fit and healthy cities

The web site of a local TV station is bragging that the DC Area Tops Index of Fit and Healthy Cities. The article says the metropolitan area which centers on Washington, DC, ranks number one in a report listing the 50 healthiest cities in America.[1] The account names but does not provide a link to the source of data. That source is a press release from the American College of Sports Medicine, America's 50 Largest Metro Areas Get Their Annual Physical.[2] The release gives a link to the full report (pdf).[3]

In calculating the index and building the ranking data, the authors considered a large number of indicators in two broad groupings: personal health indicators and community/environment indicators. The former include eating habits, incidence of obesity, amount of exercise taken, presence of disease, and the like. The latter include amenities such as availability of health care, farmers markets, rec centers, public swimming pools, ball diamonds, playgrounds, and the like per unit of the population, as well as percentage of people who walk or bike to work or use public transit.[4] The report lists all the variables and gives lots of information on their selection as variables, the collection of data for them, and the scoring process by which the index data were tallied. It does not give (that I can find) a list of the weights assigned to each variable (so you can see whether, for example, the presence of golf courses counted more or less than the likelihood that residents are eating five or more servings of fruit and vegetables a day).

Here are the results in rank order. As you can see, the number on the left is the rank, the metro area is then named, and the last bit of info is the score.

Rank Metropolitan Area Score
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1 Washington, DC 73.5
2 Boston, MA 72.6
3 Minneapolis, MN 71.7
4 Seattle, WA 70.5
5 Portland, OR 70.4
6 Denver, CO 69.9
7 Sacramento, CA 65.8
8 San Francisco, CA 64.7
9 Hartford, CT 64.4
10 Austin, TX 63.9
11 Richmond, VA 62.7
12 Cincinnati, OH 62.5
13 San Diego, CA 62.0
14 San Jose, CA 61.0
15 Salt Lake City, UT 60.6
16 Atlanta, GA 57.7
17 Virginia Beach, VA 57.2
18 Providence, RI 57.2
19 Orlando, FL 55.5
20 Baltimore, MD 53.5
21 New York, NY 52.9
22 Raleigh, NC 52.4
23 Pittsburgh, PA 52.0
24 Jacksonville, FL 51.2
25 Cleveland, OH 51.0
26 Philadelphia, PA 50.4
27 Milwaukee, WI 49.2
28 Buffalo, NY 48.8
29 Kansas City, MO 47.9
30 Tampa, FL 47.8
31 Nashville, TN 47.8*
32 Phoenix, AZ 47.4
33 Chicago, IL 47.0
34 Charlotte, NC 44.0
35 Columbus, OH 42.8*
36 Riverside, CA 42.8*
37 Saint Louis, MO 42.2
38 Los Angeles, CA 40.5
39 Miami, FL 39.9
40 Dallas, TX 39.5
41 New Orleans, LA 37.7
42 Houston, TX 37.6
43 San Antonio, TX 36.9
44 Indianapolis, IN 35.9
45 Las Vegas, NV 35.3
46 Louisville, KY 32.5
47 Detroit, MI 31.9
48 Memphis, TN 31.6
49 Birmingham, AL 31.2
50 Oklahoma, OK 24.3

Looking at the list, I thought there might be a simple and straight forward correlation between wealth and health. I checked this by comparing the ACSM rankings with a list, in rank order, of the metro areas with the highest median household income. (This something that the Census Bureau keeps track of.) Unfortunately, the only ranking I could find doesn't in every case use the exact same metro area boundaries as ACSM uses, but the results are interesting nonetheless.[5]

Here's what I found. I put the ACSM rank at left. The next number is the median income rank. There are gaps in this sequence because my source gave data for some smaller metro areas which were not covered by the ACSM study. I've indicated where the metro area boundaries differ; they're all instances where the median income data come from a Consolidated metro area and the ACSM data do not.

