Annual ranking of the healthiest cities in the U.S. reveals deteriorating mental health

Even in cities where there are parks and trails where people can exercise and keep fit, mental health deteriorated during the coronavirus pandemic.

The annual ranking of the nation's most adjusted cities included, for the first time, data on the impact of the pandemic on mental health. With social isolation, job loss, and supply chain problems experienced by Americans, nearly 40 percent of adults in the nation's 100 largest cities reported poor mental health.

"We found that cities in the top 25 generally have high health scores, but the one exception is mental health," said Stella L. Volpe, chair of the American Fitness Index advisory board.

She said this finding does not undermine the evidence linking exercise and physical activity to improved mental health. "In addition to physical health benefits, we also know that regular physical activity can benefit mental and social health," she said.

The American College of Sports Medicine and the Elevance Health Foundation have released the annual American Fitness Index, featuring the 100 most populous cities in the country over the past decade and a half. The rankings rate localities based on city and county data on 34 variables that include personal, community and environmental indicators.

Arlington, Virginia, has become the nation's healthiest community for the fifth consecutive year. Rounding out the top five are Madison, Wisconsin; Minneapolis; Washington, D.C.; and Seattle.

Oklahoma City ranked last on the list. North Las Vegas, Nevada, Tulsa, Indianapolis and Louisville ranked in the top five. At americanfitnessindex.org/rankings, people can find out how their city is doing.

How much mental health was affected?

Adults who had not previously reported anxiety or depression were more likely to report poor mental health during the pandemic. Some common reasons may include social isolation, job loss, or work in high-risk service industries, where people were more likely to be exposed to COVID-19, the report says.

Among adults who have never had a mental health problem, 58% believe the pandemic has damaged their emotional or mental health.

More than 51 percent of adults in New Orleans and Laredo, Texas, had at least one day of poor mental health in the previous month. Residents of San Francisco, Washington, D.C., and San Jose, California, round out the list of cities with the lowest mental health scores, although the three cities are among the healthiest, the report says.

This finding follows the results of a Centers for Disease Control and Prevention survey of nearly 800,000 adults through Feb. 1, 2021, which found that an increasing proportion of the population is noticing symptoms of anxiety and depression.

"It's widely recognized that anxiety and depression levels are two to three times higher than they were (before) the pandemic, and they haven't recovered," said Dr. Joe Parks, medical director of the National Council on Mental Well-Being.

Can physical activity improve mental health?

Physical and mental health are closely linked. Research shows that both aerobic exercise and strength training can prevent or reduce symptoms of anxiety and depression, the report says.

The CDC recommends at least 150 minutes a week of moderate aerobic activity and strength training twice a week. More than 1 in 5 adults had not exercised at all in the past month, and nearly half of adults did not get enough aerobic activity, the report says.

According to Volpe, the lack of exercise is a missed opportunity for those seeking to improve their mood and overall health.

"Studies conclusively show that aerobic and strength training are effective in preventing and reducing anxiety and depression, as well as improving mood, well-being and sleep quality," Volpe said.

Parks said physical and mental health are closely related. People with mental illness are more likely to suffer from chronic diseases such as high blood pressure, diabetes and heart failure.

"When people don't feel mentally healthy, more often than not their physical health suffers," Parks said. "And when people have poor physical health, their mental health is not as good."

How can cities confront mental health problems?

Representatives of the American College of Sports Medicine said city, community and business leaders can take steps to improve overall health in their communities.

One example: opening up access to green space in neighborhoods to make them more walkable. There are 527 miles of sidewalks and 14.5 miles of walking trails in Arlington, where biking and walking were included in the county's master transportation plan.

Under a bipartisan gun safety bill signed into law last month by President Joe Biden, local communities could also receive funding for mental health programs. While the gun safety bill strengthens background checks for gun purchases, it includes $8.6 billion to support certified community mental health clinics in every state, Kaiser Health News reported.

According to Parks, the eight states that have opened such clinics under the Medicaid pilot program have greatly improved access to mental health, drug and alcohol treatment. The legislation would allow up to 10 states to add such clinics each year, but states must seek funding.

"The federal government offers an opportunity, but it's up to the individual states to take advantage of that opportunity and give people better access."