Inside the West Health City Checkup

Not one of the 789 cities graded by the West Health City Checkup earned an A. Rockville, Maryland, ranked first in the country, earns the single highest grade anyone achieved: a B+. Its Safety & Security domain, on its own, sits at only the 72nd percentile.¹ Strong, not flawless, and that's true of the best report card in America.

That's not a flaw in the measurement. It's the finding, and that’s why this is a checkup, not a verdict. Underneath every one of the 789 graded cities is a full seven-domain profile, built from 70 public indicators, and the story of how that profile gets built, and how it turns into a letter grade, is worth telling on its own. Here's what's actually happening between raw government data and a City's Checkup report card.

The pipeline, in brief

The City Checkup doesn't take city data as it comes. Most public health and economic data arrives at the county level, sometimes the census tract. A county-level number can't tell you about a city sitting inside it, especially when that city is Detroit and the county is Wayne, home to dozens of other places with very different conditions.

So, the pipeline rebuilds everything from the ground up. Raw data is pulled directly from each public source and locked to the exact endpoint that produced it, so a later run can't quietly swap in a different source. County and tract-level numbers are then reallocated onto real city boundaries using population-weighted methods: each tract or county contributes to a city's number in proportion to how many of its residents actually live there. Counts like crimes, hospitals, and banks become rates per 100,000 residents.²

The one-line version: the City Checkup rebuilds every metric onto true city boundaries from named, versioned, locked sources, rather than relabeling county data and calling it a city's own.

Five things that make it trustworthy

West Health built the credibility case around five pillars, roughly in the order a skeptical reader would test them.

Every number is traceable. All 70 indicators come from seven public, authoritative sources: the U.S. Census Bureau, the City Health Dashboard at NYU Langone Health, CDC PLACES, the FBI Crime Data Explorer, the federal Climate and Economic Justice Screening Tool, CMS facility registries, and FDIC bank data. Nothing is modeled, imputed, or estimated by West Health itself.²

Cities are compared on rebuilt, like-for-like data, the spatial reallocation described above, so a city's number reflects the people who actually live inside its limits, not a wider county that happens to contain it.

Missing data is disclosed, never disguised. If a source doesn't report a value for a city, the City Checkup leaves it blank rather than filling the gap with a statistical estimate, a step several prominent indices take and the City Checkup deliberately doesn't. Every city carries a Data Score showing exactly how complete its record is, and any city below a 75-point completeness floor isn't ranked at all. The lowest Data Score among all 789 published cities is still 76.3.²

Grades follow a fixed standard, not each other. Each of the seven dimension scores is standardized to a familiar academic scale, national average around 70, and a city's Overall Score is simply the average of its seven dimension scores, no domain weighted more than another. The letter Grade then follows fixed bands the way a school transcript does: 80s are a B, 70s a C, 60s a D, anything below 60 an F. There's no curve here. No fixed share of cities is guaranteed an A, and none is condemned to an F; if every city's underlying conditions improved, every Grade could improve with them. On the current data, the strongest city in the country earns a B+, the average American city earns about a C-, and the single most common Grade is a D. We could have built a friendlier scale with more lenient grading. However, a checkup, like an annual visit to the doctor, is an honest look at data as it stands, and a checkup only serves its purpose if it tells the truth.²

The seven domains stand on established evidence. Each one tracks a factor with a documented, peer-reviewed relationship to health and longevity. That's the part worth walking through directly.

The seven domains

Seventy indicators, seven domains, all built on the same touchstone as the country's most-cited population health framework: the County Health Rankings model, which apportions modifiable health determinants roughly as social and economic factors 40%, health behaviors 30%, clinical care 20%, and physical environment 10%. The City Checkup covers the same terrain at city scale instead of county scale.²

A few of these deserve a closer look. The Financial domain rests on one of the starkest findings in health economics: men in the top 1% of U.S. income live 14.6 years longer than men in the bottom 1%, women 10.1 years longer, a gap measured across 1.4 billion tax and mortality records.³ Physical Environment carries similar weight from a different angle: fine-particulate air pollution raises all-cause mortality even at concentrations below current national standards, found in a cohort of 60.9 million Medicare beneficiaries.⁴ And Social connection isn't a soft add-on. Stronger social relationships are associated with a 50% increase in odds of survival, a pattern that held across 148 separate studies, and children not reading proficiently by third grade are four times less likely to graduate high school on time, with education itself a powerful predictor of adult health.^5,6

Physical Health carries the most indicators by far, 25 of the 70, life expectancy, premature death, chronic disease prevalence, and the preventive-care behaviors that predict them. We call it the outcome domain, the center of gravity, the other six domains all feed into.

That breadth also proves something worth stating plainly: the seven domains genuinely measure different things, not seven versions of the same ranking. Physical Environment correlates with the Overall Score at only r = 0.27, and Infrastructure at r = 0.43, compared with r = 0.88² for Physical Health. That is why a city can rank near the top overall and still have work to do in a specific domain. That is exactly why Cupertino, ranked 12th overall, still sits at only about the 40th percentile on Physical Environment alone. A city's overall Grade and its Physical Environment Grade are, statistically, almost separate questions.

Questions worth answering upfront

Isn't this just repackaged City Health Dashboard data? City Health Dashboard is the single largest source, and we credit it prominently. But the City Checkup combines it with six other federal and national sources, rebuilds county- and tract-level data onto true city boundaries, adds the transparent Data Score, and composes all of it into comparable Grades and rankings for 789 cities in one free tool. No single source does all four of those things.²

Why build a scale where nobody earns an A? Because it's honest, and honesty is the whole premise of the tool. A curve guarantees somebody an A no matter what the underlying conditions actually look like. This scale reports what the data shows: even the best-resourced American cities have real, unfinished work ahead of them. That's a harder test, not a lower mark.²

Isn't “no city earns an A” just negative? It's candid, which isn't the same as negative. The A exists on the scale. It's reachable though nobody has reached it yet. That's a starting line, not a ceiling, and it's the same growth story the City Checkup tells about every city on the list, not only the ones with the lowest Grades.²

Look up your city

Every one of the 789 cities graded, including yours, carries this same seven-domain profile, built the same transparent way. The full dataset, every indicator, every source, every score, is free to download from the dashboard. Search your city, see its Grade, and look at what's underneath it: which of the seven domains are pulling it up, and which one might be worth a closer look.

References

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

2. West Health Data Science & Analytics. “How the West Health City Checkup Is Built: A Methodology Brief.” Updated August 2026.

3. Chetty R, Stepner M, Abraham S, et al. “The Association Between Income and Life Expectancy in the United States, 2001-2014.” JAMA. 2016;315(16):1750-1766.

4. Di Q, Wang Y, Zanobetti A, et al. “Air Pollution and Mortality in the Medicare Population.” New England Journal of Medicine. 2017;376:2513-2522.

5. Holt-Lunstad J, Smith TB, Layton JB. “Social Relationships and Mortality Risk: A Meta-analytic Review.” PLoS Medicine. 2010;7(7):e1000316.

6. Hernandez DJ. “Double Jeopardy: How Third-Grade Reading Skills and Poverty Influence High School Graduation.” Annie E. Casey Foundation; 2011.