Metropolitan statistical areas ranked by median household income

Rank Metropolitan Statistical Area
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8 1 San Francisco-Oakland-San Jose CMSA, MSA: SF-Oakland-Fremont, CA
1 2 Washington–Baltimore CMSA, MSA: Washington-Arlington-Alexandria,
3 4 Minneapolis-St. Paul MSA
2 5 Boston–Worcester–Lawrence CMSA, MSA: Boston-Cambridge-Quincy
9 6 Hartford, CT MSA
16 7 Atlanta, GA MSA
6 10 Denver–Boulder–Greeley CMSA, MSA: Denver-Aurora
33 11 Chicago–Gary–Kenosha CMSA, MSA: Chicago-Naperville-Joliet
21 12 New York–Northern New Jersey–Long Island CMSA MSA: same designation
4 13 Seattle–Tacoma–Bellevue CMSA, MSA: same designation
47 16 Detroit–Ann Arbor–Flint CMSA, MSA: Detroit-Warren-Livonia
10 17 Austin–San Marcos, TX MSA
22 18 Raleigh–Durham–Cary, NC MSA
15 20 Salt Lake City–Ogden, UT MSA
26 23 Philadelphia–Wilmington–Atlantic City CMSA, MSA: Phila-Camden-Wilmngtn
40 25 Dallas–Fort Worth CMSA. MSA: Dallas-Fort Worth-Arlington
13 26 San Diego, CA MSA
29 36 Kansas City, MO–KS MSA
27 37 Milwaukee–Racine CMSA, MSA: Milwaukee-Waukesha-West Allis,
34 38 Charlotte–Gastonia–Rock Hill, NC–SC MSA
7 40 Sacramento–Yolo CMSA, MSA: Sacramento-Arden-Arcade-Roseville
5 41 Portland–Salem CMSA, MSA: Portland-Vancouver-Beaverton
44 47 Indianapolis, IN MSA Metropolitan statistical areas

It strikes me that, generally speaking, health and wealth are indeed closely correlated. Where you see a variance between the two ranks, the cause can often be ascribed to the boundary differences mentioned above.

Here are cities where the boundaries appear to be the same, but the rank is different by 6 or more: Atlanta, Austin, San Diego, and Kansas City. New York and Seattle might be outliers but I suspect not; although they both have have their MSA and CMSA described using the same jurisdictions, I suspect the boundaries are not the same.

It's interesting that Atlanta has high income rank and low fitness rank while the other outliers have the reverse. It's tempting to account for this, at least partly, by presence or absence of a commitment among taxpayers to making their metro areas congenial, as a benefit to all citizens. That is, from a health and fitness point of view (including provision of parks, public transit, pedestrian-friendly transportation policy, and such like), I suspect Atlanta taxpayers are relatively stingy and the other three are relatively generous.[6]

{source: The Hamilton Spectator}

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Notes:

[1] Full citation: DC Area Tops Index of Fit and Healthy Cities, by Pat Lawson Muse, Updated 7:16 PM EDT, Mon, May 24, 2010, on NBCWashington.com.

[2] Full citation: America's 50 Largest Metro Areas Get Their Annual Physical, For immediate release, May 24, 2010; ACSM American Fitness Index™ Provides a Snapshot of the State of Health and Fitness; Washington, D.C., Tops List of Healthiest and Fittest Metro Areas.

[3] ACSM American Fitness Index™ Health and Community Fitness Status of the 50 Largest Metropolitan Areas, 2010 Edition, by Brenda E. Chamness, Walter R. Thompson, Terrell W. Zollinger, Barbara E. Ainsworth, Carolyn M. Muegge, and Jessica M. West, for the American College of Sports Medicine

[4] My niece, Heather, will appreciate that having a relatively high number public dog walks per thousand residents is an indicator of civic fitness and health.

[5] My source for median income data is the wikipedia entry: Highest-income metropolitan statistical areas in the United States

[6] The ACSM overview lists for Atlanta and Austin shows the main categories where they fell short, compared to the average, and where they did well.

ATLANTA

STRENGTHS/ADVANTAGES
• Lower percent with disability
• Lower percent with angina or coronary heart disease
• Lower percent of days when physical health was not good during the past 30 days
• Lower death rate for diabetes
• More park units per capita
• More golf courses per capita
• More swimming pools per capita
• More recreation centers per capita
• Higher park-related expenditures per capita
• More tennis courts per capita

OPPORTUNITIES/CHALLENGES
• Higher percent unemployed
• Lower percent of city land area as parkland
• Fewer acres of parkland per capita
• Fewer farmers’ markets per capita
• Lower percent using public transportation to work
• Lower percent bicycling or walking to work
• Fewer ball diamonds per capita
• Lower number of primary health care providers per capita
• Fewer dog parks per capita
• Lower level of state requirement

AUSTIN

STRENGTHS/ADVANTAGES
• Lower percent unemployed
• Lower percent with disability
• Higher percentage eating 5+ servings of fruits/vegetables per day
• Lower percent obese
• Lower percent with angina or coronary heart disease
• Lower percent with asthma
• Lower percent with diabetes
• Lower death rate for cardiovascular disease
• More acres of parkland per capita
• Higher percent of city land area as parkland
• More swimming pools per capita
• Higher level of state requirement for Physical Education classes
• More dog parks per capita

OPPORTUNITIES/CHALLENGES
• Fewer farmers’ markets per capita
• Lower percent using public transportation to work
• Lower percent bicycling or walking to work
• Fewer ball diamonds per capita
• Fewer golf courses per capita
• Fewer park units per capita
• Fewer recreation centers per capita
• Fewer tennis courts per capita
• Lower number of primary health care providers per capita
• Lower park-related expenditures per capita