America’s Worst Counties to Live In

The U.S. economy is not only the largest in the world, but also among the most resilient. Of all countries in the Group of Seven — a forum of seven industrialized democracies that includes France, Germany, Japan, the U.K. and the United States — the U.S. reported the fastest post-pandemic reduction in core inflation and was the first G7 member to restore real GDP growth to pre-pandemic levels. Looking forward, American GDP growth is projected to outpace that of every other large, advanced economy in 2024, according to the International Monetary Fund.

Despite some strong fundamental economic indicators, a more holistic analysis reveals some deeply entrenched weaknesses in the United States. The United Nations Development Programme’s Human Development Index is a single measure made up of three components: life expectancy at birth, educational attainment, and financial stability. Designed to capture overall development potential, the HDI shows the U.S. ranking well behind many of its peers on the global stage.

According to the latest HDI report, the United States ranks 20th in the world, trailing Canada, Germany, South Korea, and several other European and Asian countries. When applied to geographies within the U.S., the HDI shows that development potential is especially low in many parts of the country.

Using an index inspired by the HDI, 24/7 Wall St. identified the 40 worst U.S. counties to live in. Counties and county equivalents are ranked on a combination of three measures – average life expectancy at birth, the share of adults with a bachelor’s degree or higher, and the poverty rate. Data used to calculate rankings are from the U.S. Census Bureau’s 2022 American Community Survey and County Health Rankings & Roadmaps, a joint program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. All ACS data are five-year averages. Counties with incomplete data were excluded from analysis.

Over half of the 40 counties and county equivalents on this list are in the South. Another 10 are in the Midwest, including eight South Dakota alone, the most of any state. Only four are in the West and none are in the Northeast. (Here is a look at America’s best counties to live in.)

Average life expectancy at birth is below the 78.5 year national average in every county on this list — in some cases, by more than 10 years. In most of these places, the poverty rate exceeds the 12.5% U.S. poverty rate by over 20 percentage points, and, among these same counties, the share of adults with a bachelor’s degree ranges from 20% to less than 5%. Meanwhile, over 34% of adults nationwide have a four-year college degree.

Explanations for widespread hardship in these places vary. Notably, many counties on this list — particularly those in South Dakota — are home to Native American reservations, places which, for a variety of historical and contemporary reasons, have long suffered from limited economic opportunity. Other counties on this list are concentrated in Appalachia, a region that has historically relied largely on coal extraction. In these places, long-term economic decline is closely linked to America’s dying coal industry. (Here is a look at 10 American cities destroyed by outsourcing jobs.)

Why It Matters

With a $27.4 trillion economy, the United States is by far the wealthiest country in the world. Even adjusting for population, U.S. GDP per capita is over $76,300, higher than in all but nine other countries, according to the World Bank. Still, not all parts of the country benefit from America’s relative prosperity. Across the U.S., there are communities largely defined by widespread financial hardship, lack of economic opportunity, and health outcomes that are well below average.