine. "What the patterns say to me, is that places where we have lower incomes, there is less access to healthy restaurants and fitness clubs and primary care doctors."

Buntin noted that while many of the criteria used to determine the rankings focused on the number of various health care facilities per capita, the actual underlying issue was the difficulty of reaching those facilities, particularly for people with limited access to transportation.

"This list and ranking is not directed at legislators or even mayors, at things they can actually do to make Tennessee healthier," she said. "If it were, it might be directed at things like smoking or physical activity, and not the cost of a fitness club membership."

"A particular issue for our state is mental illness and substance abuse," Buntin said. "Counting the number of mental health counselors per capita is not the issue but rather the number of mental health counselors per need — and we have a disproportionate need."

Overall, San Francisco, Salt Lake City, Scottsdale, Ariz., Seattle, and Portland, Ore., were the top five cities for overall health, in order.

At the bottom: Shreveport, La.; Laredo, Texas; Memphis; Brownsville, Texas; and Detroit.

In general, the healthiest cities are in California and the West Coast, with the worst rankings given to towns in the South and Appalachia, stretching up into Ohio, Indiana and Michigan.

Contact staff writer Steve Johnson at 423-757-6673, sjohnson@timesfreepress.com, on Twitter @stevejohnsonTFP, and on Facebook, www.facebook.com/noogahealth.