America's Cities Just Got a Checkup

Today, 789 American cities took the same checkup. Not one earned an A. West Health graded all of them, A+ to F, across seven dimensions of daily life: financial security, infrastructure, mental and behavioral health, physical environment, physical health, safety, and social connection. Rockville, Maryland earned the best report card in the country, a B+. Memphis, Tennessee ranked 789th out of 789. The distance between them isn't luck, and it isn't geography. It's measurable, structural, and now visible city by city, because the City Checkup connects data sources that don't normally talk to each other: the FBI's crime data next to CDC health measures next to Census financial conditions, rebuilt onto the same city boundaries.

Ask most people to guess which city actually earned that top grade, though, and they won't say Rockville. They'll probably name a famous one: Seattle, maybe, or Boston, or San Diego. They'd be wrong, and wrong in the same interesting way, over and over again.

The top-graded city in America is Rockville, Maryland. Behind it: Brookline, White Plains, Bellevue, Redmond. Not one household-name metropolis appears anywhere in the Top 10 of this 789-city checkup. Every single one of them is a suburb, a smaller community orbiting a famous city, drawing on its jobs and hospitals and paychecks while probably shielding itself from its density, pollution, and strain. While big cities built the prosperity, it seems their suburbs are the ones living well on it.

West Health built the City Checkup to measure something specific: how well a place supports its residents through the years when health, income, and independence get harder to hold onto at once, with particular emphasis on how well a community supports people as they age.¹

How the checkup works

Most well-being indexes, including Gallup's well-known national survey, ask people how they feel about their lives. The City Checkup asks no one anything. It's built from seven public, authoritative data sources, the U.S. Census, the City Health Dashboard, CDC PLACES, the FBI's Crime Data Explorer, the federal Climate and Economic Justice Screening Tool, CMS facility registries, and FDIC bank data, reallocated onto each city's true boundaries so the numbers describe the city itself, not the surrounding county².

Every input is a documented fact: poverty rates, crime counts, hospital and bank density, housing costs, chronic disease rates. Nobody is asked how they feel about their city. A city's Grade here isn't a mood. It's a measurement, and it's built to be checked: where other city indexes fill data gaps with statistical estimates, the City Checkup leaves them visible. Every city publishes its own Data Score showing exactly how complete its record is, and cities below a completeness floor aren't graded at all.² The underlying Overall Score behind each Grade isn't displayed on the public dashboard, but it drives the letter you see, and it's included in the free dataset for anyone who wants to dig deeper.

At 789 cities, it's also simply larger in scope than what has come before. U.S. News's Best Places to Live covers 250 cities. WalletHub's Healthiest Cities covers 182. Most Americans living in a city with more than 50,000 residents can find their own here, graded B+ to F against a fixed academic scale, not against each other, with the grade bands published on the dashboard for anyone to check.²

One B+, nine B’s: ten suburbs, zero major cities

Every city on this list has a bigger, more famous neighbor doing the economic heavy lifting.

Rockville (No. 1) anchors Montgomery County's federal and biotech corridor northwest of Washington, D.C. Arlington (No. 7) sits directly across the Potomac from the capital, stacked with federal jobs and now Amazon's second headquarters; its median household income tops $130,000, more than double the national figure.³ Brookline (No. 2) and Newton (No. 9) are wrapped around Boston, next door to the largest concentration of hospitals and universities in the country. White Plains (No. 3) is Westchester County's corporate hub, thirty minutes from Manhattan. Naperville (No. 10), west of Chicago, is a fixture on national best-places-to-live lists, most recently No. 16 on Money's ranking, cited for its corporate headquarters and job growth.⁴

Then there are the company towns, or near enough. Redmond (No. 5) is Microsoft's home address. Bellevue (No. 4) sits nearby in spirit, across Lake Washington from Seattle in the same tech-salary orbit, and now they're joined by Kirkland (No. 8), where Google has been building out a growing campus since 2004 and is now the city's second-largest private employer.¹¹ The Seattle metro alone places three of America's ten strongest cities, all suburbs, none of them Seattle itself. Palo Alto (No. 6) runs on Stanford and the venture capital economy around it. Cupertino, Apple's home address, just misses the list this time, sitting one grade band down at No. 12.

Notice who didn't. Boston, Seattle, Washington, New York, Chicago, the cities generating all that prosperity, are nowhere on the list. Well-being, at least as this checkup measures it, seems to pool one ring out from where the wealth is made.

No single grade tells the whole story

A letter grade is a headline, not the whole checkup. Underneath it, every city gets a full profile across all seven dimensions, and even the strongest report cards have room to grow. Palo Alto, ranked sixth in the nation with a B, still sits at roughly the national median, the 49th percentile, on physical environment alone.² Detroit tells an even starker version of the same story from the other end of the ranking: it sits at or near the 1st percentile in Financial, Physical Health, and Safety & Security, yet climbs to the 94th percentile in Physical Environment.² That's the point of grading seven dimensions instead of one: a city's overall standing barely predicts how it does on physical environment specifically, the two move almost independently across the dataset.

Other dimensions move together more closely. Cities in the top quarter of overall standing average the 84th percentile on physical health; cities in the bottom quarter average the 19th. Financial standing shows a similar split, an 82nd percentile average at the top against a 23rd at the bottom.² Where you live and how healthy you are travel together, and now that relationship is measurable, city by city, dimension by dimension. A full breakdown of what's actually driving each of these grades is where this series goes next.

The other end: different roads to an F

All ten of these cities currently carry the City Checkup's lowest Grade, and that Grade means something narrower than it used to. An F now marks the 26 most-challenged cities in the entire country, not a broad bottom slice of the map, which makes it a rarer and more serious signal than before.² That's not a verdict so much as a starting point: a checkup exists to show exactly where attention and investment would matter most, and for these ten, the picture is stark enough to demand it. Unlike the Top 10's fairly uniform suburb story, the roads to an F are more varied, and the causes are often harder to pin down.

