Special Report

The Worst Counties to Live In

Source: Public Domain / Wikimedia Commons

5. Kusilvak Census Area, Alaska
> Poverty rate: 39.0%
> Adults with a bachelor’s degree: 3.9%
> Life expectancy at birth: 68.2 years
> Total population: 8,250
> Largest place in Census area: N/A

The Kusilvak Census Area in western Alaska ranks as one of the worst places to live in the United States, in large part because of low educational attainment. Only 3.9% of adults in the area have a bachelor’s degree, nearly the smallest share of any county or county equivalent nationwide. Adults without a college education are less likely to lead healthy lives compared to those with a postsecondary degree, and in Kusilvak, life expectancy at birth is just 68.2 years, about 11 years below the national average.

Kusilvak is also a poor area. The local poverty rate of 39.0% is nearly triple the 13.4% national poverty rate.

4. Buffalo County, South Dakota
> Poverty rate: 39.7%
> Adults with a bachelor’s degree: 8.5%
> Life expectancy at birth: 61.6 years
> Total population: 2,026
> Largest place in county: Fort Thompson

Buffalo County is located in central South Dakota and covers parts of the Crow Creek Reservation along the Missouri River. Health outcomes on reservations tend to be poorer than in most of the country, and in Buffalo County, life expectancy at birth is just 61.6 years, over 17 years less than the national average and the lowest of any U.S. county.

A low-income area, nearly 23% of households in Buffalo County live on less than $10,000 a year. Additionally, the 39.7% poverty rate in the county is nearly three times higher than the national poverty rate.

3. Oglala Lakota County, South Dakota
> Poverty rate: 46.2%
> Adults with a bachelor’s degree: 10.4%
> Life expectancy at birth: 62.7 years
> Total population: 14,335
> Largest place in county: N/A

Based on several key socioeconomic measures, Oglala Lakota County, South Dakota, ranks as one of the worst counties to live in the United States. The county covers much of the Pine Ridge Reservation, and is home to one of the most economically marginalized groups in the United States.

In Oglala Lakota County, nearly half of the population live below the poverty line. Poverty is associated with lower poorer health outcomes, and when poverty is coupled with other problems faced in the area such as obesity, high smoking rates, and high drug overdose rates, life expectancy in Oglala Lakota is among the worst nationwide. Life expectancy at birth in the county is just 62.7 years, nearly the lowest of any U.S. county.

2. Mellette County, South Dakota
> Poverty rate: 52.8%
> Adults with a bachelor’s degree: 12.0%
> Life expectancy at birth: 66.7 years
> Total population: 2,052
> Largest place in county: White River

Mellette County, South Dakota, covers part of the Rosebud Indian Reservation, which is among the most economically strained communities in the United States. Native Americans commonly face extreme generational poverty resulting, in part, from their historical mistreatment by the U.S. government coupled with present-day laws, and in Mellette County, 52.8% of residents live below the poverty line.

Low-income areas typically report worse than average health outcomes, and Mellette County is no exception. Over a third of all county residents are obese, and life expectancy at birth is just 66.7 years on average. Dangerous behavior also appears to be relatively common as 66.7% of all driving deaths in the county involve alcohol, more than double the national share.

1. Todd County, South Dakota
> Poverty rate: 55.5%
> Adults with a bachelor’s degree: 15.6%
> Life expectancy at birth: 66.7 years
> Total population: 10,195
> Largest place in county: Rosebud

Todd County, South Dakota, which covers part of the Rosebud Indian Reservation along the state’s southern border ranks as the worst place to live in the country — in part because it is the poorest place in the country. Due to a number of historical and contemporary factors, Native American populations are among the most disadvantaged in the United States. An estimated 55.5% of the local population live below the poverty line, more than four times the national poverty rate of 13.4%, and most households in the area earn less than $25,000 a year.

As is the case in most poor areas in the United States, public health outcomes are also below average in Todd County. Life expectancy at birth in the county is just 66.7 years, more than 12 years below the national average. While poverty contributes to poor health outcomes in the area, so do unhealthy behaviors. For example, smoking is the leading cause of preventable death in the United States, and in Todd County, 41.5% of adults smoke, the largest share of any U.S. county.

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