Detroit is the unhealthiest city in the United States, according to a WalletHub study released Monday. The study compared 150 of the highest populated cities across the U.S., and Detroit scored the lowest health score of all with a 28.37 score.

The study based its rankings on fitness, food and green space or access to outdoor recreational spaces like hiking trails and quality of parks. Researchers also investigated how much access to medical and mental health care was available within a city, the cost of doctor visits, gym memberships and the number of people utilizing exercise facilities and compared fruit and vegetable consumption between cities.

The Motor City had significantly low scores across the board, however, it ranked the especially low in the health care and fitness categories, landing 148th out of 150 in regards to health care and 150 out of 150 for fitness.

“When you think about the causes of poor health, it has to do with the kind of environment in which people work, live and play,” Dr. Abdul El-Sayed, executive director of the Detroit Department of Health and Wellness Promotion, told Detroit News Monday. “The numbers you see around access to health care, around the quality of available food options, the ability to achieve regular exercise — those are part and parcel of the particular geography of Detroit.”

Nearly 13 percent of residents living in Wayne County in Michigan, including Detroit citizens, receive health care coverage through the Affordable Care Act (ACA) or expanded Medicaid programs. If the ACA is repealed, nearly every one in 10 Michiganders could be left without health care, which could have even more significant implications for the city’s overall health.

San Francisco ranked the healthiest city in America, scoring a total of 68.06 while Salt Lake City, Utah trailed in second with 67.50 points and Scottsdale, Arizona landed third place with 67.14 points.

Two cities in Texas, Laredo and Brownsville came in second and third respectively in the unhealthiest ranking.

WalletHub researchers used data from the U.S. Census Bureau, Council for Community and Economic Research, Centers for Disease Control and Prevention, U.S. Bureau of Labor Statistics and other public records to compile their findings.