Gary (No. 787) is the purest version of the story. U.S. Steel founded the city in 1906 as a company town, named for the corporation's own chairman, built to house workers for the mill next door. When steel contracted, Gary had nothing underneath it: the population has fallen 61% from its 1960 peak of about 178,000.⁵ Port Arthur (No. 783) presents the strangest case on the list. It hosts the largest oil refinery in North America, processing more than 650,000 barrels of crude a day.⁶ Billions of dollars of industrial capacity inside city limits, and a well-being grade at the very bottom of the scale.

Memphis (No. 789) breaks the pattern, which is exactly why it matters. This is no post-industrial ghost town. It's a major logistics and healthcare hub, home to FedEx's global headquarters. And it still ranked last. Whatever connects a city's corporate economy to its residents' daily well-being, Memphis shows the connection can fail completely.

The rest of the Bottom 10 tells milder versions of the same two stories. Rocky Mount (No. 780) grew on tobacco and textiles; its historic mill, once among the largest textile operations in North Carolina, closed in 1996.⁸ San Bernardino (No. 784) filed for bankruptcy in 2012 and stayed in it for a decade, the longest municipal bankruptcy in American history.⁹ Madera (No. 785) and Albany, Georgia (No. 788) are agricultural cities without a metro engine nearby. St. Joseph (No. 782), the Missouri river town where the Pony Express began, has watched its industrial base thin for generations.

Brownsville (No. 781) is new to this list, and it makes the opposite point just as clearly: even at the very bottom of the ranking, no city's profile is all one color. It stands in the top quarter of all 789 cities for Mental & Behavioral Health, the strongest counterweight of any Bottom 10 city.²

And then there's Hemet (No. 786).

The retirement town that landed in the bottom ten

Hemet's story should stop readers of this checkup cold. In the early 1960s, the Riverside County city built the country's first mobile-home subdivision and grew into one of Southern California's best-known retirement communities, a place people specifically moved to grow old.¹⁰ Sixty years later, it ranks 786th of 789 on a checkup built to measure how well communities support people as they age.

That's not a coincidence to skip past. It's the whole warning, condensed into one city. A community can be affordable enough to attract retirees and still lack nearly everything they'll eventually need: healthcare capacity, financial infrastructure, safe streets, transit. Affordability got people to Hemet. It couldn't keep them well there. It's also exactly the kind of gap the City Checkup was built to make visible, and the kind local leaders can act on once they can see it.

Why this matters for aging in America

Here's the uncomfortable symmetry the two lists leave us with. The places earning the highest Grades are among the most expensive housing markets in the country, largely out of reach for older adults on Social Security or a fixed pension. The places with the lowest Grades include communities, like Hemet, where older adults actually can afford to live, but where the supports they depend on are thinnest. For millions of aging Americans, the map of where you can afford to live and the map of where you can live well barely overlap. Scoring well and being livable for someone on a fixed income aren't the same test, and a single grade only captures the first one.

At the other end, the structural fragility running through the Bottom 10, a hollowed-out tax base here, a departed anchor employer there, erodes exactly what aging residents depend on most: hospital and nursing-home capacity, safe streets, financial security, infrastructure that actually works, and a healthy environment. Those aren't impressions or vibes. They're downstream, measurable consequences the City Checkup now tracks directly, city by city.

West Health already partners with Gallup on national surveys asking Americans how they experience healthcare and its costs. Gallup captures how people feel. The City Checkup now shows the structural conditions behind those feelings, block by block. Together, they're a pairing built to explain not just how Americans are doing, but why.

References

1. West Health. “City Checkup Dashboard.” westhealthmosaic.com/data-mosaics/well-being-index-scores

2. West Health. “Our Methods.” westhealthmosaic.com/data-mosaics/well-being-index-scores?tab=our-methods

3. U.S. Census Bureau, American Community Survey. Arlington County, VA. census.gov/quickfacts/fact/table/arlingtoncountyvirginia/PST045225

4. Money. “Best Places to Live,” Naperville, Illinois. naperville.il.us/about-naperville/award-winning-community/

5. U.S. Census Bureau, Decennial Census. Gary, Indiana (1960; 2020). https://stlouispatina.com/from-the-vault-gary-indiana/

6. Motiva Enterprises LLC. Port Arthur Manufacturing Complex, refining operations. https://www.motiva.com/what-we-do/operations/refining

7. The Detroit News. “Detroit's poverty rate rises to highest number since 2017 amid city's comeback.” September 2025. https://www.detroitnews.com/story/news/local/detroit-city/2025/09/11/detroit-poverty-rate-rises-highest-number-since-2017-citys-comeback-median-income/86060538007/

8. UNC Community Histories Workshop. “Digital Rocky Mount Mills” (mill closure, 1996). https://college.unc.edu/2020/06/rocky-mount-mills/

9. Rose Institute of State and Local Government; California Globe. San Bernardino Chapter 9 filing (August 2012) and 2022 case closure. https://s10294.pcdn.co/wp-content/uploads/2023/11/IEO-Fall-2023_SB-Bankruptcy.pdf

10. City of Hemet. “History of Hemet” (Sierra Dawn, first mobile-home subdivision; retirement community development). https://www.hemetca.gov/120/History-of-Hemet

11. GeekWire. “Google’s exit from big Seattle-area project shows fleeting relationship between tech and communities.” Feb. 2023 (Google as Kirkland’s second-largest private employer). https://www.geekwire.com/2023/googles-exit-from-seattle-area-project-shows-fleeting-relationship-between-tech-and-communities/