Do you live in one of America’s unhealthiest communities?

Have you ever relocated to a new city? If you’re like most people, the move was probably about seizing some fresh opportunity—to land a new job, start a new adventure, or escape the hardships, doldrums, and limitations of your hometown.

New opportunities don’t just pique our interest and motivate us, they improve our health, too. Building our finances, kindling new relationships, earning an education, and contributing to our communities—they all play a role in determining how good we feel, and even how likely we are to enjoy good health or succumb to chronic disease. 

In other words, the communities where we live determine how well and even how long we live. So, if you have the option to choose where you live, make sure you choose wisely.

To help make the decision easier, US News & World Report compiled a list of 2021 population health rankings for 500 US counties. The rankings were compiled based on CDC data on health outcomes, incidence of physical and mental health conditions, adult lifestyle behavior, and access to healthcare. These scores were combined with rankings for other determinants of health, such as housing, access to healthy food, infrastructure, and economy, to arrive at the final results. Click here for the methodology.  

We recently reported on which US communities are the healthiest. Today, we’re taking a closer look at the bottom of the list, where health rankings leave a lot to be desired.

Here are five of the unhealthiest counties in the United States, from most healthy to least healthy.

Fairfield County, Connecticut  

On the surface, it looks like Fairfield County is a pretty healthy place, earning an 83/100 score for overall population health and coming in at number 311 on the list, which is much higher than every other county listed above it. But whether or not county residents enjoy the benefits of this southwestern-most slice of Connecticut, which is wedged between New Haven and New York City, may depend on their ethnic background.

At just 24/100, Fairfield County has one of the lowest overall equity scores of all 500 counties ranked by US News & World Report. Racial disparities in the percentage of residents who earn bachelor’s degrees and graduate high school are nearly 2.5 times the national average.

Such disparities permeate many aspects of life in this county. Gaps in air pollution exposure across ethnic groups are roughly three times the national average, and gaps in rates of premature death are larger, too. Disparities also affect the way county residents earn a living; the county only earns a 20/100 score for income equality.

Affordable housing is another challenge. Fairfield County has a high percentage of overcrowded households, the eviction rate is more than double the national average, and more residents spend at least 30% of their income on housing than in most other areas of the United States. 

Parker County, Texas 

Due west of Tarrant County (home of Fort Worth) and just an hour’s drive from Dallas, Parker County comes in at number 480 on US News & World Report’s list.

Parker County has the lowest overall population health score (56) of the 500 counties ranked in the report. Availability of hospital beds and primary care doctors are both lower than the US average, and 18% of residents have no health insurance, compared with the US average of 11%.

Healthy food isn’t readily available. The county has a Food Environment Index Score that’s about half of the US average, there is only one local food outlet per 100,000 people (the US average is 4 per 100,000), and 23% of residents don’t have access to a large grocery store, compared with 22% nationally.

Clean water and air can also be hard to come by in Parker County. Nearly 11% of residents get their water from a system that has violated EPA standards and the risks of developing serious respiratory complications and cancer from air toxins are both higher than the national average.

Santa Cruz County, California 

Coastal California living sounds like a health aficionado’s dream, but Santa Cruz County, which sits about halfway between San Francisco and picturesque Big Sur State Park, may be an exception to that rule. 

The county sits near the bottom of the list at number 492, driven down by its poor rankings in equity, housing, and community vitality.

There are significant racial gaps in the percentage of residents who earn high school diplomas and bachelor's degrees, the percentage of residents who are exposed to air pollution, and the percentage of residents who face poverty.

Affordable housing is even harder to find in Santa Cruz than in Juneau, Alaska. Nearly 42% of Santa Cruz County residents spend at least 30% of their income on housing, and the average resident needs to work 98 hours per week to pay for affordable housing. Which doesn’t leave much time for enjoying the beach and fresh ocean air.  

With such high housing prices, the county’s homeownership rate is low—just 60%, compared with the 73% national average. As such, many county residents are looking for a way out—the county lost about 2.1% of its population last year.

Harris County, Georgia

For a county with such a checkered racial history (several people have been lynched there), health equity is not a huge challenge for residents of Harris County. Disparities in educational attainment by race may be more common than the average American county, but they’re less common than those in many similar counties.

Harris County’s 498th-place ranking is primarily driven by unhealthy local environmental conditions. The probability of contracting cancer over the course of a lifetime based on airborne toxins is 43.65 per million, which is close to double the US average. Risks of developing serious respiratory complications are much higher, too, and residents of Harris County are roughly eight times more likely to be exposed to toxic chemicals than most Americans.

County residents can expect to endure more than 2 full weeks of extreme heat days per year, compared with just 10 days in most US counties. The county also has more homes situated in flood zones than average, and only 11% of residents live within a half-mile of a park.

Juneau City and Borough, Alaska

 Alaska is widely known as the last frontier, and in many respects, its capital city Juneau—the only state capital on an international border (with Canada)—maintains its rustic, wild Western character.

The county scores a measly 38/100 in housing, in part because affordable housing is scarce. One would need to work nearly 60 hours per week to afford housing in Juneau, compared to the 40 hours needed to accomplish the same in most American counties. Roughly 28% of community residents spend upward of 30% of their income on housing, which is 8 percentage points higher than the national average.

Public safety is also lacking in Juneau. The county’s violent crime rate is roughly 2.5 times higher than the national average, despite the fact that a slightly greater percentage of the local population works as public safety professionals compared with the national median. On top of that, only 13% of Juneau residents live close to emergency facilities, which is much lower than the 37% national average.