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Economic Hardship Index
Economic Hardship Index in United States
United States

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Economic Hardship Index by State

Index of state economic conditions based on crowded housing, dependency, education, income, poverty and unemployment; normalized values are 1 to 100, with a higher value indicating worse economic conditions

Economic Hardship Index Trends

Index of state economic conditions based on crowded housing, dependency, education, income, poverty and unemployment; normalized values are 1 to 100, with a higher value indicating worse economic conditions

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Economic Hardship Index

About Economic Hardship Index

Top State(s): New Hampshire: 1

Bottom State(s): Louisiana: 100

Definition: Index of state economic conditions based on crowded housing, dependency, education, income, poverty and unemployment; normalized values are 1 to 100, with a higher value indicating worse economic conditions

Data Source and Years: U.S. Census Bureau, American Community Survey, 2021

Suggested Citation: America's Health Rankings analysis of U.S. Census Bureau, American Community Survey, United Health Foundation,, accessed 2023.

The economic hardship index compares economic conditions between communities. The measure combines six population-level social and economic measures, providing a more comprehensive picture of the difficulties faced in a community than a single measure could provide. The measure includes:

  • Unemployment: Proportion of the population ages 16-64 that are unemployed. Unemployment places financial stress on individuals and their families, leading to community-wide impacts.
  • Dependency: Proportion of the population younger than age 18 or older than age 64. While having dependents can be a positive experience, there are also hardships associated with caring for them. Taking care of an aging parent costs approximately $7,200 annually. Meanwhile, the cost of raising a child from birth to age 17 has risen sharply in just the last few years to an estimated average of $310,605.
  • Education: Proportion of the population ages 25 and older without a high school degree. More education leads to better job prospects and higher income, though this can vary by other factors such as industry and geography.
  • Per capita income: The community’s per capita income, averaged by dividing the sum total income of that population by the number of people in it. It is a measure that represents the relative wealth of the community.
  • Crowded housing: Proportion of housing units with more than one person per room. Living in a home with multiple occupants per room can negatively impact well-being and relationships, particularly for children.
  • Poverty: Proportion of the population living below the poverty level. There is strong evidence linking poverty with adverse health outcomes.

A high score on the economic hardship index is associated with lower life expectancy. Lower incomes can cause chronic stress, which contributes to poor health outcomes and decreased life expectancy, educational attainment and social mobility. Income inequality is also associated with increases in mental illness, obesity, infant mortality, teenage births, homicides and imprisonment.

Economic hardship and its indicators tend to be distributed geographically, reflecting pockets of hardship and contrasting areas of concentrated wealth. American Indian/Alaska Native, Black and Hispanic adults are disproportionately affected by economic hardship. The effects of structural racism are evident in the higher rates of poverty, unemployment, crowded housing and lower per capita income among racial and ethnic minority groups.

The economic hardship index is sensitive to interventions that affect any of its six underlying components. Unemployment, education, housing and poverty can all be improved through targeted interventions.

Employment and poverty are key social determinants of health in Healthy People 2030’s economic stability domain. Related objectives include:

  • Increasing employment among the working-age population. 
  • Reducing the proportion of people living in poverty. 
  • Increasing the proportion of students who graduate high school in four years with a regular diploma. 

Bailey, Zinzi D., Nancy Krieger, Madina Agénor, Jasmine Graves, Natalia Linos, and Mary T. Bassett. 2017. “Structural Racism and Health Inequities in the USA: Evidence and Interventions.” The Lancet 389 (10077): 1453–63.

Joiner, Jessica, Melissa Jordan, Keshia Reid, Kristina Kintziger, and Chris Duclos. 2019. “Economic Hardship and Life Expectancy in Nassau County, Florida.” Preventing Chronic Disease 16 (March): 180481.

Khullar, Dhruv, and Dave A. Chokshi. 2018. “Health, Income, & Poverty: Where We Are & What Could Help.” Health Affairs Health Policy Brief. Bethesda, MD: Project HOPE.

Nathan, Richard P., and Charles Adams. 1976. “Understanding Central City Hardship.” Political Science Quarterly 91 (1): 47–62.

Pickett, Kate E., and Richard G. Wilkinson. 2015. “Income Inequality and Health: A Causal Review.” Social Science & Medicine 128 (March): 316–26.

Pollack, Craig, Susan Egerter, Tabashir Sadegh-Nobari, Mercedes Dekker, and Paula Braveman. 2008. “Where We Live Matters for Our Health: The Links Between Housing and Health.” Issue Brief 2: Housing and Health. Robert Wood Johnson Foundation Commission to Build a Healthier America. Brief 2 Sept 08 - Housing and Health.pdf.

Skufca, Laura, and Chuck Rainville. 2021. “2021 Caregiving Out-of-Pocket Costs Study.” AARP Research.

Solari, Claudia D., and Robert D. Mare. 2012. “Housing Crowding Effects on Children’s Wellbeing.” Social Science Research 41 (2): 464–76.

“Why Education Matters to Health: Exploring the Causes.” 2014. Issue Brief #2 2. Education and Health Initiative. Richmond, VA: The VCU Center on Society and Health and Robert Wood Johnson Foundation.

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